Ankle

Question 1

What is the name for a bimalleolar fracture?

Answer 1

Pott’s fracture

Question 2

What PMH factors can make you more likely to suffer a fracture?

Answer 2

Osteoporosis, REDS, long-term steroid use, cancer

Question 3

You gather the following key information from a subjective Hx;

• Child
• Very active/sporty
• Complaining of Px after sport around the heal
• Localised px and swelling around the heel.

What do you hypothesise is a possible diagnosis?

Answer 3

Severs Disease - apophysitis of the calcaneus

Question 4

What are the most common sites of OA symptoms in the foot/ankle?

Answer 4

1) 1st MTPJ
2) 2nd Cuneometarsal
3) Talonavicular
4) Navicular-cuniform
5) Talocrural OA post fracture

Question 5

What might you observe around possible site of Foot/ankle OA?

Answer 5

• Mild effusion
• Hallux valgus
• Calluses/blisters over bony changes due to osteophytes

Question 6

What are the common locations for RA in the foot and ankle?

Answer 6

Metatarsal phalangeal joints
Sub-talar
Talocrural
Mid-tarsal

Question 7

What might you observe at the foot/ankle in potential OA patients?

Answer 7

• Swelling and temperature

Question 8

What would you expect to see in a patient with potential achilles tendonitis?

Answer 8

• Pain on passive movement in the opposite direction

Question 9

What are the potential sites for tendonitis in the foot/ankle?

Answer 9

Achilles
Peroneal tendons
Tibialis posterior
Flexor Hallucis Longus (esp common in ballet dancers)

Question 10

What are the risk factors for medial tibial stress syndrome (MTSS)?

Answer 10

High BMI
Athletes who run and jump repeatedly
Training overload
Change of running surface (hard)

Question 11

What are the characteristics of MTSS?

Answer 11

• Achy pain which increases during exercise
• Pain reduces with rest
• Pain located in the lower 2/3 of tibia (Px on palpation of posteromedial border of tibia)

Question 12

What anatomical factors may make someone more susceptible to MTSS?

Answer 12

• Excessive pronation (arch absorbs shock)
• Increased PF
• Increased Hip internal rotation)

Question 13

What are the risk factors for plantar fasciitis?

Answer 13

• Female > Male
• Obesity
• Prolonged standing/walking e.g. hairdresser.

Question 14

What are the pain characteristics of plantar fasciitis?

Answer 14

• Worse in the morning
• Worse when bare foot
• Pain located around heel/mid-foot