Hand, foot and sports conditions in adults

• Trigger finger (stenosing tenosynovitis) is an A1 pulley and flexor tendon size mismatch that makes a finger catch or lock; it affects about 2% of adults and is common in women aged 40 to 60.^[1]
• Dupuytren disease is a progressive fibrosis of the palmar fascia that forms nodules and cords and can pull the ring and little fingers into flexion; it is familial and more common in northern European men.^[5]
• Ganglion cysts are the most common lump in the hand, forming from joint or tendon-sheath tissue; they are not cancer, often resolve on their own, and are common in young women.^[3]
• Hallux valgus is a progressive drift of the big toe toward the lesser toes with a painful bunion at the first metatarsophalangeal (MTP) joint; heredity matters strongly.^[6]
• Plantar fasciitis is irritation of the plantar fascia, causing first-step heel pain after rest; more than 90% of patients improve within 10 months with simple measures.^[7]
• Stress fractures are overuse injuries in which load outpaces bone remodelling; they heal in 6 to 8 weeks and need load control.^[2]
• Adults benefit from at least 150 minutes of moderate-intensity physical activity per week, and worldwide 31% of adults do not reach this.^[4]
• Return to play is a criteria-based process, not a date: restore pain-free movement, strength, task-specific capacity and medical clearance.^[8]

By the end of this page you should be able to:

1. Recognise and examine trigger finger, Dupuytren disease, ganglion and hallux valgus, and separate them from mimics.
2. Explain the overuse mechanism that produces plantar fasciitis and stress fracture, and the loading rules that prevent them.
3. Outline the nonsurgical and surgical options for each common condition and the red flags that change management.
4. State the WHO activity targets for adults and apply them to a person with hand, foot or sport injury.
5. Run an exercise-prescription conversation and a return-to-play progression from injury through sport-specific drills.
6. Describe UK (BASEM, NICE CKS) and US (AAOS) sources a clinician might consult, and note where evidence is thin.

This topic groups common musculoskeletal problems that bring adults to clinics worldwide: disorders of the digits and palm (trigger finger, Dupuytren disease, ganglion), deformity and pain in the forefoot and heel (hallux valgus, plantar fasciitis), and overuse bone injury (stress fracture). It also covers two cross-cutting skills that apply to all of them: exercise prescription and return to play after injury or illness.

These conditions are usually not emergencies, but they are common, often chronic, and they affect work and sport. The goal is to relieve pain and restore function while avoiding surgery where possible. The age and activity profile of the patient is central: plantar fasciitis peaks from 40 to 60 years, ganglions present from 15 to 40, adolescents develop a different bunion, and stress fracture is a problem of load versus bone remodelling.^[3][6][7][2]

The clinical sources used here are the American Academy of Orthopaedic Surgeons (AAOS) OrthoInfo articles for each condition, which are peer-reviewed patient-education documents written by orthopaedic surgeons, together with the World Health Organization (WHO) physical activity fact sheet and the British Association of Sport and Exercise Medicine (BASEM) return-to-play resources. In the United Kingdom, NICE Clinical Knowledge Summaries (NICE CKS) provide primary-care summaries for plantar fasciitis, bunions and Dupuytren disease; the quantitative recommendations in this topic come from the open sources listed in the references and are consistent with that primary-care framing. Where evidence is thin or divided, this is stated rather than implied.

Trigger finger (stenosing tenosynovitis). A condition in which the flexor tendon and A1 pulley at the base of a finger develop a size mismatch, so the tendon can no longer glide smoothly through its tunnel. The result is catching, popping or locking, often with pain and a tender lump in the palm. Thumb involvement is called trigger thumb.^[1]

Dupuytren disease. A benign, progressive fibroproliferative condition of the palmar fascia. Thickening forms nodules, then cords; as cords shorten, one or more fingers, most often ring and little, are pulled toward the palm into a flexion contracture. Contractures at the metacarpophalangeal (MCP) joint are easier to correct than those at the proximal interphalangeal (PIP) joint.^[5]

