Acute or chronic foot strain
Osteoarthritis (esp. great toe – hallux rigidus)
Tibialis posterior tendonopathy
Serious disorders not to be missed
Complex regional pain syndromes
Ruptured Achilles’ tendon
Ruptured tibialis posterior tendon
Foreign body (especially children)
tarsal tunnel syndrome
deep peroneal nerve
Stress fracture (e.g. navicular)
Glomus tumour (under nail)
Is the patient trying to tell me something?
A non-organic cause warrants consideration with any painful condition.
Ask about the quality of the pain, its distribution, mode of onset, periodicity, relationship to weight-bearing and associated features such as swelling or colour change. Enquire about pain in other joints including sacroiliac joints.
Follow the inspection, palpation, movement and test function approach
Test active and passive movements of the ankle (talar) joint, hindfoot (subtalar) joint and mid-foot (midtarsal) joint
Check the peripheral circulation and perform a neurological examination including sensation, motor strength and reflexes
Good quality plain X-rays are important if there is doubt about the diagnosis of a painful foot.
Foot strain is probably the commonest cause of podalgia.
All the distal joints of the foot may be involved in arthritic disorders.