Common Foot Problems

• Common Foot Problems

  • Plantar Fasciitis
  • Fat Pad Atrophy
• Plantar Fasciitis

  Inflammation of the plantar fascia, which is thick connective tissue attaching to the calcaneus at the heel, traveling along the sole of the foot and branching out to connect to the flexor tendons of the toes
• Fat Pad Atrophy


  Affects the fat pad over the heel of the foot (under the calcaneus) which protects the heel from impact. Atrophy can occur with age or inflammation from repetitive impacts, such as jumping activities, running, walking, and obesity. Local steroid injections used to treat plantar fasciitis can cause fat pad atrophy
• Plantar Fasciitis Presentation


  • Gradual onset of pain on the plantar aspect of the heel, worse with pressure, particularly when walking or standing for prolonged periods, tenderness to palpation of the area
• Plantar Fasciitis Management

  1. Rest

  2. Ice

  3. Analgesia (e.g., NSAIDs)

  4. Physiotherapy

  5. Steroid injections (can be very painful and rarely cause rupture of the plantar fascia or fat pad atrophy). Rarely, specialist management may be required with extracorporeal shockwave therapy or surgery
• Fat Pad Atrophy Symptoms

  • Pain and tenderness over the plantar aspect of the heel, worse with activity
• Repetitive impacts

  • Jumping activities
  • Running
  • Walking
  • Obesity
• Local steroid injections used to treat plantar fasciitis can cause fat pad atrophy
• Symptoms of fat pad atrophy are similar to plantar fasciitis, with pain and tenderness over the plantar aspect of the heel
• Symptoms of fat pad atrophy worsen with activities, particularly when barefoot on hard surfaces
• The thickness of the fat pad can be measured with an ultrasound scan
• Management of fat pad atrophy

  1. Comfortable shoes

  2. Custom insoles

  3. Adapting activities (e.g., avoiding high heels)

  4. Weight loss if appropriate
• Morton’s neuroma refers to the dysfunction of a nerve in the intermetatarsal space towards the top of the foot
• The abnormal nerve in Morton’s neuroma is usually located between the third and fourth metatarsal
• Morton’s neuroma is caused by irritation of the nerve relating to the biomechanics of the foot
• High-heels or narrow shoes may exacerbate Morton’s neuroma
• Typical symptoms of Morton’s neuroma

  • Pain at the front of the foot at the location of the lesion
  • Sensation of a lump in the shoe
  • Burning, numbness or “pins and needles” felt in the distal toes
• Ways to test for Morton’s neuroma

  1. Deep pressure applied to the affected intermetatarsal space on the dorsal foot causes pain

  2. Metatarsal squeeze test causes pain

  3. Mulder’s sign causes a painful click

  4. Ultrasound or MRI can be used to confirm the diagnosis
• Management options for Morton’s neuroma

  1. Adapting activities (e.g., avoiding high heels)

  2. Analgesia (NSAIDs if suitable)

  3. Insoles

  4. Weight loss if appropriate

  5. Steroid injections

  6. Radiofrequency ablation

  7. Surgery (e.g., excision of the neuroma)
• The medical name for bunions is hallux valgus
• Bunions are a bony lump created by a deformity at the metatarsophalangeal joint at the base of the big toe
• Bunions develop slowly and can be painful, particularly when walking and wearing tight shoes
• Weight-bearing x-rays can be used to assess the extent of bunions
• Conservative management of bunions

  1. Wide, comfortable shoes

  2. Analgesia

  3. Use of bunion pads to protect from friction
• Surgery for bunions

  Various options depending on individual factors to realign the bones and correct the deformity
• Gout is a common cause of pain and swelling in the metatarsophalangeal joint at the base of the big toe
• Gout is associated with chronically high blood uric acid levels and urate crystals
• Gout is a common cause of pain and swelling in the metatarsophalangeal joint (MTP) at the base of the big toe
• Gout can also affect the ankle, wrists, base of the thumb, or knee
• Gout


  A type of crystal arthropathy associated with chronically high blood uric acid levels
• Urate crystals collect in the joint, causing it to become acutely hot, swollen, and painful
• Diagnosis of Gout


  1. Usually made clinically

  2. May require joint fluid aspiration
• Joint fluid aspiration findings

  • No bacterial growth
  • Needle-shaped crystals
  • Negatively birefringent of polarised light
  • Monosodium urate crystals
• Management during acute flare of Gout

  1. First-line: NSAIDs (e.g. ibuprofen)

  2. Second-line: Colchicine

  3. Third-line: Steroids

  4. Allopurinol is a xanthine oxidase inhibitor used for the prophylaxis of gout. It reduces the uric acid level
• Lifestyle changes to reduce the risk of developing gout

  • Losing weight
  • Staying hydrated
  • Minimising the consumption of alcohol and purine-based foods (such as meat and seafood)
• TOM TIP: 'Do not initiate allopurinol prophylaxis until after the acute attack has settled. Starting allopurinol can cause or worsen an attack of gout. When a patient is already using allopurinol, they can continue taking it during further acute episodes'
• Last updated

  August 2021