Common Problems of the Foot & Ankle

Question 1

What are the signs of arthritis on an x-ray?

Answer 1

SONS = subchondral cysts, osteophytes (extra bone), narrowing: missing gap which represent cartilage, subchondral sclerosis (hardened bone)

Question 2

Discuss an Achilles tendon rupture

Answer 2

Hypovascular area = prone to weakness/rupture. Rupture typically 30-50yr old men. Examine by = loss of definition, Thompson test: squeeze posterior calf, should have continuity = plantarflexion.

Question 3

What is claw toe?

Answer 3

Toe that is contracted at the PIP and DIP joints = severe pressure and pain. Ligaments/tendons have tightened causing toe’s joints to curl downwards. Claw toes may occur in any toe, except the big toe.

Question 4

How does flat foot occur?

Answer 4

Tallus collapse – medial arch drops = loss of medial longitudinal arch. Heel begins to tip towards valgus. Tends to be post-menopausal women.

Question 5

What anatomy is effected with a sprained ankle?

Answer 5

Partial/complete tears in ankle ligaments = plantarflexed weight-bearing foot, excessively inverted = lateral ligament more likely damaged = weaker than medial ligament + lateral ligament resists inversion

Question 6

How would you identify an ankle fracture?

Answer 6

Tenderness on palpation, inability to bear weight = order x-ray. Can be open. Bone pushing against tissue, can become ishaemic = necrosis. Stable = 1 break. Unstable = 2 breaks. Talar shift?

Question 7

What is a bunion?

Answer 7

Hallux (toe) Valgus = deviation of distal limb away from midline. Varus = deviation of distal limb towards midline

Question 8

Discuss osteoarthritis of the foot and ankle

Answer 8

Big toe arthritis = hallux rigidus. Loss of joint space, osteocytes, cysts, subchondral sclerosis. Gold standard treatment = fusion of ankle joint or ankle joint replacement

Question 9

How can diabetes mellitus affect the foot?

Answer 9

Desensitisation of foot, immunocompromised and vasculature problems = can lead to leg amputation. Proprioception = losing the sensation = bashing joint to pieces. Pt profile = obese, cognitive problems, immunocompromised, self-neglect. Charcots foot (progressive degeneration), Rocker bottom foot (prominent calcaneus, convex rounded bottom to the foot)

Question 10

How can a base of 5th metatarsal fracture occur?

Answer 10

Caused by excessive inversion = fibularis brevis avulses a fragment of bone

Question 11

What is talar shift?

Answer 11

talus is not anatomically placed underneath tibia.

medial malleolus is fractured or the deltoid ligament is ruptured = lateralisation of the under the tibia.