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THE PAINFUL FOOT

Nilesh Baxi
Family Physician, Tardeo, Mumbai 400 007.

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There are so many conditions which afflict such a small area that it looks very difficult to diagnose a given condition. Following simplified tabular version will surely help you reach the right diagnosis. For convenience, painful foot has been divided into forefoot pain, midfoot pain and hind foot pain.

Forefoot pain
Site of pain/tenderness	Disease	Management
2nd or 3rd metatarsal shaft	March # (stress)	Walking POP
Intermetatarsal spaces-3rd/4th	Neuroma	Surgery
1st MTP joint	1. Gout	NSAID or colchicine
	2. Hallux rigidus (OA)	Pad, NSAID, inj., surgery
	3. Hallux valgus (bunion)	Pad. Inject, surgery
Head of 5th metatarsal	Bunion	Pad, Inject, surgery
MTP and PIP	RA	NSAID and rocker bar
DIP	SSA	NSAID
Sole of the foot	1. Plantar warts	Cryosurgery
	2. Corns and callosities	Corn tapes/chiropody

Midfoot pain
Site of pain/tenderness	Disease	Management
Arch	Pes planus	Insole + intrinsic muscle exercises
Navicular	Kohler’s disease	Rest or ignore
Dorsum	1. Extensor tenosynovitis	Local steroid inj., ultrasound
	2. Midtarsal strain	NSAID + rest

Hindfoot pain
Site of pain/tenderness	Disease	Management
Achilles Tendon	Achilles tendinitis	Rest, ultrasound, stretching exercises
Lower end of Achilles Tendon Heel	Subachilles bursitisPlantar fasciitis	Local steroid injectionRubber heel pad, NSAID,exercises, local steroid injection
Behind and below medialmalleolus	1.Flexor tenosynovitis 2. Medical ligament strain	Ultrasound or local steroid injection RICE, NSAID +/- Local steroid injection
Behind and below lateral Malleolus	1.Peronial tenosynovitis 2.Lateral ligament strain	Ultrasound or local steroid injection RICE, NSAID +/- Local steroid injection
Diffuse foot pain could be due to PVD, peripheral neuropathy, tarsal tunnel syndrome, extensive RA, diabetic charcot’s joint etc.

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