Ch 48 Foot and Ankle

Question 1

Common diagnosis:

1. Hindfoot pain
2. Midfoot pain
3. Forefoot pain

Answer 1

1. Fat pad, Plantar Fascitis, S1
2. Navicular stress fracture, tendenopathies
3. Metatarsal fracture, flex/extense tendenopathies.

Question 2

Risk factors for plantar fasciitis

Answer 2

1. Obesity
2. Limited dorsiflexion
3. Age

Question 3

Acquired flat foot ?

Answer 3

Posterior tibial tendon insufficiency in adult 40yo:

1. Pain medial malleolus
2. Difficulty walking
3. External rotated, pronated abducted foot.

“Too many toes”

Question 4

Tarsal Tunnel Syndrom and Tx

Answer 4

Entrapment of tibial nerve under flexor retinaculum.

R/O R.A, SLE, DM, Gout, Hypothyroid

Causes: tenosynovitis

Clinically: pain, tingling, burning, +ve Tinel’s sign

Tx: NSAID, Injection, Surgical release

Question 5

How to diagnose metatarsal stress fracture

Answer 5

Xray: normal 4-6 weeks
Bone scan: 20-40%
MRI: False positive in athletes

Question 6

Jones Fracture

Answer 6

“Little toes fracture”

metaphyseal-diaphyseal on the fifth metatarsal
1.5cm distal to the tubersotiy of fifth metatarsal

Tx: Cast 6-8 weeks > ambulation

Question 7

Patient c/o pain in 3rd toes space.

Most common Dx?

1st Line of Tx?

Answer 7

Interdigital neuroma “Morton neuroma”

Enlargement of fibrotic layers of planter digit nerve due to shear force of metatarsal head or tightness from inter metatarsal ligament.

Tx: wide footwear, pad, steroid, surgery

Question 8

Best management for achilis tendonitis?

Answer 8

Eccentric calf exercises

1. strengthen and hypertrophy of gastrocnemius
2. increase tendon tensile strength

Question 9

Common ligaments injuries in ankle sprain?
Clinical Tests?
Management

Answer 9

1. ATFL > anterior drawer test
2. PTFL
3. CFL > talar tilt

P.O.L.I.C.E.

Acute: RICE + NSAID + Protect 4 weeks for Grade lll

Chronic: Optimal loading exercises + coordination + proprioceptive.

Question 10

Diabetic foot neuropathy
A) Theories?
B) Ulcer grading?
C) Management?
D) Reduce pain?

Answer 10

A) Theories
German > neurotrumatic & French > neurovascular

B) Grading:
G1 superfecial
G2 deep ulcer
G3 deep ulcer with abscess or osteomyelitis 
G4 gangrene of forefoot
G5 gangrene of entire foot

C) Management:

1. Adequate perfusion
2. Debridement
3. ABx
4. Offloading pressure areas

D) Reduce plantar pain:
Achilies lengthening