이진우 선생님, 군자출판사와 제휴를 통해 책 내용 및 그림을 제공합니다.
무단 복제/배포 금지.
..발의 통증은 후족부, 중족부, 전족부로 나눠 생각하는게 진단에 유리하다.
..전족부 통증의 원인 : most common site-prevalence 2~10%
- 티눈과 못 (Corns and callus)
Anatomy of the Foot
- 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
The Root of ambulatory care
the plantar fascia
can cause heel 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?
- 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
The Root of ambulatory care
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
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