Foot

Almost all patients presenting with foot problems have pain. For this
reason, a precise history is very important in diagnosing the disorder.
Age, gender, occupation, and leisure activities are important factors
to consider in every patient. It is important to enquire about the char-
acter of the onset of pain, its location and radiation, its nature, and about
factors that can cause pain. Both feet and the adjacent joints such as the
knee should be examined and assessed comparatively. Axial deviations
in the legs should also be given consideration. Inspection of the shape
and soles of the patient’s shoes is important as asymmetric wear on the
soles may provide an initial indication of the cause of the patient’s
complaints.
In addition to a palpatory examination with assessment of mobility
and tenderness to palpation in the specific region, it is important to
observe the foot during weight bearing and walking. Metatarsalgia is a
general term for pain in the forefoot. Splay foot is the most common
deformity of the foot and the most common cause of metatarsalgia. The
collapse of the transverse metatarsal arch as a result of weakness of the
muscles and ligaments leads to secondary changes in the foot with claw
toe and hammer toe deformities and hallux valgus. Plantar calluses from
the increased stresses on the metatarsal heads in turn lead to additional
problems.
Other causes of forefoot pain include osteoarthritis (hallux rigidus),
neuromas (Morton neuroma), stress fractures, avascular necrosis (Koeh-
ler disease), disorders of the sesamoids, plantar warts, and compression
neuropathies (tarsal tunnel syndrome).
Certain systemic diseases tend to involve the foot. Often the first
clinical symptoms of these disorders will appear in the foot. Such dis-
orders include diabetes mellitus, peripheral arterial disease, gout, psor-
iasis, collagen disorders, and rheumatoid arthritis.