Ankle And Foot Flashcards
(Bone) Fractures: interview
Mechanism of injury - trauma
Pott’s fracture (bimalleolar)
Overuse/stress fractions
Metatarsals-march fracture 2nd/3rd
Fracture 5th in distance running
Tibia, fibula, navicular
Avulsion fracture - pulling away of bone from the fracture site
Base of 5th metatarsal - Peroneus brevis and tertius
Past medical history - osteoporosis; brittle bones, relatively energy deficiency (REDS), long term steroid use, cancer
Localised pain worse on wight brearing relieved when weight taken off
Limp
(Bone) Fractures: examination
Palpation
Observation
Functional task e.g. gait
Active range of motion
X-rays and greater checks
(Bone) Severs disease calcaneal apophysitis: interview
Age - childhood
Sporty children who complain of pain after sport locally over the heal
Localised pain
Localised swelling
(Bone) Severs disease calcaneal apophysitis: examination
Observation
Palpation
Pain on isometric flexion - Achilles tendon
(Bone) Anterior impingement syndrome: interview
Past medical history - ankle sprains, reduced Proprioception
Social history - sports that require full dorsiflexion e.g. footballers, dancers, athletes
(Bone) Anterior impingement syndrome: examination
Palpation - pain at the joint line
Passive movement - symptomatic in full dorsiflexion
Active movement - symptomatic in full dorsiflexion
Osteoarthritis: interview
Localised symptoms - 1st metatarsophalangeal joint (7.8%), 2nd cuneometatarsal (3.9%), talonavicular (5.8%), navicularcuniform (5.2%)
Talocrural osteoarthritis post fracture
Gradual onset or post trauma
> 45 years old
Joint pain relative to activity and weight bearing
Mild swelling
No early morning stiffness (EMS) or morning stiffness longer than 30 mins
Osteoarthritis: examination
Passive movements - non-contractile structures
Observation - mild effusion, Hallux vagus, calluses or blisters over bony changes (Osteophytes)
Active range
Rheumatoid arthritis: interview
Location - Metatarsalphalangeal joints, subtalar, Talocrural and mid-tarsal
Early morning stiffness (EMS) longer than 30 minutes
Swelling and heat
General health - malaise (feeling unwell), fatigue, low grade fever as systemic
Extra-articular rheumatoid nodes, vasculitis, pulmonary fibrosis, carditis, ocular disease
Rheumatoid arthritis: examination
Palpation - swelling and temperature
Observation - swelling
Passive range of motion - non-contractile structures
Rheumatoid arthritis: treatment
Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause
Achilles tendonopathy
Retrocalcaneal bursitis
Achilles tendonitis
Enthesitis - where a tendon or ligament attaches to bone, pathological feature of spondyloarthritis
Muscle injuries and tendonitis: interview
Rupture - Achilles tendon rupture
Strains - gastrocnemius
Tendonitis - Achilles tendonitis, peroneal tendons, tibialis posterior, flexor hallucis longus (ballet dancers)
Mechanisms of injury - sudden (sprain/rupture), gradual onset (tendonitis)
Muscle injuries and tendonitis: examination
Isometric muscle testing - contractile structures
Palpation - show me where your pain is?
Pain on passive movement in opposite direction
Shin splints/ medial tibial stress syndrome: interview
Pain (“ache”) increasing during exercise or after exercise, reduces with rest
Worse running on hard, non-compliant surfaces
Pain located in lower 2/3 of tibia on the front of shin
High BMI
Social history - athletes who run and jump e.g. netball, tennis, gymnastics
Training overload
Shin splints/ medial tibial stress syndrome: examination
Palpation - pain along posteromedial border of tibia >5cm
Tibialis posterior, flexor digitorum longus and soleus muscles are overloaded
Associated with - pronation as arch has an important role to absorb shock, increased ankle plantar flexion, increased hip external rotation
Plantar fasciitis: interview
Location of pain - medial heel and midfoot
Worse o standing in the morning and when bare foot
Female > male
Past medical history - obesity
Social history - prolonged standing/walking e.g. hairdressers
Plantar fasciitis: examination
Palpation
Passive dorsiflexion and toe extension (plantar flexion on stretch)
Associated with reduced dorsiflexion
Ligament injuries: interview
Mechanism of injury - excessive inversion, “twisting ankle”
Swelling and bruising
Difficultly weight bearing
X-ray shows no fracture
Ligament injuries: examination
Passive movement - inversion reproduces symptoms
Accessory movements - anterior draw to test instability anteriorly (ATFL)
Palpation
Nerve and blood supply
Referred from back
Deep vein thrombosis - red, swollen calf
Peripheral neuropathy - diabetes
Gout
Diabetic foot arthropathy - numbness in the foot
Upper motor neurone (brain and spinal cord) - stroke, cerebral palsy, spinal cord injuries, MS, acquired brain injuries
Lower motor neurone (from anterior horn cell to muscle) - damage to peripheral nerve
Impact injury - feel pins and needles and numbness
