Lower limb (3) pathologies Flashcards
Describe the symptoms and signs of compartment syndrome
Symptoms: pain, tenderness, tightness in the muscle
Signs: severe pain in the limb increasing & not relieved by analgesia, pain is exacerbated by passive stretch of the muscles
Surgical decompression should be performed on all affected compartments if compartment syndrome is suspected
Describe the short and long-term consequences if compartment syndrome is not adequately treated
Short-term: increase in intercompartmental pressure, rhabdomyolysis, acute kidney injury, distal paraesthesia (precedes loss of motor function)
Long-term: chronic kidney injury, Volkmann’s ischaemic contracture = permanent painful and disabling contracture of affected muscle groups
Describe ankle fractures
Usually inversion/eversion injuries
Need to assess co-morbidities -> affects fracture-healing time
Fracture blisters are relatively common & surgery needs to be delayed until blisters have healed
Treatment: stable ankle fractures usually treated non-operatively with an aircast boot/fibreglass cast for comfort however unstable ankle fractures need surgical stabilisation
Describe sprained ankle and 5th metatarsal fracture
Ankle sprain = partial/complete tear of one or more ligaments of the ankle joint
Caused by excessive external rotation, inversion or eversion of foot due to external force
Inversion injury most common -> can cause 5th metatarsal fracture because peroneus brevis tendon inserts there and can therefore pull off a fragment of the bone
Describe Achilles tendon rupture
Most commonly occurs in men 30-50 years during recreational sports
Sudden and severe pain at the back of the ankle, sound of a loud pop, palpable gap in the tendon
Thompson’s test (sometimes called Simmond’s test) used to test for a rupture Achilles tendon
Treatment: conservative (foot held in the correct position in a boot), surgery
Describe bunions (hallux valgus)
Distal part of big toe deviated laterally
Most common in middle-aged females & can lead to painful movement and difficulty with footwear
Bunions = bony deformity at the 1st MTPJ
Cause poorly understood & surgery should not be carried out for cosmetic reasons alone
Describe hallux rigidus
Osteoarthritis of the 1st MTPJ resulting in stiffness of the joint
Under tremendous stress during walking
Pain is present on walking and patients tend to compensate by walking on the outside of their foot
Treatment: firstly conservative, then surgery (arthrodesis)
Describe OA of the ankle joint
Nearly all cases of OA of the ankle are secondary arthritis
Treatment: arthrodesis, ankle arthroplasty
Describe Achilles tendinopathy
Degenerative process
Often follows many years of overuse
Symptoms and signs: pain and stiffness in the morning, pain at back of heel that worsens with activity, thickening at the tendon
Treatment: physiotherapy
Describe claw toe / hammer toe
Claw toe = toes are hyperextended at the MTP & flexed at the PIP joint
-result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight
-usually due to neurological damage
Hammer toe = deformity in which the toe is flexed at the PIPJ
-causes by ill-fitting shoes
Describe flat foot
Implies the medial arch of the foot has collapsed so that the medial border of the foot almost touches the ground
Treatment: insoles & physiotherapy
Describe the effect of diabetes mellitus on the the foot, including Charcot arthropathy
Common and serious complication of diabetes -> infection, ulceration or destruction of the tissues of the foot
People with diabetes attend regular foot clinics
Charcot arthropathy = progressive destruction of the bones, joints & soft tissues
Treatment: optimisation of glycaemic control and reduction of the load placed on the affected joints
Describe some common gait abnormalities
Antalgic gait = patients walk in a manner that reduces pain & tend to walk with a limp eg. OA of the hip, walking stick used in the hand opposite to the painful limb
Trendelenburg gait = superior gluteal nerve lesion, pelvis drops on the unaffected side
Hemiplegic gait = due to paralysis of one side of the body eg. result of a stroke, consequence of cerebral palsy
Diplegic gait = spasticity affects both lower limbs eg. in cerebral palsy
High-steppage gait = patients with weakness of ankle dorsiflexion, resulting in foot drop eg. sciatica, common peroneal nerve palsy
Parkinsonian gait = patients with Parkinson’s disease (find it difficult to initiate movement)
Ataxic gait = characterised by clumsy, staggering movements with a broad-base eg. cerebellar disease
