The majority of painful conditions of the foot originate in the soft tissues: the muscles, ligaments, tendons, nerves, and blood vessels. Articular and skeletal causes may be present from congenital abnormalities, infections, neoplasms, or trauma, but even in these cases the early symptoms come from soft-tissue changes.In most cases of foot and ankle pain, the symptoms can be explained by local lesions. Usually, the area of pain pointed out by the patient specifies its exact anatomic site.
The history gives the mechanism producing pain. Only rarely is foot pain referred from a proximal site, but the examiner must be aware that a local disturbance, such as flatfoot, may be an incidental finding in cases in which the pain is referred. Foot StrainFoot strain may be acute, subacute, or chronic. It may occur in the normal foot from normal walking or standing if the patient has been unaccustomed to a great deal of activity. Since foot strain has a mechanical effect on the soft tissues, if it is allowed to persist, deformity may result.A foot, considered mechanically abnormal may be strained by essentially normal activity. Stress on a pre-existing deformity will cause earlier and more intense pain and the foot will resist correction and palliation. The general rule that applies to all musculoskeletal dysfunctions applies here; that is, pain and dysfunction can occur fromabnormal stress on a normal structure,normal stress on an abnormal structure,ornormal stress on a normal structure when the structure is not prepared for the stress.
The static foot is supported by ligamentous tissues. There is no muscular activity in the foot or leg muscles during standing, even when large weights are superimposed upon the body. The muscular activity during locomotion prevents excessive strain upon the supportive ligaments and ’ joint tissues. Therefore, pain in the static foot must result from faulty mechanics or an overwhelming stress upon the ligaments.In the moving foot, pain results when muscular incompetence due to disuse, imbalance, or abuse places an excessive burden upon the ligaments. In either case, the stress upon the soft tissues causes inflammation, elongation, and ultimately degeneration of the ligaments.
The history gives the mechanism producing pain. Only rarely is foot pain referred from a proximal site, but the examiner must be aware that a local disturbance, such as flatfoot, may be an incidental finding in cases in which the pain is referred. Foot StrainFoot strain may be acute, subacute, or chronic. It may occur in the normal foot from normal walking or standing if the patient has been unaccustomed to a great deal of activity. Since foot strain has a mechanical effect on the soft tissues, if it is allowed to persist, deformity may result.A foot, considered mechanically abnormal may be strained by essentially normal activity. Stress on a pre-existing deformity will cause earlier and more intense pain and the foot will resist correction and palliation. The general rule that applies to all musculoskeletal dysfunctions applies here; that is, pain and dysfunction can occur fromabnormal stress on a normal structure,normal stress on an abnormal structure,ornormal stress on a normal structure when the structure is not prepared for the stress.
The static foot is supported by ligamentous tissues. There is no muscular activity in the foot or leg muscles during standing, even when large weights are superimposed upon the body. The muscular activity during locomotion prevents excessive strain upon the supportive ligaments and ’ joint tissues. Therefore, pain in the static foot must result from faulty mechanics or an overwhelming stress upon the ligaments.In the moving foot, pain results when muscular incompetence due to disuse, imbalance, or abuse places an excessive burden upon the ligaments. In either case, the stress upon the soft tissues causes inflammation, elongation, and ultimately degeneration of the ligaments.
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