Foot Manifestations of Systemic Disorders
Foot Symptoms or Signs | Possible Cause |
|---|---|
Pain at rest (feet elevated), relieved by dependency | End-stage peripheral arterial disease |
Cold, erythematous, or cyanotic feet | Advanced arterial ischemia |
Episodically erythematous, hot, very painful, burning feet | Erythromelalgia—idiopathic (most commonly) or secondary to various disorders (eg, myeloproliferative disorders, which are rare) |
Foot pain that becomes severe within seconds or possibly minutes, particularly in patients with atrial fibrillation; foot often cool and pale with areas of discoloration | Embolic arterial occlusion |
Cyanosis of a single toe (blue toe syndrome) | Thromboembolic disease due to aortic-iliac stenosis, arrhythmia, or cholesterol embolization (after coronary artery bypass or catheterization) Warfarin therapy |
Bilateral or unilateral episodic digital discomfort, pallor, and cyanosis, sometimes with longer lasting tender reddish purple papules ("pernio") | |
Bilateral painless cyanosis | Acrocyanosis, drug-induced discoloration (eg, minocycline) |
Bilateral edema | Renal, hepatic, or cardiac dysfunction, intra-abdominal venous obstruction Medications (eg, calcium channel blockers) |
Unilateral edema | Lymphatic obstruction |
Firm nonpitting foot and leg edema | Systemic sclerosis (bilateral, usually with Raynaud syndrome) |
Firm, nonpitting edema with nodular appearance above the malleoli | Pretibial myxedema |
Edema with hemosiderin deposition and brownish discoloration | Recurrent or prior small-vessel vasculitis |
Numbness and pain at the ankle and heel (tarsal tunnel syndrome) more common in people with chronic edema | Relapsing symmetric seronegative synovitis (rare) |
Erythematous, dusky patches on the dorsum with flaccid bullae (necrolytic acral erythema) | Emboli |
Isolated toe swelling and deformity (dactylitis, or sausage digits) with pain | Infection (including nontuberculous mycobacteria) |
Painful feet with paresthesias | Peripheral neuropathy (local or systemic—eg, diabetic neuropathy) Ischemia |
Pain or paresthesias in the leg and foot; pain in the foot and back when the leg is extended, relieved when the knee is flexed | |
Toe, foot, or ankle pain with warmth and erythema | Cellulitis, crystal-induced arthritis, infectious arthritis Stress fracture, usually midfoot and associated with osteoporosis or repetitive trauma |
Foot swelling, erythema, and warmth with little or no pain | Neuropathic osteoarthropathy (Charcot joints; usually in the absence of pain due to neuropathy) |
Posterior heel pain below the top of the shoe counter during ambulation Tendon tenderness at its insertion (diagnostic) Exacerbation of tendon pain by passive ankle dorsiflexion | Achilles enthesopathy associated with spondyloarthropathies (eg, ankylosing spondylitis, psoriatic arthritis), retrocalcaneal bursitis, calcaneal apophysitis (in children and young adolescents) |