Lower Limb - Foot and Ankle

Question 1

What is the underlying pathology of plantar fasciitis?

Answer 1

Inflammation or degeneration of the plantar aponeurosis at its origin on the calcaneus

Question 2

What symptom is most characteristic of plantar fasciitis?

Answer 2

Sharp heel pain with first steps after rest (“start-up pain”) that improves with activity but may worsen again after exercise

Question 2

What is a key risk factor for plantar fasciitis related to lifestyle?

Answer 2

Physical overload, such as excessive running or obesity

Question 3

Which foot abnormalities are risk factors for plantar fasciitis?

Answer 3

1. Pes planus (flat feet)
2. Cavovarus (high-arched feet)

Question 4

Why is plantar fasciitis more common with age?

Answer 4

The fat pad under the heel atrophies, reducing cushioning

Question 5

What is Tinel’s sign used to test in plantar fasciitis?

Answer 5

Baxter’s nerve irritation – it may be positive

Question 5

What would you expect on examination in plantar fasciitis?

Answer 5

Local tenderness on the plantar-medial aspect of the heel and possible fullness or swelling

Question 6

How is plantar fasciitis diagnosed?

Answer 6

Clinically - imaging not needed

Question 7

What is the first-line management of plantar fasciitis?

Answer 7

Rest, NSAIDs, and physiotherapy, especially stretching of the Achilles and plantar fascia

Question 8

What interventions may be used if conservative management fails?

Answer 8

1. Night splints
2. Heel cups
3. Corticosteroid injections

Question 9

How long can symptoms of plantar fasciitis take to resolve?

Answer 9

up to 2 years

Question 10

A 46-year-old male comes into the clinic with severe stabbing pain in his heel that is noticeably worse in the morning. The patient recently started running daily after his family physician recommended losing weight.

On physical exam, he has an increase in pain with passive extension of the great toe. What is likely causing this patient’s pain?

Answer 10

Plantar fasciitis due to inflammation of the plantar aponeurosis

Question 11

A 35-year-old runner presents with heel pain. On examination, there is diffuse tenderness which is worse on the medial aspect of the heel bed. Although the patient has stopped running for the past week, the pain is aggravated by being on their feet at work all day.

Pain is worse when you ask them to walk on their toes. What is the most likely diagnosis?

Answer 11

Plantar fasciitis

Question 12

Plantar fasciitis is best managed initially with what?

Answer 12

rest, stretching and weight loss if overweight

Question 13

What is Morton’s neuroma?

Answer 13

A benign fibrotic thickening of a plantar digital nerve, usually due to repeated trauma or irritation near its bifurcation beneath the intermetatarsal ligament

Question 14

Which interdigital space is most commonly affected in Morton’s neuroma?

Answer 14

The third interspace, followed by the second

Question 14

What are the main risk factors for Morton’s neuroma?

Answer 14

(1) Age 45–50
(2) Female sex (4x more common)
(3) Wearing high heels
(4) Obesity

Question 15

What are the typical symptoms of Morton’s neuroma?

Answer 15

1. Burning pain and tingling radiating to the toes
2. Worse with tight footwear
3. Relieved by removing shoes or massaging the foot

Question 16

What is Mulder’s click and what condition is it associated with?

Answer 16

A palpable or audible click on squeezing the forefoot, reproducing pain – associated with Morton’s neuroma

Question 17

How is Morton’s neuroma diagnosed?

Answer 17

Ultrasound (1st-line imaging)

Question 18

What neurological sign may be found in Morton’s neuroma?

Answer 18

Loss of sensation in the affected web space

Question 19

What is the first-line management for Morton’s neuroma?

Answer 19

Conservative: footwear changes, metatarsal pads, weight loss

Question 20

When is surgery indicated in Morton’s neuroma?

Answer 20

1. If symptoms persist after 2–3 months of conservative treatment and inadequate response to injections
2. Involves excision of the neuroma

Question 21

What is a possible complication of Morton’s neuroma surgery?

Answer 21

Persistent pain or recurrence

Question 22

A 50-year-old female presents to the outpatient clinic with a sharp pain on the sole of her right foot when she walks. She reports that the pain began two months ago, and there has been no known trauma or injury to the foot. The pain is exacerbated when she wears tight shoes or high heels. On physical exam, there is no oedema or erythema, but there is mild tenderness on palpation of the plantar aspect of the foot between the third and fourth metatarsophalangeal joints. The posterior tibial pulse and dorsalis pedis pulse are normal, and she has a full active range of motion in the ankle. All other vital signs are within normal limits. What is the most likely cause of the patient’s symptoms?

Answer 22

Motor neuroma

Question 23

Severe midfoot pain is what injury?

Answer 23

Lisfranc Injury

Question 24

What is the treatment of metatarsal stress fractures?

Answer 24

Prolonged rest for 6‐12 weeks in a rigid soled boot