Ganglion cyst. A fluid-filled cyst arising from a joint capsule or tendon sheath, with a stalk linking it to the joint. It is the most common lump in the hand, it is not cancer, and it can change size rapidly with activity and rest. A "mucous cyst" is a ganglion at the distal interphalangeal joint of a finger, linked to arthritis.^[3]

Hallux valgus (bunion). A progressive deformity in which the first metatarsal shifts medially and the proximal phalanx of the big toe drifts laterally, producing a painful bony bump at the first MTP joint. "Bunion" names the bump and hallux valgus the deformity behind it. A bunionette, or tailor's bunion, is the analogous bump laterally at the fifth toe.^[6]

Plantar fasciitis. Irritation and microtearing of the plantar fascia, the strong band supporting the arch, giving heel pain on the sole that is worst with the first steps after rest. It is among the most common causes of heel pain.^[7]

Stress fracture. A small crack or severe bruising within bone from repetitive load; most are overuse injuries in which bone breakdown outpaces remodelling. Bones with poor blood supply, such as the base of the fifth metatarsal and the navicular, need closer attention.^[2]

Return to play (RTP). The structured process of restoring an athlete or active person to sport or activity after injury or illness, using clinical criteria rather than the calendar alone.^[8]

Trigger finger affects about 2% of the general population and can involve any finger, most often the ring finger and thumb, in one or both hands. It is most common in women aged 40 to 60 and is rare in children, although a congenital trigger thumb can lock a child's thumb in flexion.^[1]

Dupuytren disease may appear with nodules in early adulthood but becomes more common with age. It is more frequent in biologic men, in people of northern European and Scandinavian ancestry, and in those with a positive family history; both hands are often affected.^[5]

Ganglions are the most common mass in the hand. They are common in people aged 15 to 40, in joints affected by arthritis, in people who load the wrist repeatedly such as gymnasts, and they are more common in women than in men. Mucous cysts at the fingertip are most common in women aged 40 to 70.^[3]

Bunions are more common in women than men and develop more often in adulthood than childhood. Up to 70% of people with bunions have a family history, and adolescent bunions are seen most often in girls aged 10 to 15.^[6]

Plantar fasciitis is extremely common: about 2 million patients are treated each year, it is most common from 40 to 60 years, and it is seen in athletes, in people who stand for long hours, and in people with excess body weight.^[7]

Stress fractures are common in running and jumping sports. They are more common when training load rises abruptly, and female athletes are more susceptible, in part through low bone density related to relative energy deficiency in sport (REDs).^[2]

On the exercise side, one third (31%) of the world's adult population, about 1.8 billion adults, are physically inactive and do not meet the global recommendation of at least 150 minutes of moderate-intensity activity per week. The proportion rises with age, women are about 5 percentage points less active than men, and 81% of adolescents aged 11 to 17 are inactive.^[4]

Trigger finger has no clear cause in most cases. Risk is higher in women aged 40 to 60, in people with diabetes, rheumatoid arthritis or amyloidosis, in those doing repetitive gripping or pinching, and in hands with structural tendon differences.^[1] Repetitive finger use inflames and thickens the A1 pulley and tendon sheath.

Dupuytren disease is predominantly genetic. Ancestry, male sex, increasing age, family history, alcohol, diabetes, seizure disorders and trauma (including surgery) to the hand are associated. Overuse is not a convincing cause.^[5]

Ganglions have no proven cause. Repeated wrist stress, female sex, young adulthood and co-existing arthritis, especially for mucous cysts, are the main associations.^[3]

Hallux valgus is multifactorial. Footwear with a narrow toe box, family history, ligamentous laxity, flat foot (pes planus), Achilles tightness, neuromuscular disorders such as cerebral palsy, and inflammatory arthritis all contribute, and genetics appears to play a large part.^[6]

Plantar fasciitis risk factors are new or increased activity, repetitive high-impact activity, prolonged standing on hard surfaces, flat or high-arched feet, tight calf muscles, obesity and age 40 to 60.^[7]

