Ankle and Foot Flashcards
A 46-year-old male presents with pain in the sole of the right foot. He had injured that ankle previously. On examination, percussion of the posterior tibial nerve behind the medial malleolus resulted in reproduction of the pain in the sole of the foot. No tests were done otherwise.
Tarsal Tunnel Syndrome
A 57-year-old male presents with sudden onset of severe big toe pain. He attended a wedding last night. On examination, the 1st MTP joint is very swollen, red, shiny and painful. Serum uric acid levels not elevated. Aspirated joint synovial fluid shows numerous negatively birefringent crystals under polarized light.
Gout
A 19-year-old female dancer presents with pain in the lateral aspect of her right foot. On examination, there is swelling and pain over the base of her 5th metatarsal bone. X-ray of her right foot shows a transverse fracture through the base of the 5th metatarsus.
Jones fracture (Dancer’s fx)
A 53-year-old man complains of severe right ankle pain during a tennis match after lunging to reach a ball. Although he can bear weight on the affected ankle, he is unable to walk. On examination, squeezing the patient’s calf muscles on the affected side does not in plantar flexion. MRI confirms the tear in the tendon.
Achilles tendon rupture
A 53-year-old army colonel presents with pain in the middle of his right foot, especially when he walks. It is worse when he wears a new pair of shoes. On examination, there is tenderness in the sole of the foot between the heads of the 3rd and 4th metatarsal bones. Mulder’s squish is positive. No other tests were done.
Morton’s Neuroma (Mulder’s is also called Morton’s test)
A 23-year-old soccer player presents with severe pain in the left ankle after injuring it during an international game. He was not able to take any weight-bearing steps on it since the injury occurred an hour ago. On examination, there is marked discoloration, swelling and pain over the lateral malleolus. Percussion of the left lateral malleolus is extremely painful. X-ray of the ankle shows an oblique bony defect in the lower end of the fibula with displacement of the distal fragment.
Pott’s fracture
A 19-year-old male presents with pain in the right ankle after injuring it during a beach volleyball game yesterday. He was able to take more than 4 weight-bearing steps on the ankle immediately after the injury. On examination, the right ankle is swollen, discolored and tender. The tenderness is worse on passive inversion of the ankle. There is no bony tenderness on percussion of the malleolus, fibula or tarsal bones. X-ray wasn’t ordered.
Sprain/strain
A 23-year-old army private presents with pain in the middle of his foot that gets worse when walking. On examination, there is tenderness on palpation over the shaft of the 3rd metatarsus. No fracture visible on x-ray of the foot. A technetium-99 bone scan reveals a hot spot on the shaft of the 3rd metatarsus.
March fracture (special name for stress fracture of this area)
