differential diagnoses of ankle and foot

Question 1

lateral ankle pain

Answer 1

Ankle sprain (atfl most common)

Fibular fracture - compression, avulsion

Peroneal tendinopathy- overuse or strain

osteochondritis dissecans talar dome

Question 2

osteochondritis dissecans talar dome

Answer 2

often with high energy, sprain, or compression

Nutrient to bone and cartilage disrupted

Continued sheer after injury can progress the lesion

Question 3

posterior ankle pain

Answer 3

Achilles tendinopathy

sever’s disease

calcaneal fx

posterior ankle impingement

Question 4

achilles tendinopathy

Answer 4

Pain and inflammation or hypervascular thickening of Achilles tendon

Rupture is a disruption between the gastroc and Achilles insertion along the tendon

Limitation in df mobility

Eccentric program for Gastroc soleus complex

Question 5

calcaneal fx

Answer 5

High energy impact
Stress fracture
Repetitive load or increase in activity level

Question 6

Posterior ankle impingement

Answer 6

Painful plantar flexion

Deep difficult to localize

Activities like dance, or soccer

Question 7

Medial ankle pain

Answer 7

medial tibial stress syndrome

Anterior tib tendinopathy

posterior tib tendinopathy

Exertional compartment syndrome

FHL tendinopathy

Medial ankle sprain

Question 8

Medial tibial stress syndrome

Answer 8

repetitive stress, overuse injury, running marching

Spuring inflammation response along the tibial crest

tenderness, tight, activity worsens it, rest helps

Question 9

anterior/posterior tibialis tendinopathy

Answer 9

Repetitive stress

tib a or p tender to palpation
tib a or p mmt produces symptoms

Question 10

Exertional compartment syndrome

Answer 10

repetitive stress
Commonly misdiagnosed

Worse with exertion better with rest

Five Ps- pain, pressure, pulseless, late pallor and paresthesia

Question 11

flexor hallucis longus tendinopathy

Answer 11

Forceful and repetitive plantarflexion

Creates an overuse of this tendon

Question 12

medial ankle sprain

Answer 12

deltoid ligament sprain, much less common than lateral

valgus force to ankle

Question 13

plantar heel pain

Answer 13

10% of population

Risk factors - lack of df, standing on hard surface

Plantar heel, near calcaneal tubercle, along plantar fascia

First steps after period of nonweightbearing

Pain produced with windlass

Question 14

heel fat pad syndrome

Answer 14

degenerative changes to fat pad

Older age, hard surfaces

Modify activity support cushion the pad

Question 15

Tarsal tunnel syndrome

Answer 15

posterior tibialis or medial/lateral plantar nerve irritation

Causes - trauma, swelling, pes planus

Pain burning medial/plantar surface

Positive- tinels, df/ev test

Question 16

Midfoot pain

Answer 16

cuboid syndrome
Charcot injuries
lisfranc fracture or injury

Question 17

cuboid syndrome

Answer 17

Lateral mid foot pain
Calcaneocuboid joint

symptoms of instability similar to sprain
Lateral movements problem
Push off when loading supinated foot problem

Manage with manipulation or support

Question 18

forefoot pain

Answer 18

hallux valgus limitus and rigidus

mortons neuroma

claw toes

hammer toes

Question 19

hallux valgus limitus

Answer 19

1st MTP painful limite extension
soft tissue involvement

Question 20

hallux valgus rigidus

Answer 20

1st MTP painful limited ext

MTP joint osteoarthritis

Question 21

hallux valgus first ray deformity

Answer 21

medial deviation of first metatarsal head
-Abduction of the first metatarsal and proximal phalanx
-Adduction of first distal phalanx

1/3 of population over 65

Woman four times more frequently than men

Question 22

Morton’s neuroma

Answer 22

pain paresthesia between metatarsal heads

2/3 or 3/4 metatarsal heads common

Decompression separation of metatarsal heads

Question 23

claw toes

Answer 23

MTP extension and interphalangeal joint flexion

Caused by soft tissue limitations, inflammatory arthropathies like RA

Neurological conditions like diabetic neuropathy

Corns on top of PIP joints are common

Question 24

hammer toes

Answer 24

MTP extension
PIP flexion of toes 2-4
DIP extension

Muscle imbalance may adaptively shorten