Painful Foot And Ankle Flashcards
Common cause of foot pain
Acute or cheonic foot strain Sprained ankle O/A esp grt. Toe Planter fasciitis Achilles tendon Wart/ corn Ingrowing toe nail/ paronychia
Serious diorders not to be missed for foot pain
Vascular insufficiency Neoplasia-osteoma,osteosarcoma Infection- osteomyelitis, sep. arthritis, actinomycosis RA Peripheral neuropathy Regional pain syndrome Ruptured achilles Ruptured tibialis post. Tendon
Pitfall foot pain
FB Gout Nerve entrapment-morton metatarsalgia,tarsal tunnel syndrome, deep peroneal nerve Chilbains Stress fracture Erythema nodosum Spondyloarthropathy Osteochondritis- kohler( navicular) Freiberg ( metatarsal head), calcaneum( severs) Glomus tumour Pagets disease.
Regional pain syndrome
Reflex sympathetic dystrophy Sudecks dystrophy Neurovascular d/o causing osteoporosis and hyperaemia Cause: Trauma Prolong immobilisation
S/s Middle age Pain at night Sudden onset Swelling and stiff joint Disability of foot Xray patchy decalcification of bone diagnostic
Treatment Reassurance Self limiting last. For 2 years Pain relief Physio encourage mobility
Osteoid osteoma
Benign tumour
Child adolescent
Occurs in tibia , femur or any bone except skull
Pain at night relief by aspirin classic sign
X ray sclerotic bone with central translucency
Surgical removal
Osteochondritis
/ aseptic necrosis
Severs disorder Calcaneum apophysitis - pain in the back of the heal at the insertion of acilles tendon Cild 7-10 year mostly boys Xray diagnostic Avoid flat shoes , slight heal preferred Avoid sport activity for 12 weeks Review
Freibergs disorder
Metararsal head affected 2nd rarely the 3rd
Girls 12-16years and young adult
Pain on palp over the metatarsal head
X ray collapse metatarsal head
Treatment
ProtectivePadding and restriction of activity.
Kohler disorder ( navicular bone) Painful limp Tender over navicular area Boys 3-6 years Improves completely with resting Sometimes supportive strapping required.
Clinical features pf sprained lateral ligaments of the ankle
Ankle Gives way
Limited weight bearing
Pain mild to moderate
Bruising 12-24hr) indicating severe injury
Functional instability ( ankle gives way on uneven ground)
Tarsal tunnel syndrome
Entrapment os post. Tibial N. Under the flexer retinaculum on the medial side of ankle.
Cause
RA
Tenosynovitis os tendons
Fracture
Dislocation
Burning pain toes sole and heel
Retrograde radiation to calf sometimes to the buttocks
Discomfort in bed and worse after standing.
Diagnosed by nerve conduction study.
Treat
- orthotics
- corticosteroid injection
- decompession surgery.
Peroneal N entrapment
Entrapped at the neck of fibula or
2.5cm below neck fibula after division
Cause is usually injury
S/s
Pain in lateral shin dorsum of foot
Sensory symptoms in same area
Weakness of eversion dorsiflexion of foot
D/d L5 nerve root symptoms
Treatment
Shoe wedging or orthotics to maintain eversion
Neurolysis is the most effective treatment.
Meralgia paresthetica
Commonest L.L entrapment Lat. femoral cut. N of thigh entrapped under lateral end of inguinal ligament. It is sensory N from L2,3. Occurs in middle age, mainly due to thickening of the fibrous tunnel Cause Pregnancy Obesity Ascites Belts Trusses/ corsets
S/s Burning pain lateral thigh does not cross midline of the thigh. D/D L2,3nerve root pain (L2 causes buttock pain also) Femoral neuropathy( pain extends to the medial of thigh) Treat Corticosteroid injection Surgical release( neurolysis)
