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CCEB Part B > Foot > Flashcards

Foot Flashcards

1
Q
  • Very common (1/10), F(2:1), peak (30-50)
  • MOI: Overuse, direct trauma
  • Point tenderness ANT/MED calc
  • Pain first step in morning (or period NWB)
  • Limited and painful DORSIFLEXION
  • +/- walk on tiptoes
A

Plantar Fasciitis

Test:
Calc Squeeze test, Windlass Test

Management: PRICE, STRETCH

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2
Q
  • 10-30 (any age)
  • Sport injury
  • Mild pain with extreme end ROM, no bruising
  • Reoccurrence rate is 50%
  • TENDERNESS + SWELLING OVER OUTER ANKLE
  • No bruising, (-) stress test, no instability
A

Inversion Ankle Sprain (grade 1)
Test
Anterior Drawer, Talor Tilt (INVERSION)

Management
Ottawa rules >
week 1: PFROM
week 2: ROM rocker board (flex/ext)
week 3: ROM wobble board (ever/inv)
week 4: sports specific (as tollerated)

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3
Q
  • 10 - 30, Rare
  • Associated w/ fracture (MM or other ankle bones)
  • Reoccurrence rate is 50%
  • TENDERNESS + SWELLING OVER INNER ANKLE
  • Retinaculum involvement (decreased proprioception)
A

Eversion Ankle Sprain
* associated with fracture + dec proprioception

Test:
Anterior Drawer, Talor Tilt (EVERSION)

Management
same as previous

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4
Q
  • Dull, achy medial foot pain
  • MOI: Eversion, Abduction, dorsiflexion
  • Runners
  • Worn out medial part of shoes
  • Hellbing’s sign (achilles tendon)
  • Management?
A

Overpronation syndrome

Management:
medial arch supports > motion control shoes >

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5
Q
  • Normal and asymptomatic < 10 y.o.
  • May be associated with pain inner heel
  • Associated with Ehlers Danslow, Marfans, Charcot joint
  • Typically due to failure of one of:
    Tib posterior, Spring ligament, Deltoid ligament, Plantar aponeurosis, FHL + FHB
A

Pes Planus

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6
Q
  • Middle aged, M (5:1)
  • Posterior heel pain (2-6 cm above calcaneus) and
    along the LATERAL MARGINS (not posterior - think bursitis)
  • Pain with (P) dorsiflexion, (R) plantar flexion
  • +/- swelling or bruising
A

Test:
Tender palpation, Achilles Squeeze, Thompson Test

Management:
PFROM (asap) > Calf stretch + strengthen

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7
Q

DDX posterior ankle TENDERNESS:
(1) Achilles insertion (anterior)?
(2) Medial malleolus (post + inf)
(3) Point tenderness DIRECTLY over Tibia
(4) Other considerations/likely ddx:

A

(1) Retro-calcaneal bursitis
(2) Tibialis Posterior tendonitis
(3) Stress fracture
(4):
Tennis ankle (med gastrocnemius tear)
Sever’s disease
Syndesmotic ankle sprain
Reiters inflammatory arthropathy

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8
Q
  • F, 18-50
  • Pain anterior or posterior/medial leg (bottom 2/3rds)
  • Pain at start of run > subsides > returns post run
  • (-) direct palpation, (+) rest
  • PAIN TENDS TO SUBSIDE WITHIN 2-3 DAYS
  • +/- Swelling (RARE)
  • Aggravation dorsiflexion/ plantarflexion
A

Shin Splints

DDX:
- Chronic exertional compartment syndrome
(extreme feeling of firmness in anterior compartment)
- Tibial stress fracture (PAIN LASTS 2-3 WEEKS)

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9
Q

Compartment Syndrome
(1) 6 P’s?
(2) big clue to differentiate acute vs chronic/exertional
(3) DDX - pain post/med tibia + selling
(4)

A

(1) Pain, Paresis, Paralysis, Pallor, Paresthesia, Pulseless
(2) acute - not relieved with rest while chronic is
(3) Tibial stress fracture

