KEYWORDS: ..발의 통증은 후족부, 중족부, 전족부로 나눠 생각하는게 진단에 유리하다. ..전족부 통증의 원인 : most common site-prevalence 2~10% - 티눈과 못 (Corns and callus) Foot pain Anatomy of the Foot Corn Callurs Distal phalanx ForeFoot MidFoot HindFoot Calcaneus Middle phalanx Proximal phalanx Cuboid bone Cuneiform bone Navicular bone Talus - Morton interdigital neuroma - Stress fracture - Diabetic neuropathy ..후족부 통증의 원인 : second most common site-prevalence 1% - Plantar fasciitis (insidious) - Fat pad contusion (acute onset) - Calcaneal stress fracture ..중족부 통증의 원인 - Stress fracture of the navicular : Tarsal navicular bone fractures are easily missed, because patients may have minimal pain over the midfoot and medial arch,these fractures are important to diagnose 213 The Root of ambulatory care Neuroma Normal nerve Achilles tendon Inflammation of the plantar fascia can cause heel pain Plantar fascia Key questions Key tests Foot pain early because navicular fractures have a high rate of nonunion. Plain X rays of the foot are often inconclusive, therefore bone scan, computerized tomography, or magnetic resonance imaging may be necessary for diagnosis. - Extensor tendonitis 1. Description of pain : - pain when first step down after sleeping or sitting? → plantar fasciitis - pain activity-related? History of increased activity? → tendonitis/stress fracture - pain better with shoe off? Burning or sharp pain with weight- bearing? “electric shock”? → neuroma - tender with direct pressure? → Corns and Calluses - Stocking distribution to pain? → diabetic neuropathy 2. Occupational or athletic history 3. Frequent use of high-heeled shoes with narrow toe box? ..plantar warts can be distinguished from calluses by interruption of skin lines, blood vessels in the core, and tenderness on squeezing. 1. Foot Weight-bearing AP/lat/supine oblique if fracture suspected 2. Bone scan for suspected stress fracture 215 The Root of ambulatory care RICED 1. Rest from pain-producing activities 2. Ice for 20minutes several times a day while area is swollen 3. Compression with padding and a wrap 4. Elevation above level of heart to reduce edema 5. Drug : NSAIDs (e.g., Ibuprofen 400~800mg tid-qid & Acetaminophen 650mg every 4~6hours until edema and pain subside) Plantar fasciitis : heel pad or wedge, stretching exercises for plantar fascia, PT, steroid injection, orthotics, night splints Calluses : remove hyperkeratotic area with scapel or pumice stone/ insoles or orthotics to relieve friction Neuroma : metatarsal pad, steroid injection, PT, surgery Key treatments 참고 문헌 James R. Barrett : Ankle and Foot pain, in Saunders Manual of Medical Practice, 2nd ed, Robert E. Rakel(ed). Philadelphia, Saunders, 2000, P 988-991 양윤준 : 발목, 발 통증, in 가정의학 임상편. 서울, 계측문화사, 2002, P 1182-1189 Walter B. Greene, M.D.(ed) : Corns and calluses,Morton Neuroma, Plantar Fasciitis, Stress fractures of the Foot and Ankle, in Essentials of Musculoskeletal Care. Rosemont, American Academy of Orthopaedic Surgeons, 2001, P 437-441, P 477-479, P 487-490, P 508-510 James R. Barrett, M.D., Caqsm, & kent W. Davidson, M.D. : Foot Complaints, in A Lange clinical manual Family Medicine Ambulatory Care & Prevention, 4th ed, Mark B. Mengel, M.D., L. Peter Schwiebert M.D. (ed). United States of America, The McGrwa-Hill Companies, Inc., 2005, P 159-170