II. History

  1. Mechanism of foot injury
  2. Pain location (as well as timing and character)
  3. Associated swelling or Ecchymosis
  4. Neurologic symptoms (foot weakness, Paresthesias)
  5. Provocative activities
  6. Prior foot injury or surgery
  7. Inability to bear weight on affected foot

III. Exam

  1. Compare with opposite, unaffected foot
  2. Inspection
    1. Deformity
    2. Ecchymosis
    3. Focal soft tissue swelling
    4. Skin Discoloration
    5. Wounds (e.g. Lacerations or scars)
  3. Palpation over bony landmarks
    1. Proximal fifth Metatarsal
    2. Tarsal Navicular Bone
    3. Joint margins (interphalangeal joints and lis franc joint)
  4. Function
    1. Active and passive foot range of motion
    2. Muscle Strength
      1. Plantar flexion and dorsiflexion
      2. Inversion and eversion
    3. Sensation
    4. Dorsalis pedis pulse, posterior pulse and Capillary Refill

VI. Imaging

  1. XRay Indications (Anteroposterior, Lateral and Oblique views)
    1. See Foot Fracture
    2. See Foot XRay in Osteoarthritis
    3. Foot XRay is first-line imaging in nearly all cases of Foot Pain
    4. Ottawa Ankle Rule may be used to direct imaging in Ankle Sprain
      1. However, protocol does not apply to direct foot Trauma
    5. Additional views to consider (beyond standard anteroposterior, lateral and oblique views)
      1. Weight bearing (e.g. suspected Lisfranc Fracture)
      2. Canale View (talar neck)
      3. Harris View (Calcaneal Fracture)
  2. CT Indications (when XRay is not diagnostic)
    1. Subtle Fractures (esp. midfoot)
    2. Stress Fracture (follow-up to demonstrate healing)
    3. Tarsal Coalition
  3. MRI Indications (when XRay is not diagnostic)
    1. Morton's Neuroma (minimum of 5 mm lesion and corresponding clinical findings)
    2. Accessory Bone Pain
    3. Plantar Fasciitis
    4. Stress Fracture
    5. Tarsal Tunnel Syndrome
  4. Ultrasound (when XRay is not diagnostic, operator dependent)
    1. Morton's Neuroma
    2. Plantar Fasciitis
    3. Tarsal Tunnel Syndrome
  5. Bone scan Indications (when XRay is not diagnostic)
    1. Reflex Sympathetic Dystrophy

VII. References

  1. Feden and Kiel (2017) Crit Dec Emerg Med 31(11): 3-10
  2. Ahn (2007) Am Fam Physician 76(7):975-83 [PubMed]

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Related Studies

Ontology: Foot pain (C0016512)

Concepts Sign or Symptom (T184)
SnomedCT 47933007, 203126008, 389344003, 390077002, 203124006
Dutch pijn voet, pijn in voet, voetpijn
French Douleur au pied, Douleur du pied, Douleur dans le pied
German Fussschmerz, Schmerz Fuss
Italian Dolore al piede
Portuguese Dor no pé
Spanish Dolor en pie, Dolor de pie, dolor de pies, podalgia (hallazgo), podalgia
Japanese 足部痛, ソクブツウ
English Podalgia, Foot pain, Pain foot, Pain in foot, Pain;musculoskeletal;foot/feet, Pain;foot/feet, pain foot, foot pain, foot pains, pain in foot, Hindfoot painful, Foot pain (finding), Foot Pain, foot/feet pain, musculoskeletal foot/feet pain
Czech Bolest chodidla, Bolest v chodidle
Hungarian Lábfájdalom, Fájdalom lábban