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10
Q
  • MOI: Trauma (acute) or Exercise induced (chronic)
  • “A runner who is experiencing gradual onset of burning leg pain and numbness on dorsum of foot ~ 15 min into run which resolves after 30 min of rest”
  • FEELING OF FULLNESS IN LEG
A

Compartment Syndrome

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11
Q
  • Pain in the big toe + swelling + tender
  • TIGHT ACHILLES
  • Progressive Pes Planus
  • Decreased big toe Abd (AROM) + tight FHB
  • Management/imaging?
A

Hallux Valgus

Test: Radiograph: HV angle >15

Management:
Educate/prevent > footwear/orthosis > stretch achilles > strengthen Halux Abd, Add, Flex

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12
Q
  • Gradual onset of diffuse forefoot pain
  • (-) activity (+) rest
  • Flat foot, callus formation ball of foot
  • Toe (A) extension is decreased + (R) flexion is weak
  • POINT TENDERNESS OVER DISTAL MT/FAT PAD
  • Management?
A

Metatarsalgia
Test: Morton’s Squeeze Test (rule out)
DDX:
- Pain interdigital - Mortans neuroma
- Pain midshaft with direct palpation - Stress fracture

Management
Education > PRICE > MT pad > orthotic (planus/cavus) > Surgery > Rehab (swim)

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13
Q
  • Gradual onset of pain on plantar surface of forefoot
    (2nd or 3rd MT interspace)
  • “WALKING ON MARBLES”
  • Gradual progression of sharp pain > numbness
  • (-) walking, (+) rest
  • TOE EXTENSION MAY AGGRAVATE SYMPTOMS
A

Morton’s Neuroma

Test: Morton’s Squeeze Test

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14
Q
  • Foot pain (-) walking, running, squatting
  • Loss of ROM at 1st MTP (sagital plane)
  • Red/swell, plantar callus, enlarged joint
  • +/- burning/paresthesia
  • Assoc. w/: ANTALGIC GAIT (hip hike + circumduction)
  • Management/Imaging?
A

Hallux Rigidus
Hallux valgus –> hallux limitus > Hallux Rigidus

Test: ROM + Xray
Management:
PRICE > proper shoe/ortho > Mop > stretch + strengthen

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15
Q

Compartment Syndrome Presentation
- Anterior
- Lateral
- Deep Posterior

A

(A): Deep peroneal:
sensation first 2 toes + weak DORSI FLEXION
(L): Superficial peroneal:
ant/lat shin, dorsum + weak EVERSION
(DP): Tibial
sensation foot arch + weak PLANTAR FLEXION, TOE MOVEMENT
* pulse dorsal pedal and tibial should NOT be effected, if so MEDICAL EMERGENCY

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16
Q
  • W
  • paresthesia into medial, lateral or both forefoot
  • +/- weakness in foot abductors + flexors, atrophy
  • TENDERNESS BEHIND MEDIAL MALLEOLUS
  • aggravated w/ (P) eversion, dorsiflexion
A

Tarsal Tunnel Syndrome

Test: Tinnel, EMG

Management:
PRICE > Taping > stretch (calf) > floss > Manual > Surgery

17
Q
  • Deep, bruise-like pain in the middle heel
  • (-) walking, standing, direct firm palpation of MID HEEL
  • Unilateral
  • DDX?
  • Management/imaging?
A

Heel Fat Pad Syndrome

DDX: PF - ANT/MED HEEL, HFPS - CENTRAL HEEL

X-ray: normal HPT = 1-2 cm (< 1cm = atrophied)
Management: Act mod. > Mobs > Ortho > stretch/streng

18
Q
  • F, RF: OP, Amenorrhea, underweight, over pronation
  • Gradual onset of dull, diffuse pain with exercise and
    eventually progresses to more constant pain
  • antalgic limp, +/- swelling,
    • Morton’s squeeze,
  • Management/Imaging:
A

MT Stress Fx
Test: Mortons Squeeze Test:
- Pain local to MT shaft (Fx) pain between MT heads (MN)

US (x-ray may not show up immediately)
Lab panes: thyroid (OP) +ESR (RA)
Management:
PRICE > rest (3-6 wks) > low impact (water run) (4-8 wks)

CCEB Part B (15 decks)

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