Knee, Ankle, and Foot Pain Flashcards
When obtaining a history for knee pain, it’s important to obtain what?
Mechanism of injury
Characteristics of the pain in the knee
Mechanical symptoms (i.e., popping, locking, instability)
Inspection of swelling, bruising, etc.
Are we born naturally with genu varus or genu valgum?
Between ages 2-4, it switches it what?
What age is does it return to normal adult alignment?
Born with genu varus
Becomes more genu valgum between 2-4
By age 7, we decrease to a slight genu valgum, which is normal
What could cause rickets, blount’s disease (abnormal formation of the proximal tibia), skeletal dysplasia, etc.?
Genu varus (AKA bow-legs)
What is caused by intrauterine molding, Cozen fracture, or obesity, and could present with pain on medial side of foot or knee
Genu valgum
A 23 yo presents to ER w/ R knee pain. After kicking soccer ball, he pivoted his leg to the right and heard a loud pop before feeling severe pain at the knee. You also notice swelling. He tests positive for Lachman’s and the anterior drawer test.
Differential?
ACL injury or tear
What type of ligament injury or tear is thought of as uncommon due to it being the strongest and largest of the knee ligaments, and would cause a positive posterior drawer test and sag sign
PCL injury or tear
A 15 yo presents w/ knee pain that started 2 hours ago. Felt sudden pain just as he was trying to run to second base while his shoe was caught on first base. He has pain and swelling of the knee as well as increase in laxity when compared bilaterally. He tests positive with valgus stress test.
Differential?
MCL injury
Which of the collateral ligament injuries is least common and can be tested for with a varus stress test or dial test.
LCL injury
57 obese female presents w/ pain on right inner aspect of knee after bending down to pick up a cat. She states it feels like her knee will “give way.” On exam, knee is swollen and tender to palpation, you perform a McMurray test and an Apley grind test, both result in a positive.
Differential?
Meniscal injury.
Usually caused by twisting injuries
22 yo F ballroom dancer presents w/ pain on anterior aspect of her knee. She states she has been training nonstop for the last 2 months. Knee appears normal but pain is elicited by palpating the patella and moving it laterally and medially. You have her squat which results in pain, and additionally perform an apprehension test by patellar glide, which also yields a positive result.
Differential?
Patellofemoral pain
What is the most common cause of knee pain in primary care?
Patellofemoral pain
53 yo F morbid obesity w/ PMH of HTN, T2D, sleep apnea presents w/ progressively worsening bilateral knee pain. No obvious swelling noted. Her ROM is maintained, but is painful. She does have crepitus noted w/ flexion and extension of the knee.
Differential?
OA
13 yo M brought in by mom after several weeks of anterior knee pain. Pt is active, and states pain is more severe w/ activity. Mild swelling of anterior knee and pain with ROM.
Differential?
Osgood Schlatters
What are the Ottawa knee rules, and what are they used for.
- Age 55 years or older
- Tenderness @ head of fibula
- Isolated tenderness of patella
- Inability to flex knee to 90°
- Inability to walk four weight-bearing steps immediately after the injury and in the ED
If pt meets any of these rules, you need to order an XR
Ottawa knee rule and Pittsburgh rule are both […]
Sensitive
53 yo F w/ T2D presents w/ complaints of pins and needles on both feet. Pt has had diabetes for 8 years and blood sugars have fluctuated as she has not cut back on her carbs. The physician is concerned the diabetes has affected her feet. What can he do to assess (3 things)?
Pressure sensation using monofilament testing
Vibration sensation using tuning fork
Superficial pain using pinprick
REMEMBER: A complete diabetic foot exam includes pulses, checking for skin lesions (don’t forget to check between the toes)
16 yo F presents to office 1 hour after injuring her right foot while trying to hit a soccer ball. Instead of hitting the soccer ball, her foot rolled inward. Mild swelling and tenderness over lateral ankle. Pt tested positive for anterior drawer test and talar tilt test. What structure is affected, and what is possible differential?
Ankle sprain
16 yo F presents to office 1 hour after injuring her right foot while trying to hit a soccer ball. Instead of hitting the soccer ball, her foot rolled inward. Mild swelling and tenderness over lateral ankle. Pt tested positive for squeeze test. What structure is affected, and what is possible differential?
Syndesmotic ankle injury
36 yo nurse w/o PMH presents w/ pain localized to the left heel, especially when she walks on her kitchen tile barefoot after getting off of a 12 hour shift the night prior. You note she has pain with passive dorsiflexion.
Differential
Plantar fasciitis
41 yo F presents w/ pain in feet. Pain is localized between 3rd and 4th toes. She usually is wearing heels. You test positive for Mulder’s sign (clicking sensation when palpating the 3rd intermetatarsal space).
Differential?
Morton’s neuroma
72 yo male w/ PMH of HTN, DM, gout, sleep apnea presents with pain and swelling of great toe. He states it started 2 days ago w/ mild tenderness, but has slowly increased in pain. He states now a blanket grazing his toe is extremely painful. You palpate and it is warm to touch and erythematous.
Differential?
Gout
