Sometimes doctors speak a different language. I am flying home after taking part in a lecture series at the podiatry school in Oakland, CA. There were 4 speakers from prestigious teaching hospitals lecturing to an audience of 2nd year medical students. I enjoy listening to my friends lecture, but as I looked at the audience it was a sea of blank expressions. It was like the lecture was in a foreign language and the interpreter had taken a break. I suddenly realized that the lectures and slides were complicated surgeries and doctor talk. These students have been in a classroom for 2 years working in the science of medicine. No one in that audience had seen a patient yet, so the lecture was in a foreign language.
When I talk to you about the causes of your foot pain I have to remember that we speak different languages. For example, your big toe in podiatry talk is your hallux (hal-ux). I’ve been calling the big toe a hallux since the beginning of medical school. I have to speak your language, but sometimes I can slip so let’s go over some common causes of foot pain in both for comparison.
First of all the foot is divided into three areas. The front part containing your toes and the ball of your foot is called the forefoot. Your arch is in the middle of your foot and is called the midfoot. The back part of your foot has the heel, but of course that’s too easy for doctor talk so we refer to the back of the foot as the rearfoot. Each area has a unique set of problems that can cause foot pain. Since this is like learning a foreign language I will cover the front of the foot in this article and then the middle and heel next time.
It doesn’t matter if your 2nd toe is longer or shorter than your big toe. Any toe that is buckled or bent is called a hammertoe. When a toe is crooked like it can press harder on your shoe causing hard skin to form. An area of hard skin that develops on a toe from pressure is called a corn or heloma durum. Your toe can curl so much that it almost sits on the top of your foot. This causes increased pressure on the bone in the ball of your foot and hard skin can form at this point. Hard skin forming on the ball of the foot is called a callus or IPK, which stands for intractable plantar keratoma. Not all hard skin is a corn or callus. Warts are areas of hard skin with tiny black spots in the center. This is a virus infection of the skin called verruca.
What about lumps and bumps on the toes and ball of the foot? A bump at the base of your big toe, remember that’s called the hallux, is a bunion. In podiatry talk we say the big toe has drifted toward the 2nd toe or hallux valgus. On the opposite side of your foot at the base of the little toe you can get a bump. At some point in time this was common in jobs where people sat with their legs criss-crossed or Indian style. Tailors used to sew sitting in this position so they call this a tailor’s bunion or little bunion, bunionette. In the center could be due to a broken bone. Stress fractures are a common cause of swelling, bruising, and pain in the forefoot.
Another cause of pain in the forefoot is a pinched nerve called a neuroma. You might have a neuroma if the pain is in the ball of your foot and shoots out your toes. Unfortunately not all foot pain in the ball of your foot is a pinched nerve. There are tendons and joint capsules in the same area that can become irritated. When tendon or joint capsule becomes inflamed this is called tendonitis or capsulitis.
That’s a lot of new words so I’ll let you study this for a while then come back with the common terms used in the middle and back of the foot, the midfoot and rearfoot.