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Pocket Primary Care > Foot & Ankle Disorders > Flashcards

Foot & Ankle Disorders Flashcards

1
Q

History

A

Inciting injuries, specific location of pain, functional impairment, chronicity of sx, exacerbating conditions; medical hx including DM, arthropathies, vascular disease, neuropathy

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2
Q

Exam

A

Asses gait, ability to toe rise; look at ankle alignment from behind; assess hindfoot alignment and arch (cavus vs neutral vs planus); visually inspect pedal skin and nails for soft tissue breakdown or asymmetry in color, temp, texture; palpate foot for areas of tenderness, masses or swelling; assess active ROM, including tibialis anterior (ankle dorsiflexion), gastrocsoleus (plantarflexion), inversion w/the foot plantar-flexed (posterior tibialis), eversion w/the foot dorsiflexed (peroneal); gentle passive ROM of ankle (tibiotalar joints), subtalar joint, transverse tarsal joint, Lisfranc joint (plantarflexion of 1st metatarsal and adduction), & MTP joints; palpate pulses (dorsalis pedis and posterior tibial) and capillary refill; test reflexes and sensation to light tought and pinprick.

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3
Q

Imaging

A

Radiograph of ankle should include AP, lateral, mortise; Radiograph of feet should include AP, lateral, oblique, and wt bearing views (default unless assessing for fracture or pt unable to bear weight); stress fracture may take 2-6 weeks to be apparent on radiographs; MRI more sensitive.

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4
Q

Ottawa rules: Ankle radiograph for ankle injury if:

A

Pain near malleoli + either (1) inability to bear wt (4 steps) immediately after injury & at eval or (2) bone tenderness at posterior edge/tip of either malleolus

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5
Q

Ottowa rules: Foot radiograph for foot injury if:

A

Pain at midfoot + either (1) inability to bear wt (4 steps) immediately after injury and at eval or (2) bone tenderness at navicular bone or base of 5th metatarsal (se nearly 100%, sp 30-50%)

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6
Q

Atraumatic Foot Pain

A 
Calcaneal bursitis
Hallux rigidus
Morton neuroma
Plantar fasciitis
Cysts/Ganglions
Bunions
Pes Planus
Plantar fibromatosis
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7
Q

Calcaneal bursitis

A

Infra- of retrocalcaneal pain in SC or subtendinous bursa;

Dx: tenderness and swelling, pain w/supracalcaneal squeeze

DDx: achilles tendinopathy

Tx: time, NSAIDs, ice

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8
Q

Hallux Rigidus

A

OA of the 1st MTP joint

Dx: Sx include decrease motion, crepitation, tenderness, readiographs

Tx: Nonspecific; stiff sole or rocker sole shoe

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9
Q

Morton (interdigital) neuroma

A

Irritation of digital nerve usually in 3rd or 4th web space; burning pain in webspace +/- numbness of digits

Dx: Reproduction of sx w/pressure in the web space; mulder click-palpable click between metatarsal heads elicited by compressing forefoot

Ddx: stress x

Tx: podiatry referral for orthotics and steroid injection in refractory cases

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10
Q

Plantar Fasciitis

A

Medial/plantar heel/arch pain increases in AM and w/standing after prolonged siting, appears to be self-limiting enthesopathy

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11
Q

Plantar Fasciitis

Risk Factors

A

Pts often middle-aged; specific risk factors include female gender, obesity, tight gastrocnemius, and prolonged wt bearing at work

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12
Q

Plantar Fasciitis

Dx

A

Tenderness of plantar fascia originates from calcaneus

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13
Q

Plantar Fasciitis

Ddx

A

Tibial nerve compression (tinel sign behind medial malleolus), bursitis at Achilles insertion, calcaneal stress fracture(squeeze test), heel pad pain (pain more posteriorly at center of heel pad), posterior tibial tendinitis (palpate tendon behind medial malleolus)

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14
Q

Plantar Fasciitis

Tx

A

NSAIDs, ice, heel cord stretching and plantar fascia stretches, silicone gel heel cups; steroid injection in refractory cases may be considered; wt loss.

