Gastrocnemius strain | 20–40 | Sudden overload | Upper calf | Heel raise | Antalgic gait | Painful and limited DF | Pain with overpressure into DF Restricted range of DF with knee extended | Pain on PF | | Mid to upper calf |
Plantar fascitis | 20–60 | Gradual with no known cause | Sole of foot (under heel) | Weight-bearing especially first thing in the morning | Unremark able Flattened arches Pronated foot | Full and pain free | Pain with overpressure into great toe extension | Weak foot intrinsics | Pressure applied over plantar fascial insertion site on the calcaneus | Plantar aspect of heel |
Achilles tendinitis | 20–40 | Overuse | Posterior ankle | Jumping, running | Minor swelling of posterior ankle | Painful and limited DF | Pain with overpressure into DF Restricted range of DF with knee extended | Pain on PF | | Posterior ankle |
Posterior tibialis tendinitis | 20–40 | Overuse with a flat pronated foot | Medial ankle, along the course of the tendon | Activities involving weight-bearing plantar flexion | Possible peritendinous swelling over medial ankle | Pain on eversion Pain on PF | Pain with overpressure into eversion Pain with overpressure into PF | Pain on resited inversion with the foot plantar flexed | Rule out tear with heel raise symmetry | Medial ankle |
Morton's neuroma | 40–60 | Gradual with no known cause | Sole of foot | Weight-bearing | Pronated foot Flattened arches | Full and pain free | Pain with overpressure into toe extension | Strong and painless | | Web spaces of toes |
Retrocalcaneal bursitis | Varies | Direct irritation of bursa, usually from shoe | Hindfoot | Friction | Possible swelling, erythema of hindfoot | Usually unremarkable | Usually unremarkable | Usually unremarkable | Palpation | Just above the insertion site of the Achilles tendon on the calcaneus |
Anterior tibialis tendinitis | 15–45 | Overuse | Anterior lower leg | Activities involving repetitive dorsiflexion | Unremarkable | Pain with combined PF and inversion | Pain with overpressure into PF | Pain on DF | | Anterolateral lower leg |
Tarsal tunnel syndrome | 25–50 | Posttraumatic, neoplastic, inflammatory, rapid weight gain, fluid retention, abnormal foot/ankle mechanics, or a valgus foot deformity | Medial malleolus, distribution of posterior tibial nerve up the leg, or down into the medial arch, plantar surface of the foot and toes | Excessive dynamic pronation in walking or running | Pronated foot, pes planus, possible swelling | Full and pain free | Pain with extreme plantar flexion and eversion | Weak toe flexion (late) | Positive Tinel's over tarsal tunnel | No tenderness usually |
Midfoot Sprain | 15–40 | High impact landing sports Foot twisted when in fixed position | Midfoot | Walking on toes | Usually unremarkable | Usually unremarkable | Usually unremarkable | Usually unremarkable | Weight-bearing lateral and anterior–posterior radiographs | Generalized tenderness of midfoot |
Medial tibial stress syndrome | 15–30 | Overuse | Anterior lower leg Posterior-medial lower leg | Exercise involving involved lower extremity | | Pain with combined PF and inversion | Full and pain free | Pain on PF Pain on eversion | | Posteromedial calf |
Metatarsal stress fracture | 15–45 | Overuse | Forefoot | Weight-bearing activities | Possible edema over fracture site | Usually unremarkable | Usually unremarkable | Usually unremarkable | Palpation, ultrasound, tuning fork, bone scan, MRI, CT scan | Maximal point tenderness over the bone at the fracture site |
Referred | Varies | Symptoms can be referred from the lumbar spine, hip, knee, or from systemic diseases such as diabetes mellitus (DM), spondyloarthropathy (Reiter's syndrome) | May be dermatom |