Ankle Pain

Question 1

ACHILLES TENDINOPATHY

• when is pain worst?
• where does pain occur?
• morning stiffness?
• Mx?

Answer 1

gradual onset of posterior heel pain that is worse following activity

gradual onset of posterior heel pain

morning pain and stiffness are common

The management is typically supportive including simple analgesia and reduction in precipitating activities.

Question 2

RF for tendon disorders?

Answer 2

• quinolone use (ciprofloxacin)

- hypercholesterolaemia (predisposes to tendon xanthomata)

Question 3

ACHILLES TENDON RUPTURE

• should be suspected if the person describes the following whilst playing a sport or running?
• features of pain?
• findings on examination?
• test for achilles tendon rupture?

Answer 3

• an audible ‘pop’ in the ankle
• sudden onset significant pain in the calf or ankle or the inability to walk or continue the sport.

Achilles tendon rupture may lead to greater dorsiflexion of the injured foot compared to the uninjured limb

+ve simmonds sign

Question 4

most common cause of heel pain seen in adults?

Answer 4

Plantar fasciitis

Question 5

PLANTAR FASCIITIS

• where is pain worst?
• Mx?

Answer 5

The pain is usually worse around the medial calcaneal tuberosity

Management
rest the feet where possible
wear shoes with good arch support and cushioned heels
insoles and heel pads may be helpful

Question 6

MORTON’S NEUROMA

• a benign neuroma affecting which nerve?
• where does forefoot pain most commonly occur?
• what do patients say it feels like?
• loss of sensation where?
• Dx?
• Conservative Mx?
• if symptoms persist >3months despite the above measures?

Answer 6

• intermetatarsal plantar nerve,
• most commonly in the third inter-metatarsophalangeal space
• Patients may feel they have a pebble in their shoe
• there may be loss of sensation distally in the toes
• usually clinical although ultrasound may be helpful
• avoid high-heels
• metatarsal pad
• may give the patient a metatarsal dome orthotic

Question 7

BUNIONS

• What kind of deformity is it?
• cause?

Tx:

• conservative
• device to straighten toe?
• when is an operation advised?

Answer 7

hallux valgus is a deformity of the base joint of the big toe

hallux - big toe
valgus - angled outwards

Cause

• associated with genetic
• associated with OA and RA
• wearing tightly fitted shoes and heels makes it worse

Wearing good footwear does not cure the deformity but may ease symptoms of pain and discomfort

Devices which help to straighten the toe (orthoses) may be recommended.

An operation may be advised if a change of footwear does not ease symptoms.