Stress fractures share a simple unifying cause: doing too much too soon. Sudden increases in frequency, duration or intensity, changes in footwear or surface, poor conditioning, altered biomechanics from a blister or bunion, and systemic bone weakening (osteoporosis, low vitamin D, REDs) all lower the threshold.^[2]

For exercise-related harm, the WHO data are a useful counterpoint: inactivity itself is a risk factor for many diseases, so the clinical message is to add activity as well as to remove overload.^[4]

Trigger finger. There is a size mismatch between the flexor tendon and the A1 pulley. The tendon thickens or develops a nodule, the pulley thickens and narrows, and the nodule snaps through the pulley during deep flexion and strikes it during extension. Stiffness and locking are worse after inactivity.^[1]

Dupuytren disease. Fibroproliferation in the palmar fascia forms nodules, then longitudinal cords. As the cord shortens, it tethers skin and bone and produces a flexion deformity. Tendons, nerves and joints are not primarily diseased; the problem is fascial.^[5]

Ganglion. A balloon-like herniation of synovial or capsular tissue on a stalk, filled with thick slippery fluid similar to joint fluid. The stalk acts as a one-way valve, so the cyst can grow with load and shrink with rest. Pressure on adjacent nerves produces pain, paraesthesia or weakness.^[3]

Hallux valgus. Misalignment at the first MTP joint produces a medial eminence (the bunion) that becomes inflamed from shoe pressure and altered mechanics. Chronic malalignment damages articular cartilage and leads to arthritis, and second toe disorders can follow.^[6]

Plantar fasciitis. The plantar fascia absorbs high stresses with each step. Surplus load creates microtrauma at its insertion; the inflammatory response gives heel pain, worst on the first steps after the fascia has rested and shortened, then easing as it warms up.^[7]

Stress fracture. Bone remodels constantly. If loading is excessive or recovery inadequate, osteoclastic resorption outpaces formation, microdamage accumulates, and a painful microcrack or bruise develops. Poor blood supply at the fifth metatarsal base and navicular slows healing.^[2]

Exercise and tissue. Loading is the stimulus for bone, tendon and muscle adaptation; absence of loading is the stimulus for deconditioning. Exercise prescription therefore aims to bring daily load into line with the capacity of the tissue being treated.^[4]

Let the patient tell the story freely first, then narrow it down: which digit, which side, how long, steady or fluctuating, locking versus pain only, and effects on work, sleep, shoes and sport. Ask about diabetes, rheumatoid arthritis, gout, alcohol intake, family history of bent fingers or feet, occupation and repetitive hand tasks, footwear, recent training changes, diet and, in athletes, weight change, menstrual history and eating behaviour.

Red flags include pain at night or at rest, fever, weight loss, rapidly growing mass, neurovascular compromise, open wound or bite, inability to bear weight, fracture pain away from the expected site, and any suspected eating disorder or REDs in a young active woman.

Look at posture of the hand at rest, active and resisted movement, sensation, circulation and swelling. Key findings by condition:

• Tabletop test (Dupuytren): the patient tries to flatten the palm on a table; a contracture prevents it.
• Finger motion: trigger finger is felt rather than maxed out - catching, then a click, often with a nodule moving with the tendon.
• Transillumination (ganglion): light through the mass confirms fluid.
• Standing foot X-ray (hallux valgus): alignment and arthritis, before and after loading.
• Heel squeeze and hop test (stress fracture): focal, well-localised pain; imaging if it persists.

The common dilemma is to sort overlapping presentations: a hand mass, a bent finger, a painful foot and a runner with heel pain.

Trigger finger. Usually clinical. X-rays or other tests are not needed to make the diagnosis unless arthritis or an alternative is suspected.^[1]

Dupuytren disease. Clinical diagnosis; measure joint contracture during follow-up. Imaging is not required unless another problem is suspected.^[5]

Ganglion. Usually clinical. Transillumination distinguishes fluid from solid. Ultrasound shows a fluid-filled cyst with clear borders; MRI finds hidden (occult) ganglions; X-ray excludes bony causes and shows arthritic change.^[3]

Hallux valgus. Clinical diagnosis confirmed by standing foot X-ray: bone alignment, MTP joint damage and arthritis, which guide treatment.^[6]

