Ankle/Foot Medical Screen Flashcards
During the Review of Systems and Systems Review, what will can cause pain at the foot?
- Neighboring joints
- Non MSK conditions
With the Medical Screen, what are the systemic conditions we should look out for?
- Peripheral Artery Disease (PAD)
- Peripheral Neuropathy
- Gout
- Compartmental Syndrome (Anterior Compartment Syndrome) - Deep Vein Thrombosis
With the Medical Screen, what fractures should we look out for?
- Fibular Shaft
- Malleolar Fracture (Uni-, Bi-, and Tri-)
- Talus
- Calcaneus
- 5th Metatarsal
Med Screen
With Peripheral Artery Disease, what are the Risk Factors? What can cause this?
This is a slow progressing circulatory disorder
Risk Factors
- Modifiable: CAD, DM, Smoking, Obesity, High cholesterol, Physical inactivity
- Non-Modifiable: Age > 50, Male, Postmenopausal Female, Family Hx of HTN, and High Cholesterol
Causes
- Atherosclerosis, Acute Trauma to Vessels, infection
What are the S/S of Peripheral Artery Disease?
- Asymptomatic
- Intermittent Claudication (Diff Dx: Neurogenic Claudication)
- Trophic Changes
-Hair loss, shiny skin, thick nails - Cool skin temp.
- Weak/absent pulse
- Slow or nonhealing wounds
- Slow capillary refill
What is typically done during the Peripheral Arterial Disease Physical Examination?
Ankle-Brachial Index
- Ankle SBP / Arm SBP
-≤0.90 = PAD (Diagnostic criteria)
Med Screen
What are the Risk Factors for Peripheral Neuropathy?
- Age > 55
- Type 1 and 2 DM
- Chemotherapy
- Long-term Alcohol consumption
- Meds:
-HIV/AIDS
-Fluroquinolones (antibiotic)
With Perihpheral Neuropathy, what can a Sensory Neuropathy increase risk of?
Risk of minor cuts going unnoticed
- Infecion, unhealing ulcers
With Perihpheral Neuropathy, what can a Motor Neuropathy increase risk of?
Risk of muscle imbalances and atrophy
With Perihpheral Neuropathy, what can a Autonomic Neuropathy increase risk of?
Leads to decreased sweating and sebaceous oil production
- Dry, cracked skin
What is typically done during the Peripheral Neuropathy Physical Examination?
Test Sensation
- Light touch or monofilament, pin-prick, vibration with 128Hz tuning fork
-DM - Vibration and monofilament
When to do which tests:
Light Touch = Nerve Irritation
Sharp/Dull = Sensation issues
With Peripheral Neuropathy, what can be done as Interventions?
- Daily feet washing in warm water
-Do no soak feet - Daily inspection for cuts, bruises, blisters, calluses and swelling
-Mirror training as indicated - Regular nail inspection and trimming
- Avoid walking barefoot/socks
- Daily exercises that minimize impact forces
-Bike, swimming - Smoking cessation
Med Screen
What is Gout?
Acute Inflammatory Arthritis
- Accumulation of monosodium urate crystals in synovial fluid
- Affects one joint at a time
- 1st MTP most common
With Gout, what are the S/S?
- Severe joint pain
- Warmth and Redness
- Difficulty weight bearing and walking
- Symptoms resolve within 2 weeks
With Gout, what are the Risk Factors?
- Male
- Age > 40
- High-Purine diet
- Family Hx of gout
- Hx of flare ups
Med Screen
What is Compartment Syndrome?
Compartmental Increase in tissue pressure due to sustained exercise resulting in pain
- Pain associated with affected compartment
With Compartment Syndrome, what are the effects with exercise?
Exercise increases with heavy exercise and ceases when activity is stopped
- Exercise increases interstitial fluid combined with limited expanding fascia
- Increase intramuscular pressure results in capillary collapse, hypoxia and cell death
With Compartment Syndrome, what are the 5 Ps?
- Pain (Disproportionate)
- Paralysis
- Paresthesia
- Pallor
- Pulselessness
With Compartment Syndrome, what happens if the Anterior Compartment is affeected?
Emergent Fasciotomy required
Med Screen
What is Deep Vein Thrombosis? Which DVT is the most life threatening
Blood Clot of the Venous System
- Proximal = Popliteal or Thigh Veins
- Distal = Calf Veins
Proximal DVT is most life threatening
- Pulmonary Embolism
What are the Risk Factors for DVT?
- Age > 60
- Bed Rest
- CHF
- Indwelling Catheters
- Long-distance travel
- Major trauma/surgery
- Obesity
- Smoking
- Hx of stroke
- Pregnant and post-partem
- African Amercian
Also drugs: Contraceptive agents, hormone replacements in post-menopaual women, antidepressants, glucocorticoids steroids
What are the S/S of DVT?
- Acute calf pain and/or tenderness
- Swelling with pitting edema
- Increased skin temp
- (+) Homan’s Sign
- Calf redness/discoloration
- ## Superficial venous distention or cyanosis
What is the Clinical Descision Rule for OP Suspected Proximal DVT?
If ≥ 2, Refer to imaging