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15
Q

Cysts/Ganglions

A

Pain w weight bearing, friction,

Dx: clinical, U/S, MRI

Tx: surgery for off-loading, aspiration, excision if painful.

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16
Q

Bunions

A

1st MTP joint w/medial prominence; pain onset gradual, progressive, increases w/ROM, weight bearing, shoe pressur; a/w RA, OA, DM, neuropathy, increase age, FHx, footwear, running

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17
Q

Bunions

Tx

A

Footwear modification, bunion shield, surgical correction only for refractory pain or deformity severe enough to prevent nl shoewear (ie not for cosmesis); APAP for pain relief

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18
Q

Pes planus (flat foot) or Pes cavus (high arch)

dx

A

Clinical, plain fimls; varied adult presentations; cavus often assoc w/neuromuscular disease; planus assoc w/medial ankle pain -> suspect adult-acquired flat foot 2/2 posterior tibialis pathology

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19
Q

Pes planus (flat foot) or Pes cavus (high arch)

Tx

A

Off-the-shelf orthotic w/medial arch support; otherwise referral for footwear modification, orthoses, bracing, surgical correction

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20
Q

Plantar fibromatosis

A

Foot manifestation of Dupuytren disease; genetic (autosomal dominant; British Isles and Scandinavia); firm, palpable SC plantar nodules, continuous w/plantar fascia; pts often p/w pain, but lesions not typically painful; most pts do not binrg this problem to the attendion of a dr

Tx: nonspecific and palliative

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21
Q

Skin and nail disorders

A 
Hyperkeratotic
Verruca
Blisters
Tinea pedis (Athlete's foot)
Xerosis cutis
Ingrown nail
Onychodystrophy
Onychomycosis
Paronychia
Nail contusion
22
Q

Hyperkeratotic

A

Pressure induced (corns) vs shear induced (calluses); assoc w/neuropathy, deformity, activity, middle to advanced age

23
Q

Hyperkeratotic

Ddx

A

Verruca plantaris, dermatofibroma, hypertrophic scar, prokeratosis

24
Q

Hyperkeratotic

Tx

A

Topical keratolytics (lactic acid 12% lotion, urea 20-40% cream, footwear modification)

25
Q

Verruca

A

Virally-induced (HPV) hyperkeratotic lesions w/punctate bleeding, disrupted skin lines, pain w/compression: increase in youth, immunosuppressed, skin trauma, gym/pool use

26
Q

Verruca

Tx

A

topical acids/vesicants

27
Q

Blisters

A

Serous/blood filled vesicles/bullae; increase w/friction, shear, deformity, activity, tight shoes, hyperhidrosis, neuropathy

28
Q

Blisters

Tx

A

Neoprene insoles, acrylic socks, off-loading, aspiration (do not deroof); if derooted, hydrocolloid dressing.

29
Q

Tinea pedis (athlete’s foot)

A

Rubor, scaling, desiccated vesicles, moccasin distribution, maceration fissuring, pustules, malodor

Dx: +KOH

Ddx: Eczema, xerosis, dermatitis

Tx: topical antifungal

30
Q

Xerosis Cutis

A

Skin dry, rough, pruritic, fissuring; increase with age, DM, autonomic dysregulation

Tx: topical emollients, barrier creams; discourage prolonged frequent or hot foot soaks

31
Q

Ingrown Nail (onychocryptosis)

A

Nail plate encroaching uon nail fold w/pain, welling, bleeding/drainage, hypertrophy of nail fold +/- paronychia; assoc with/HAV, tight footwear, improper trimming

Tx: foot soaks, wide shoe, podiatry referral

32
Q

Onychodystrophy

A

Change in nail plate morphology +/- pain; increase w/age, DM, runners

Hutchinson sing: Brown/black pigmentation of nail assoc w/melanoma

33
Q

Onychomycosis

A

Fungal nail infection; onychodystrophy + nail erosion; increase w/DM, immunocompromised, incrase age, nail, salon use, trauma, tinea pedis

Dx: +KOH, +PAS

Tx: podiatrly referral, antifungal tincture (ciclopirox), PO terbinafine (check LFTS)

34
Q

Paronychia

A

Nail fold infection a/w onychocryptosis; erythema, warmth, edema, purulent d/c, pain

Tx: Saline soaks, BID, topical antiseptic, consider oral abx, prompt podiatry referral

35
Q

Nail contusion

A

Subungual hematoma/seroma s/p stubbing or crush injury; if pain in toe, obtain plain film

DDx: glomus tumor (benign subungual vascular lesion)

Tx: If no fracture, podiatry referral; if fracture + nail bed laceration, podiatry/ortho referral.