Plantar fasciitis. Clinical; imaging is for other causes. X-ray can exclude fracture or arthritis and shows heel spurs, but spurs do not cause the pain. MRI or ultrasound are rarely needed.^[7]

Stress fracture. X-ray is first line but may be normal for weeks; a healing callus later makes the line visible. Bone scan or MRI is more sensitive early; CT defines fracture extent for surgery. DEXA is considered when fracture occurs with light activity, to assess bone density.^[2]

Across these conditions, investigations answer a specific question; if the question is clinical, added tests do not help. Blood glucose control matters when steroid injections are planned for trigger finger, because steroids raise blood sugar in insulin-using diabetics for 10 to 14 days.^[1]

There is no single score that groups all of these conditions. Instead, severity is judged by anatomy and function:

• Trigger finger: no recognised grading score in the AAOS patient guidance; severity is defined by frequency of locking and whether the finger can be straightened actively or only passively.
• Dupuytren disease: the degree of MCP and PIP contracture in degrees; the tabletop test is a practical functional marker. Clinically significant deformity is judged by functional loss and specialist assessment; primary-care summaries describe contracture thresholds for referral.
• Ganglion: symptomatic versus asymptomatic; size and whether it limits movement or compresses nerves.
• Hallux valgus: radiographic angles and MTP arthritis; whether the patient can wear shoes and walk.
• Plantar fasciitis: pain and function over months; 90% improve within 10 months with simple treatment.^[7]
• Stress fracture: site, severity and blood supply determine management; Jones fracture and navicular injuries are higher risk.^[2]

Most of these conditions are managed electively. Acute recognition matters for infection, neurovascular compromise, open wound, stress fracture pain that suddenly worsens (possible complete fracture), and any eating-disorder or menstrual change in a young active woman.

The goal is to reduce pain and let the tendon glide.

Nonsurgical options (first line). Activity modification (rest from repetitive gripping or pinching), night-time splinting in extension, NSAIDs such as ibuprofen or naproxen or paracetamol if NSAIDs are not tolerated, gentle stretching, and corticosteroid injection into the A1 pulley. In many cases the injection resolves the condition; up to three injections may be given, and surgery is considered if injections fail. Steroid injections are less likely to work, but may still help, in people with diabetes, long-standing triggering or trigger thumb, and they transiently raise blood sugar in insulin-using diabetics.^[1]

Surgical trigger finger release. An outpatient procedure that cuts (or needle-divides) the A1 pulley to give the tendon room; occasionally part of a tendon is removed if triggering has been long-standing. Fingers are moved immediately; incision heals in a few weeks, but swelling and stiffness can take 4 to 6 months to settle, and full recovery averages about 6 months.^[1]

Complications of surgery are rare (infection, stiffness, return of symptoms). When surgery is needed, early intervention and compliance improve outcomes.^[1]

If there is no contracture or significant loss of function, no treatment is needed: explain, reassure that it is not cancer, and advise return if a contracture develops. Painful nodules without contracture may receive corticosteroid injection. Physical therapy and splinting have not been shown to prevent progression, and forceful stretching can injure.^[5]

Minimally invasive secondary-care options. Collagenase injection ruptures a cord in two steps (inject, then manipulate 2 to 3 days later); needle aponeurotomy cuts the cord in clinic. Both improve motion but recur more often than surgery. Corticosteroids may help painful nodules; radiotherapy has restricted use.^[5]

Surgery. Fasciotomy (divide the cord, leave diseased tissue) or partial palmar fasciectomy (remove abnormal tissue with zig-zag incisions). Fasciectomy means longer recovery but removes diseased tissue and lowers recurrence. About 20% of patients experience a meaningful contracture recurrence after surgery; further surgery may be required. Minimally invasive treatments are usually preferred when suitable because they recover faster, although they are less effective for severe contractures.^[5]

Referral: contracture or significant loss of function merits hand-surgeon review; referral is also appropriate for severe thumb contracture affecting function, or rapidly progressive disease.^[5]

