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Evaluation and diagnosis of common causes of forefoot pain in adults

Karl B Fields, MD
Section Editor
Patrice Eiff, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Foot pain is common among adults and a frequent reason for primary care visits. Nevertheless, as the differential diagnosis for foot pain is broad and exposure to foot-related problems is often limited during medical training, many clinicians may not be adequately prepared to assess the patient with foot complaints.

This topic reviews the common causes of forefoot pain in the adult, including descriptions of important conditions and a discussion of how to reach a diagnosis. An overview of foot pain generally, including more detailed discussions of foot anatomy and biomechanics, and how to conduct a history and examination of the patient with foot complaints, is provided separately (see "Evaluation and diagnosis of common causes of foot pain in adults"). A topic devoted to running injuries, including foot-related problems, is also available. (See "Overview of running injuries of the lower extremity", section on 'Foot and ankle injuries'.)


The anatomy and biomechanics of the foot are reviewed separately. (See "Foot and ankle pain in the active child or skeletally immature adolescent: Evaluation", section on 'Anatomy' and "Evaluation and diagnosis of common causes of foot pain in adults", section on 'Basic foot structure and biomechanics'.)


The forefoot is the most common location for foot pain in adults. Problems with toes and toenails affect between 60 and 75 percent of older individuals. Common problems include bunions (hallux valgus), hammertoes, and bunionettes, and a majority of adults have corns or calluses located on their toes or plantar foot surface [1]. Forefoot pain causes disabling symptoms in up to 36 percent of individuals older than 70. Women are more commonly affected [2].

Certain activities and occupations place significant stress on the feet. In a study of female professional Flamenco dancers, 80.7 percent had metatarsal pain while dancing and 84.1 percent demonstrated plantar hyperkeratosis [3]. Ballet and some forms of martial arts also expose the forefoot to greater risk of injury. Intense training and marching by soldiers and police officers is associated with stress fractures of the forefoot [4]. The surface on which activities are performed may predispose to forefoot pain. As an example, some forms of artificial turf are associated with higher great toe injury rates among both soccer and American football players [5,6].

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Literature review current through: Nov 2017. | This topic last updated: Jul 31, 2017.
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