Foot Conditions in Adults

Foot health is an important but often overlooked aspect of overall wellness that can substantially affect mobility and quality of life. This edition of FP Essentials provides information about a variety of foot conditions in adults, emphasizing the role that family physicians play in the prevention and management of these conditions, and providing us with information needed to guide patients through the complexities of foot health management.

Section One addresses diabetic foot ulcers, which affect more than 30% of the 37 million people in the United States with diabetes during their lifetimes. Neuropathic loss of sensation and other complications of diabetes increase vulnerability to foot ulceration and infection. These patients need periodic standardized foot evaluations. Family physicians should perform these crucial examinations and initiate early interventions, such as offloading, that help avoid severe outcomes.

Section Two covers foot infections such as tinea pedis, plantar warts, and pitted keratolysis. Recognizing these infections is vital to prevent deeper tissue involvement. By understanding their varied presentations across different skin tones, we can effectively treat these conditions and, when necessary, expedite referrals for unresolved cases.

Section Three focuses on foot deformities such as hallux valgus, hammer toe, and pes planus. These deformities affect mobility and cause discomfort, and they benefit from timely diagnosis and tailored management strategies, which range from orthotics to surgical interventions.

In Section Four, foot pain and overuse disorders are addressed. Conditions such as Achilles tendinopathy, Morton neuroma, and plantar fasciitis arise from both intrinsic and extrinsic factors, necessitating a thorough clinical assessment. Treatment is primarily conservative, followed by procedural and surgical options when needed.

I hope you find this edition of FP Essentials helpful for your practice. When you have finished studying it and are ready to submit your answers to the test questions, please use the comment section to tell us what was most useful and what we can do to improve. We also look forward to hearing your ideas for topics you would like us to cover in future editions.

Please also let us know your thoughts about the roles of artificial intelligence (AI) tools in the work we do as family physicians. Our policy at FP Essentials is that authors (and editors) who use this technology must disclose their use of AI, the type of AI used, and how they used it. I used the University of Michigan GPT AI tool to create the first draft of this foreword. It did a pretty good job summarizing the content of the monograph, but the tone and style did not sound like me at all, so I made lots of changes.

Karl T. Rew, MD, Associate Medical Editor
Clinical Associate Professor, Departments of Family Medicine and Urology
University of Michigan Medical School, Ann Arbor

Angela Cherry, MD, MBA, FAAFP, is an assistant professor in the Department of Family Medicine Eastern Division at West Virginia University (WVU) School of Medicine. For more than 20 years she has served rural and underserved communities in West Virginia, practicing full spectrum family medicine, including medication treatment for opioid use disorder and obstetrics. She teaches allied health students, medical students, and residents and serves on numerous state and institutional committees. Dr. Cherry developed the WVU Rural Maternal Child Health Fellowship to train residents in surgical obstetrics to practice in underserved communities. She has worked with the National Board of Medical Examiners since 2015 and now serves on the US Medical Licensing Examination Management Committee.

Kairi Horsley, DPM, is an assistant professor in the Department of Orthopaedics Eastern Division at WVU School of Medicine. He is a diplomate of the American Board of Foot and Ankle Surgery and the American Board of Podiatric Medicine. He has trained podiatric residents since 2013. Before joining the Department of Orthopaedics at WVU, Dr. Horsley was in private practice while also teaching.

Lynnette A. Morrison, MD, FAAFP, is the Regional Medical Director in the South Division for RestorixHealth and the Medical Director for Northwest Health Wound Care and Hyperbaric Center in Bentonville, Arkansas. She is a certified wound care specialist; a fellow of the American Professional Wound Care Association and the American College of Clinical Wound Specialists; and a diplomate of the American Board of Wound Medicine and Surgery. She serves as a collaborative physician, national speaker, and leader who regularly engages at conferences and symposiums. Dr. Morrison also actively participates in medical mission work, bringing her wound care expertise to underserved communities globally.

Cassandra Clayborne, MD, is an assistant professor in the Department of Family Medicine Eastern Division at WVU School of Medicine. She specializes in geriatric medicine. She has worked at the National Cancer Institute and National Institutes of Health as a principal investigator. She has been an invited speaker to discuss the student perspective on education in Appalachia and served as a panelist to discuss the challenges of black females in health care.

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

• Perform periodic comprehensive standardized diabetic foot examinations to identify preulcerative conditions.
• Initiate care for diabetic foot ulcers in the primary care setting by assessing the ulcer, offloading it, treating infection if present, and promptly referring to specialists when appropriate.
• Recognize and treat common foot infections.
• Diagnose and provide initial management for common foot deformities.
• Identify and address the factors that contribute to foot pain and overuse disorders.
• Provide initial management for Achilles tendinopathy, Morton neuroma, and plantar fasciitis.