If painless, observe: the approach is safe, the cyst is not cancer and more than half resolve on their own. Rest and a wrist brace or splint can reduce a cyst; activity makes it grow larger. Aspiration drains the cyst but commonly fails because the root is left behind, like a weed. Avoid striking the cyst with a heavy object, the old "Bible bump" remedy.^[3]

Surgery (excision) removes the cyst plus stalk and is offered if nonsurgical care fails; recurrence is still common. Most people return to normal activities 2 to 6 weeks after surgery. Cysts on the palm side of the wrist are harder to aspirate because of nearby vessels and nerves.^[3]

Mild or painless bunions can simply be observed. Nonsurgical care does not reverse deformity but relieves pain and slows progression: footwear with a wide toe box, silicone padding, over-the-counter or custom orthotics, toe spacers, night splint (not permanently corrective), NSAIDs, and attention to shoe fit (3/8 to 1/2 inch of room at the toe).^[6]

Surgery is for painful bunions after footwear and nonsurgical measures have failed, or when daily function is compromised. Open bunionectomy or minimally invasive techniques both realign bone, ligament, tendon and nerve; fixation holds the repair while it heals, and a long recovery is common. In adolescents, surgery is usually delayed until growth is nearly complete because recurrence risk is high before skeletal maturity.^[6]

More than 90% of patients improve within 10 months of simple measures, so patience and consistency matter. First-line nonsurgical care: rest and activity change (stop pounding on hard surfaces), low-impact alternatives such as cycling or swimming, stretching of calf and plantar fascia (hold 10 seconds, 20 repetitions for each foot), ice for 20 minutes 3 to 4 times daily, NSAIDs not to be used for more than 1 month without talking to a primary care doctor, physical therapy, supportive footwear and orthotics, and night splints, which are effective though hard to tolerate.^{[7] [2]}

Further nonsurgical options if symptoms persist: corticosteroid injection (which can weaken the fascia and risk rupture), platelet-rich plasma injection (still being studied), botulinum injection into the calf to reduce tension, extracorporeal shockwave therapy (mixed results) and ultrasonic tissue repair for persistent cases.^[7]

Surgery is saved for people without improvement after 12 months of aggressive nonsurgical treatment and is rarely needed. Options include partial plantar fascia release (open or endoscopic), with a short period of protected weightbearing afterwards, and gastrocnemius recession to lengthen a tight calf muscle. Complications are uncommon but include sural nerve injury and calf weakness.^[7]

Heel spurs do not cause plantar fasciitis pain.^[7]

Initial management is the RICE approach: rest from weightbearing activity, ice (cold packs 20 minutes at a time, several times a day, not on the skin), compression and elevation, with NSAIDs for pain and swelling. Use crutches to keep weight off until pain subsides. Switch to non-impact alternatives such as swimming or cycling. Some fractures need a stiff-soled shoe, removable brace or cast.^[2]

It typically takes 6 to 8 weeks for a stress fracture to heal; chronic fractures or those in bone with poor blood supply take longer. More serious fractures, including Jones fractures at the base of the fifth metatarsal, require non-weightbearing immobilisation in a cast or boot for at least 6 weeks, with return to sports often delayed to about 12 weeks, and surgery is sometimes used. Navicular fractures also often need protected weightbearing and may be fixed surgically. Return to activity is gradual, beginning with alternating activity and rest days, and should be pain-free, confirmed clinically and sometimes on X-ray or CT.^[2]

Exercise is a treatment, not a lifestyle extra, and it is under-prescribed for these conditions. The WHO adult target is at least 150 minutes of moderate-intensity activity per week, with added health benefits as volume increases. A balanced prescription includes aerobic work, muscle-strengthening on several days each week, and flexibility and balance (especially important from middle age onward).^[4]

Regular activity in adults reduces all-cause and cardiovascular mortality, incident hypertension, site-specific cancer, type 2 diabetes and falls, and improves mental health, cognition, sleep and body composition. In children and adolescents it promotes bone health, growth and motor and cognitive development. Inactivity has the opposite effect.^[4]

In practice, a consultation for these conditions can follow a simple script:

• Ask. What does the patient already do, what do they want to do, and what stops them?
• Advise. State clearly what would help, with a named weekly target and an activity type suited to their injury and life.
• Agree. Set one realistic goal the patient chooses (for example, 20 minutes of brisk walking on 3 days this week), and write it down.
• Assist. Provide a short home programme, arrange physiotherapy if needed, and address barriers such as pain, footwear, time or confidence.
• Arrange. Book review, and use follow-up to progress load.

