MSK - Foot and Ankle Examination

Question 1

VIVA

What is a foot drop and what are the causes of a foot drop?

Answer 1

Foot drop is the inability to dorsiflex the ankle. It may be caused by:
Damage to the common peroneal nerve
Damage to other nerves (sciatic, lumbosacral plexus, L5 nerve root, Cauda equina)
Peripheral neuropathy
Neuromuscular disease

Question 2

VIVA

You review a patient with an acutely hot swollen and painful first metatarsal phalangeal (MTP) joint. What is your main differential and how would you treat them?

Answer 2

Gout
Treat with NSAIDS, colchicine or corticosteroids
Consider allopurinol as prophylaxis after the acute episode has resolved

Question 3

VIVA

What is plantar fasciitis and how can it be managed?

Answer 3

Conservative treatment
Offer physiotherapy
Advice rest
Advice weight loss
Change shoes regularly
NSAIDs
Night splints
Heel and arch supports

Medical treatment
Corticosteroid injection
Botulinum injection
Radiotherapy for pain relief

Surgical treatment
Fasciotomy if pain continues

Question 4

VIVA

What are the categories of bones in the foot?

Answer 4

Categories of bones:
Tarsal bones: calcaneus, talus, cuboid, navicular, medial and lateral cuneiforms
Metatarsal bones
Phalanges

Question 5

VIVA

What is Simmonds’s test used to diagnose?

Answer 5

Achilles tendon rupture (if no ankle plantar-flexion when squeezing the calf)

Question 6

VIVA

What is Morton’s neuroma?

Answer 6

Morton’s neuroma is a benign neuroma of an intermetatarsal plantar nerve. It usually occurs between the second and third or third and fourth metatarsal heads. Patients often feel as if they are walking with a stone in their shoe.

Question 7

VIVA

What is a Charcot foot?

Answer 7

• Pain-free joint destruction after minor trauma
• Usually occurs in patients with peripheral neuropathy due to diabetes
• In developing countries, tabes dorsalis and leprosy are common causes
• Signs: erythema and swelling in the acute phase only; gross joint deformity; instability
• Managed by educating patient, treating underlying cause, podiatry and joint immobilisation with a cast/boot in the acute phase

Question 8

What are the main three toe deformities?

Answer 8

Question 9

Answer 9

Gout

Question 10

Answer 10

Hallux valgus (bunion)

Question 11

Diabetic foot features

Answer 11

Question 12

Charcot joints

Answer 12

Question 13

Charcot-Marie-Tooth disease?

Answer 13

Question 14

Describe the ankle joints

Answer 14