Ankle and foot Flashcards
(37 cards)
Red flag: Rheumatoid arthritis of the foot/ankle
- Metacarpophalangeal mainly affected and can involve proximal interphalangeal joint
- Swelling and stiffness
- Nodules
Red flag: Psoriatic arthritis
- Distal interphalangeal joints affected mainly
- Dactylitis
- Nail bed pitting
- Nail bed separation
Red flag: Achilles tendon rupture
- Audible snap during activity
- Sudden significant pain in calf/ankle
- Inability to continue with activity
- Unable to single leg heel raise
- Simmons triad - altered angle of declination, palpable gap and a positive thompson test
Red flag: Charcot foot
A disease which attacks the bones, joints and soft tissue in your feet
- Neuropathy
- Trauma history
- Hot, swollen foot
- Bounding pedal pulses in early stages
- May develop bone infection and/or inflammation of the joint membrane
Red flag: Navicular AVN
- Midfoot pain over the dorsomedial aspect of the foot
- Stiffness in hindfoot/midfoot
Red flag: Compartment syndrome
5 P’s
- Pain
- Pallor
- Paraesthesia
- Pulselessness
- Paralysis
Red flag: Lower limb DVT
- Throbbing or cramping pain in affected leg
- Usually in calf or thigh
- Swelling
- Swollen veins
- Breathlessness or chest pain
Achilles tendinopathy: Pathophysiology
- Mid portion= non-insertional tendinopathy, approx 2-6cm above insertion. Due to poor vascular supply
- Insertional= tendinopathy of the insertion on the calcaneous
Achilles tendinopathy: Mid-portion risk factors
- Certain drugs- e.g corticosteriods
- Diabetes
- History of injury
- Factors associated with training
- Increased cholesterol
Achilles tendinopathy: Insertional risk factors
- Increasing age
- RA
- New exercise
- Inappropriate footwear
Clinical presentation, signs and symptoms of Achilles tendinopathy
- Pain either at mid portion or insertion on the calcaneous
- Aggr factors: activity or direct pressure
- Occur gradually
- Some people can present with both
- Stiffnes in morning and after prolonged rest
- Mid portion= aching pain
- Insertional= sharp pain in heel
Special tests/objective findings for Achilles tendinopathy
- Antalgic gait
- Haglunds deformity (lump on back of heel)
- Pain reproduced with hopping and heel-raise endurance test
- Most demonstrate full range with pain on active plantar flexion
Management of Achilles Tendinopathy
- Education, symptom management and self management
- Rest initially and gradually increase activity
- Modifications of activities
- PEACE & LOVE approach
- Direct to GP
If no improvement in 7-10 days: - Physio: eccentric exercise or a heavy load, slow-speed exercise programme
Achilles tendon tear/rupture: pathophysiology and risk factors
Most commonly seen within people aged between 37 and 43 year old approx.
The tear or rupture of the achilles tendon caused by overstretching of the heel during recreational sports; a forceful plantar flexion of the heel; or a fall from a height
Risks:
- Increasing age
- Achilles tendinopathy
- Poor vascular supply
- Certain drugs e.g corticosteriod
- Sports
- History of injury
Clinical presentation: signs and symptoms of achilles tendon rupture
- Usually a traumatic onset usually during high velocity movement
- Description of being ‘kicked or shot’ in the back of calf
- Sudden pain in calf with an audible snap or pop
- Weakness is a common symptom described particularly when pushing off with the affected foot
- Inability to weight bear however may be able due to other plantar flexors helping with this movement
Special tests/ objective signs for Achilles rupture
- Palpable gap if not too much swelling
- Foot drop may be apparent in gait
- Active plantarflexion may be completely or partially lost
- Greater degree of dorsiflexion available on passive movement
- Thompsons test usually positive with complete ruptures
- Calf muscle atrophy
Management of Achilles rupture
With suspected rupture refer to A+E
Ankle OA: pathophysiology and risk factors
Is a chronic degenerative joint disease which leads to the breaking down of cartilage and other tissues about a joint
Can affect both talocrural and subtalar joints in the ankle
Risks:
- RA
- Obesity
- Intense physical exercise
- Knee OA
- Age
Clinical presentation, signs and symptomsof ankle OA
- Ankle joint pain
- It most commonly affects one joint but can occur bilaterally
- Aggravating factors: weight bearing particularly walking and prolonged standing
- Ease: usually rest
- Stiffness in the joint first thing but less than 30 minutes in duration
- Crepitus in the ankle joint on movement with clicking and crunching being reported
- More commonly seen in patients with manual labour jobs and in those who spend significant periods standing or walking
Management of ankle OA
- Education, symptom management and self management
- Advise on lifestyle modifications
- Direct to GP
- Physio: manual therapy, mobility, strenghtening
- Consider walking aids and CSI
If persistent: referral for arthroplasty or fusion
Morton’s neuroma: pathophysiology and risk factors
Inflammation or thickening of the nerves between the metatarsal bones
- The thickening of the nerve is usually secondary to pressure or repetitive irritation
Risk factors:
- Female
- Associated with tight or high heeled shoes
- Common in runners
- Foot or hallux deformity
Clinical presentation, signs and symptoms of Morton’s neuroma
- Paraesthesia (tingling, prickling, burning sensation) within the affected digital nerve with pain apparent in the corresponding intermetatarsal space (third more commonly than the second)
- Burning and tingling sensation in the third or second intertarsal space
- Feeling of a ‘stone in their shoe’
- Aggr factors: walking, wearing tight shoes, high heels and running
- Ease factors: resting the foot, removing shoes
Special tests/objective signs for Morton’s neuroma
- Thumb index finger squeeze test- positive sign being referred to as a Mulder’s click
- Observation of any plantar calloses around the second and third metatarsal heads can also predispose to this complaint
Management of Morton’s neuroma
- Patient education
- Rest
- Advise for wider fitting shoe is the first line of management
- Orthotics
- Glucocorticosteroid injection
If ineffective: - Surgery to remove the neuroma
