7 Over-PronationMany foot problems are due to excessive pronation (flat feet):Plantar fasciitisAchilles and posterior tibial tendinitisSesamoiditisBunionsSinus tarsi and tarsal tunnel syndromesMetatarsalgia
12 Hindfoot ProblemsPlantar fasciitis is the most common. Pain is plantar/medial.Heel pad pain is usually a ‘stone bruise’ or due to atrophy of the fat pad.Posterior tibial tendon dysfunction is the most overlooked problem of the foot.
16 Bunions Hallux ValgusThe bunion is the enlarged medial prominence of the first MTP joint.Often there are secondary lesser toe deformities (corns, calluses, hammertoes, bunionette)Get xrays if patient is going to be referred.TX: shoe change: widen the toe box, arch + heel support (bunion pads crowd shoe)
18 1st MTP Arthritis Hallux rigidus (ortho) or limitus (pod) 1st MTP can be swollen, spur is dorsal on the xray.Limited MTP extension (compare to other foot), pain is during the toe-off phase of walking.Tx with stiff soled shoes, NSAIDs
21 Funny Toes Hammer and Claw Toes Usually due to IMPROPER SHOE WEARClaws are usually seen in diabetics. These are fixed extension of MPJ, and flexion of PIP and DIP joints.Hammertoes have flexion deformities of the PIP joint, and flexible MP and DIP joints.Can develop corns and callusesTx with wide shoes and toe straps, pads OK; non-operative treatment as long as it is flexible.
23 Metatarsalgia It just means forefoot pain. Pain is under a metatarsal head (usually 2nd) as opposed to between the heads for neuromas.Often associated with hammertoes and calluses.Get wider shoes, use metatarsal pads or cut-outs, shave the calluses.
25 SesamoiditisSesamoids are embedded in the flexor hallucis brevis tendon beneath the first metatarsal head.Caused by repeated stress, and can be inflamed, fracture, or even get arthritic.Very tender, will move with flex/ext of great toe MPJ. Get xrays.Tx: stiff shoe, pads/cut-outs; no heels.
27 Interdigital NeuromaReally ‘perineural fibrosis’ secondary to repetitive irritation (from tight shoes!)90% are in the third interspace; rest in 2ndFeels like walking on a pebble. Feels better out of shoes.+ squeeze test. Pain is between MT heads.Tx: wide shoes, MT pads/cut-outs, inject.
29 Stress FracturePain directly over a metatarsal, usually more proximal than MT heads.Change in activities, worse with wt bearingInitial xray often normal. Bone scan positive early.Tx with modified activity, stiff soled shoe or boot/cast, time.
31 Midfoot Arthritis Dorsal bossing or spurs over the involved joint(s). XR and/or bone scan will show changes.Tx with stiff soled shoes, firm arch support, NSAIDs, activity modification.
32 Plantar Fasciits Pain with arising, especially first AM steps Almost always at plantar-medial origin.Inflammation and chronic degeneration.Worse with obesity, overpronation.Not due to spursTx: Arch support, elevate heel. NO barefeet, flat shoes; NSAIDs, injections, PT for ultrasound.
36 Posterior Tibial Tendinitis (PTT) Most missed problem of the foot.Pain/aching between navicular and medial malleolus. Looks swollenFlatfeet. Heel should invert with rising on toes.Tx: arch supports, slight heel. NSAIDs and PT for u/s.
38 Tarsal Tunnel Syndrome Post Tib nerve gets entrapped near med malleolus. Plantar tingling/burning as opposed to pain/swelling of PTT. Not whole foot like with diabetes.+ Tinel test; can be loss of PP sensation, can be toe clawing.Tx: arch support if overpronated. Consider NCV tests.