Damiano Joël
Universités Paris 5 et 6.
Rev Prat. 2010 Mar 20;60(3):327-33.
The diagnostic process in case of painful foot must always begin with a first clinical phase that is the most important. The history, conditions of happening and the clinical examination are essentials to orient appropriately the secondary examinations, if necessary, and establish a proper diagnosis. After the taking of the history, the clinical examination of the foot, bilateral and comparative, should begin with an evaluation of the entire musculoskeletal system for systemic and general conditions which can affect the foot and ankle. The function and structure of the foot may be evaluated using observation, palpation and manipulation of the different joints. The foot, and the patient's shoes, should be evaluated during unloaded and loaded conditions with gait observation. The location of the pain must be accurately precised: hindfoot pain (inferior, posterior, lateral, medial, anterior), middle foot pain or forefoot pain (medial with the first ray pathology or lateral). This first clinical assesment, with a basic radiography and sometimes an ultrasosonography study are able to diagnose the most frequent pathologies. Other additional examinations could be more rarely neccessary and must always be oriented by the knowledge of the foot pathology and the first obligatory clinical evaluation.
对于足部疼痛的诊断过程，必须始终从最重要的首个临床阶段开始。病史、发病情况及临床检查是必要的，以便在必要时合理安排进一步检查，并做出正确诊断。在采集病史后，应对足部进行双侧对比的临床检查，首先要评估整个肌肉骨骼系统，以排查可能影响足踝的全身性和一般性状况。可通过观察、触诊和对不同关节的手法检查来评估足部的功能和结构。应在足部负重和非负重状态下观察步态，同时评估足部及患者的鞋子。必须准确确定疼痛的位置：后足疼痛（下方、后方、外侧、内侧、前方）、中足疼痛或前足疼痛（内侧伴第一跖骨病变或外侧）。这一初步临床评估，结合基本的X光检查，有时还需超声检查，能够诊断出最常见的病症。其他额外检查很少有必要，且必须始终依据足部病理学知识和首次必要的临床评估来安排。