For hand and foot conditions, principles are:

• Modify rather than stop: protect the injured structure (splint, footwear, orthotic) while keeping the rest of the body strong.
• Use non-impact cardiorespiratory work (cycling, swimming, deep-water running) while foot pain settles.^[7]
• Stretch the calf and plantar fascia for plantar fasciitis, with 10-second holds repeated 20 times per foot.^[7]
• Progress load in small steps: for running and bone loading, a rise of about 10% per week is a common and sensible ceiling.^[2]
• Rebuild strength, balance and movement quality before full sporting load.
• In athletes with recurrent or fatigue-related injuries, screen for REDs: under-fuelling causes menstrual disturbance, low bone density and stress fracture, and training harder will not fix it.^[2]

Return to play is a decision, not a date. The BASEM resources frame it after injury and illness, and the principles apply to all the conditions above.^[8] A robust plan checks:

1. Tissue healed. Symptoms resolved or stable; any imaging done has healed or clinician-cleared.
2. Full pain-free range of motion of the affected joint or limb.
3. Strength and endurance restored to near pre-injury level (strength close to the uninjured side, measured if possible rather than guessed).
4. Task-specific drills completed at graded intensity: straight-line running, then cutting, acceleration and deceleration, then contact or implement work.
5. Performance testing passed (sport-specific, standardised, recorded).
6. Psychological readiness present; fear of re-injury drives avoidance and re-injury.
7. Medical clearance given, and any comorbidity treated (for example, eating disorder or menstrual dysfunction).
8. Load management after return: avoid sudden spikes; use the "no more than 10% increase per week" rule as a guide.^[2]

After illness (including viral infections), RTP should be graded and, for cardiac or systemic symptoms, preceded by medical assessment, as infections can reduce exercise tolerance. BASEM lists return-to-play guidance following acute illness among its resources.^[8]

Acute red flags during progression - worsening focal bone pain, night pain, swelling, or new neurovascular signs - stop the progression and re-evaluate.

A single framework helps: complications arise from delayed diagnosis, undertreatment, overtreatment and missed risk.

• Trigger finger: stiffness, tendon sheath rupture after injection (uncommon), recurrence, postoperative pain and stiffness, occasional tendon division at surgery.^[1]
• Dupuytren disease: incomplete correction, nerve or vessel injury, skin problems, stiffness, complex regional pain syndrome, flare reaction and recurrence, worst after surgery for recurrence. About one in five experience significant recurrence after surgery.^[5]
• Ganglion: recurrence after aspiration or excision; scarring and stiffness after surgery; rare complications from aspiration near neurovascular structures.^[3]
• Hallux valgus: progression, MTP arthritis, second toe deformity, bursitis, impaired balance and falls, postoperative stiffness, over- or under-correction, prolonged swelling.^[6]
• Plantar fasciitis: chronic pain and disability, plantar fascia rupture after repeated steroid injections with collapse of the arch, and surgical complications (sural nerve injury, calf weakness).^[7]
• Stress fracture: progression to complete fracture, delayed union or non-union (notably at the 5th metatarsal base and navicular), compensatory injury upstream, and chronic pain. Treating only the fracture without addressing REDs or footwear leads to recurrence.^[2]

Most of these conditions are chronic-lifestyle problems rather than threats to life. Trigger finger usually improves with injection and, failing that, surgery. Dupuytren disease is not curable but correctable, with about 20% meaningful recurrence after surgery. Ganglion cysts are harmless and often resolve; recurrence is common but rarely matters functionally. Hallux valgus worsens slowly; surgery can relieve pain but the timeline is long. Plantar fasciitis has a favourable natural history, with more than 90% better within 10 months with simple measures. Stress fractures heal in 6 to 8 weeks when the load is controlled, but only if underlying energy deficit and training errors are corrected. ^[5]

