Search

The diagnostic process in case of painful foot must always begin with a first clinical phase that is the most important. The history, conditions of happening and the clinical examination are essentials to orient appropriately the secondary examinations, if necessary, and establish a proper diagnosis. After the taking of the history, the clinical examination of the foot, bilateral and comparative, should begin with an evaluation of the entire musculoskeletal system for systemic and general conditions which can affect the foot and ankle. The function and structure of the foot may be evaluated using observation, palpation and manipulation of the different joints. The foot, and the patient's shoes, should be evaluated during unloaded and loaded conditions with gait observation. The location of the pain must be accurately precised: hindfoot pain (inferior, posterior, lateral, medial, anterior), middle foot pain or forefoot pain (medial with the first ray pathology or lateral). This first clinical assesment, with a basic radiography and sometimes an ultrasosonography study are able to diagnose the most frequent pathologies. Other additional examinations could be more rarely neccessary and must always be oriented by the knowledge of the foot pathology and the first obligatory clinical evaluation.

Forefoot chronic pain is a frequent problem in daily clinical practice. Mechanical pathology of the forefoot, usually called static metatarsalgia, represents the most frequent reason for consultation in pathology of the foot. The cause is a functionnal disorder or anatomic derangement of the forefoot architecture. Metatarsalgia can originate from a wide range of affections. Etiologies of chronic pain are described from medial to lateral with first ray pathologies (hallux valgus, hallux rigidus and sesamoid pathology) and first ray insufficiency, pathologies of the second, third and fourth ray and intermetatarsal spaces (second ray syndrome, Freiberg's disease, Morton neuroma, stress or bone insufficiency metatarsal fractures, intermetatarsal bursitis) and fifth ray pathology (lateral bursitis, quintus varus). Sometimes forefoot pain could also be caused by chronic inflammatory rheumatic diseases (rheumatoid and psoriatic arthritis) with a risk of structural metatarsophalangeal joints alteration. The pathology of the toes can, more rarely, explain a forefoot pain. So, several pathologic conditions can produce forefoot pain and the diagnostic approach must always be based on the anamnesis and clinical examination. In a second time if the cause is difficult to establish based solely on clinical findings, radiography and ultrasonography are today the most usefull auxiliary investigations.

The hindfoot is the part of the foot which is proximal to the midtarsal joint. The obvious causes of pain are not considered (post-traumatic etiologies, sprains and fractures but also cutaneous lesions). The main etiologies on the subject are successively exposed by following the localization of the pain. Diffuse pains (ankle arthritis tarsal osteoarthritis, algodystrophy, calcaneo-navicular synostosis but also bone diseases like stress fractures, Paget disease or tumors). Plantar talalgia (Sever's disease, plantar fasciitis and entrapment neuropathies such as (esions of the medial calcaneal nerve, of the first branch of the plantar lateral nerve, medial plantar nerve and lateral plantar nerve). Posterior pains: calcaneal tendinopathy including peritendinitis, tendinosis, retro-calcaneal bursitis and pathology of the postero-lateral talar tuberosity. Medial pains: tendinopathies of the posterior tibial tendon and tendinopathy of the flexor hallucis longus tendon and tarsal tunnel syndrome. Lateral pains: fibularis tendinopathies including split lesions of the fibularis brevis tendon, displacement of the fibularis iongus tendon, sinus tarsi syndrome and finally thickenings of capsules and ligaments and ossifications localized under the tibial malleoli. Anterior pains: antero-inferior tibio-fibular ligament, anterior tibial tendinopathy and anterior impingment syndrome.

Introduction: Colic diverticulosis rarely occurs in the young and, in such cases, therefore requires search for a predisposing affection., Observation: A 25 year-old woman was hospitalised for abdominal pain and fever predominating in the right iliac fossa and leading to the diagnosis of right diverticular colitis. The clinical examination revealed features suggestive of an Ehlers-Danlos syndrome., Discussion: The Ehlers-Danlos syndrome combines cutaneous sensitivity and articular hypermobility related to abnormality in the supporting connective tissue. Colic diverticulosis is found among the complications. Diverticular colitis occurring in a young adult should lead to the search for an originating disease of the connective tissue.