Skip to Main Content




The victim goes to bed and sleeps in good health. About two o'clock in the morning he is awakened by a severe pain in the great toe; more rarely in the heel, ankle, or instepThe part affected cannot bear the weight of the bed clothes nor the jar of a person walking in the room. The night is spent in torture.

Thomas Sydenham (1624–89) on gout


Pain in the foot (podalgia) and ankle problems are a common occurrence in general practice. Various characteristics of the pain can give an indication of its cause, such as the description of gout by Thomas Sydenham. There are many traumatic causes of podalgia and ankle dysfunction, especially fractures and torn ligaments, but this chapter will focus mainly on everyday problems that develop spontaneously or through overuse. Forefoot pain is common especially in the elderly. The forefoot comprises the toes to the middle of the metatarsals and all of the supporting structures. Metatarsalgia is a term used to describe pain in the distal aspect of one or more of the metatarsal bones during weight-bearing.1


Key facts and checkpoints

  • Foot deformities such as flat feet (pes planus) are often painless.

  • Foot strain is probably the commonest cause of podalgia.2

  • A common deformity of the toes is hallux valgus, with or without bunion formation.

  • Osteoarthritis is a common sequel to hallux valgus.

  • Osteoarthritis affecting the ankle is relatively uncommon.

  • All the distal joints of the foot may be involved in arthritic disorders.

  • Many foot and ankle problems are caused by unsuitable footwear and lack of foot care.

  • Ankle sprains are the most common injury in sport, representing about 25% of injuries.

  • Severe sprains of the lateral ligaments of the ankle due to an inversion force may be associated with various fractures.

  • Bunions and hammer toes are generally best treated by surgery.


A diagnostic approach


A summary of the diagnostic strategy model is presented in Table 68.1.

Table Graphic Jump Location
Table 68.1

The painful foot and ankle: diagnostic strategy model

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.

$145 USD
Buy Now

Pay Per View: Timed Access to all of Murtagh Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.