• Footwear and foot care: wide toe boxes, shock-absorbing soles, replace worn running shoes.^[6]
• Load management: increase training by no more than about 10% per week, vary surfaces, cross-train and include strength training.^[2]
• Stretch calves and plantar fascia, especially with new activity.^[7]
• Protect fingers from repetitive high-load gripping where feasible; pad tools.
• Detect REDs early in sport: weight, menstrual history, bone mineral density, stress fracture history.^[2]
• Prevent osteoporosis-related fractures: adequate calcium and vitamin D, resistance training, avoid smoking and excess alcohol.^[2]
• No population screening is needed for these conditions; opportunistic education at sport, occupational and lifestyle encounters is the practical approach.

Children and adolescents. Trigger finger is rare in children (except congenital trigger thumb). Adolescent bunions differ from adult bunions: the young person can usually move the big toe up and down, but pain and shoe difficulty still matter, and surgery is delayed until near skeletal maturity. Stress fracture and REDs are major concerns in young athletes. Ganglions at the wrist are common and usually benign.^[1][6][2][3]

Older adults. These conditions are common with age. Plantar fasciitis peaks 40 to 60, bone quality falls, and surgery recovery is slower; balance and fall prevention become more important than symptom relief alone.^[7][2]

Pregnancy. The WHO facts support continued physical activity in pregnancy with appropriate modification, and foot problems can worsen with weight gain and laxity. Work with obstetric guidance on medication (NSAIDs) and surgical timing.

Diabetes and other conditions. Trigger finger and Dupuytren disease are more common; steroid injections raise blood glucose for 10 to 14 days in insulin users.^[1][5] Rheumatoid arthritis, thyroid disease and other systemic conditions can present with hand nodules and heel pain and must not be missed.

Immunocompromised and people who inject drugs. Any hand infection in these groups needs early surgical review, and superficial infections progress to deep sepsis quickly.

Where specialist imaging and surgery are not available, care still helps:

• Most of these diagnoses are clinical. A good history and careful palpation identify plantar fasciitis, ganglion, trigger finger and Dupuytren disease without imaging.
• Footwear advice, calf and plantar fascia stretching, rest from impact and a 10% weekly load increase are free or low cost.^[7][2]
• Use splints from available materials (volar splint for trigger finger positioning, night splint for plantar fascia) and teach the patient and family.
• Ice, compression and elevation plus NSAIDs (with local cautions) manage early stress fracture pain.^[2]
• Refer early when there is neurovascular compromise, open wound or bite, suspected complete fracture or severe contracture, rather than exhausting local options first.
• If surgery is needed and unavailable locally, document the clinical and imaging findings and the functional deficit; staged transfer beats emergency improvisation.

• Trigger finger is an A1 pulley/flexor tendon size mismatch affecting about 2% of adults; first-line care includes splinting, NSAIDs, stretching and up to three steroid injections.^[1]
• Dupuytren disease is a progressive palmar fibrosis; observe if asymptomatic, and consider minimally invasive or surgical release if contracture or loss of function. About 20% of patients have meaningful recurrence after surgery.^[5]
• Ganglion cysts are the most common hand lump, not cancer, and more than half resolve spontaneously.^[3]
• Hallux valgus is a progressive deformity; wider footwear and orthotics relieve symptoms, surgery is for pain after failure of nonsurgical care.^[6]
• Plantar fasciitis affects about 2 million patients a year; more than 90% improve within 10 months with stretching, ice, footwear change and load reduction.^[7]
• Stress fractures heal in 6 to 8 weeks; high-risk sites (5th metatarsal base, navicular) need greater protection and sometimes fixation. Screen for load errors and REDs.^[2]

No existing verified topic links are included. Plain-text follow-ons for deeper study: hand tendon and nerve injuries, arthritis of the hand and foot, osteoporosis and bone health, sports nutrition and REDs, injury-prevention and warm-up programmes, and physiotherapy-led rehabilitation.