The Ankle And Foot

Question 1

Achilles tendinitis clinical features

Answer 1

Overuse
Pain
Swelling
Warmth
Worse with activity

Question 2

Achilles tendinitis specific tests

Answer 2

Tendon thickening

Pain through full rom

Question 3

Achilles tendinitis investigations

Answer 3

X Ray

MRI

Question 4

Achilles tendinitis management

Answer 4

Conservative

• activity modification
• shoe wear modification-> heel lifts, heels sleaves
• eccentric physio
• NSAIDs

Surgery

• per cutaneous tenotomy
• excision of degeneration
• tendon transfer
• calcaneal resection

Question 5

Achilles enthesopathy clinical features

Answer 5

Insertion inflammation 
Post heel pain and swelling
Bony enlargement of calcaneous 
Tender over insertion
Shoe pain
Degenerative

Question 6

Plantar fasciitis clinical features

Answer 6

Inflammation at the origin on calcaneous 
Sharp heel pain
Incidious onset
Worse in mornings and end of day
Walk on toes
Commonly bilateral

Question 7

Plantar fasciitis specific tests

Answer 7

Origin tenderness

Worse on dorsiflexion

Question 8

Plantar fasciitis investigations

Answer 8

MRI -> only to plan surgery

Bone scan -> inflammation or stress #

Question 9

Plantar fasciitis management

Answer 9

Conservative

• NSAIDs
• splinting and arthrosis
• stretching
• shock wave therapy

Surgery
-release

Question 10

Subcalcaneal bursitis clinical features

Answer 10

Inflammation of the bursa between the anterior aspect of the Achilles and posterior calcaneous
Localised pain anterior to the Achilles
Fullness/fluctuats medial and lateral to the tendon
Pain on dorsiflexion
Bony prominence at insertion

Question 11

Subcalcaneal bursitis investigations

Answer 11

X Ray-> Hagland deformity

Question 12

Subcalcaneal bursitis management

Answer 12

Conservative

• activity modification
• shoe wear modification-> padding
• physio
• NSAIDS

Surgery
-bursa excision and resection of haglands

Question 13

Ankle sprain clinical features

Answer 13

ATFL most commonly involved
#-> 5th metatarsal base, anterior process of calcaneous, lateral/posterior process of talus 
Plantar flexion and inversion -> ATFL
Dorsiflexion and inversion-> CFL
Pain with wt bearing
Recurrent instability 
Swelling and bruising
Localised tenderness

Question 14

Ankle sprain specific tests

Answer 14

Anterior draw tests

• plantar flexion-> ATFL
• dorsiflexion-> CFL

Question 15

Ankle sprain investigations

Answer 15

X Ray if:

• inability to wt bear
• medial/lateral malleolus
• SMT tenderness
• navicular tenderness

Question 16

Ankle sprain management

Answer 16

Conservative

• RICE
• tubigrip
• physio

Surgery

• persistent instability
• avulsion #

Question 17

Ankle dislocation clinical features

Answer 17

Most commonly posterior 
High energy plantar flexion and in/eversion 
Pain 
Swelling
Deformity 
Joint line and ligament tenderness

Question 18

Ankle dislocation investigate

Answer 18

Conservative

• analgesia
• splinting
• reduction

Surgery

• # fixation
• lig repair

Question 19

Martons metarsalgia clinical features

Answer 19

Compressive neuropathy of the interdigital nerve 
Middle aged females
Most commonly between the second and third toes
Pain
-wt bearing
-narrow shoes
-relief by massage
Parasthesia- plantar web space

Question 20

Martons metarsalgia specific tests

Answer 20

Web space compression test

Mulders click-> burial click on metatarsal squeeze

Question 21

Martons metarsalgia investigations

Answer 21

USS-> neuroma

Pain relief on digital nerve block

Question 22

Martons metarsalgia management

Answer 22

Conservative

• wide shoe box with metatarsal pad
• corticosteroid

Surgery
-neurectomy