36
Q

Foot and Ankle Trauma

A

Achilles tendon rupture
Fractures
Lisfranc dislocation
Plantar plate injury (turf toe)

37
Q

Achilles Tendon rupture

A

Popping and sudden onset of pain -> instability

Dx: Ecchymosis and palpable deficit posterior ankle, Thompson test + (no plantarflexion of foot w/calf squeeze), MRI, U/S.

Tx: Referall to ortho, in the interim splint in 20degrees of plantar flexion (not neutral); brief cast immobilization followed by achilles rehab protocols; surgery

38
Q

Fractures

A

high index of suspicion if pain onset acute, pt w/DM, increase age, osteopenia, neuropathy, hx Fx, smoking, +/- trauma

Dx: Tenderness, edema, ecchymosis, pain, plain films (if negative, presume stress Fx)

39
Q

Metatarsal fx

A

5th metatarsal tuberosity avulsion Fx occur w/inversion of foot/ankle while in plantar flexion or inversion -> pt may report sprained ankle; acute and stress diaphyseal Fx also occur, w/stress Fx frequently only visible on radiography once healing creates bony callus; Ortho referral for 1st metatarsa, multiple, displaced, stress Fx of proximal diaphysis of 5th metatarsal, or intraarticular Fx; O/w, splint, progressive wt bearing (often in hardsole shoe), ide, elevation

40
Q

Sesamoid fx

A

Pain under 1st MTP joint

41
Q

Calcaneus fx

A

Pain s/p fall/jump; pain w/lateral squeeze, Mondor sign (ecchymosis extending to sole); stress Fx may present like plantar fasciitis, however unlike plantar fasciitis, tenderness on sides of calcaneus present

42
Q

toes Fx

A

Ortho/podiatry referral for great toe Fx, circulatory compromise, displaced intraarticular or irreducicle Fx

43
Q

Fx Tx

A

Cast or boot, buddy toe taping X 4-6 weeks for lesser toe fractures; if intra-articular, comminuted, displaced >3mm, urgent podiatry/ortho referral

44
Q

Lisfranc dislocation

A

High energy insult -> damage to Lisfranc ligaments (maintain relationship between forefoot and midfoot) -> midfoot pain/swelling; must have high index of suspicion and cannot r/o unless have wt-bearing radiographs (may only displace w/wt bearing0: if pt unable to wt bear, repeat radiographs in 2 wks when pt able to wt bear

45
Q

Lisfranc dislocation

Dx

A

Midfoot diastasis, 2nd metatarsal step off, fleck sign (bony fragment at base of 2nd metatarsal), +/s metatarsal fx on plain films, CT, MRI

46
Q

Lisfranc dislocation

Tx

A

Jones dressing, posterior splint, emergent orthopedic eval

47
Q

Plantar plate injury

A

Turf Toe

Dorsiflexion injury causing attenuation of 1st MTP joint plantar plate w/pain, swelling, ecchymosis

Ddx: gout, sesamoid injury, cellulitis

Dx: clinical, arthrogram

Tx: cast or boot, podiatry/orthopedic referral

48
Q

Ankle Pain

A

Achilles tendonitis
Ankle sprain
Ankle fracture

49
Q

Ankle tendonitis

A

Pain w/exercise, relieved by rest, morning stiffness; pain w/passive rotation of ankle; MRI may aid dx

Tx: Rest, ice, APAP, orthotics, PT

50
Q

Ankle Sprain

A

Limited wt bearing, early mobilization, range of motion exercises, ice, compression (ace wrap), elevation, NSAIDs

51
Q

Ankle fracture

A

Fx that are stable and can be managed nonoperatively w/splinting, ice, elevation, analgesics include completely nondisplaced fractures where the talus remains perfectly seated within the ankle mortise

Pocket Primary Care (18 decks)

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