Nontraumatic Problems of the Foot. Keith Baker, MD
Compartment syndrome-
- Compartments of foot- 9
- Signs and symptoms of compartment syndrome- 6 Ps
Planter fasciitis
- Pain under heel
- Calcaneal spur commonly seen on xray
- Runners, occupatients with excessive walking standing, obesity
- Bilateral calcaneus- rheum shit
- Treatment
- REST, ICE, PT, Stretching
Heel pad atrophy – obesity proonged activity
Calcaneal bursitis-
- Typically causes posterior calcaneal burisits- poor fitting shoes/ high heels
-Morton neuroma- bengin- entrapment neuropathy of interdigital nurve, fusiform swelling proximal to bifurcation of nerve
– parestehsia and numbness near the toes
- Treatment –
Forefoot bursitis-
- 2 most common sites of forefoot bursitis:
- Dorsla ip joints of toes, navicular tuberosity
- 3 treatments
- Rest, ice, nsaids, steroids
Sesamoiditis
- Typically, first toe
Navicular Osteochondrosis
- Kohler’s disease
- Male dominant
- Age 4-10
- Navicular bone last to ossify.
- TX: restricted activities and casting
Freiberg Disease
- Avascular necrosis of metatarsal head, most commonly 2nd toe
- Commonly in females
Entrapment Neuropathies
- Two entrapment syndromes of the foot
- Tarsal tunnel syndrome
- Poster tibial nerve
- Lateral plantar calcaneal
- Ski boot compression syndrome
- Pain dorsum of foot
- Deep peroneal nerve injured.
- Sural nerve entrapment
- Medial plantar nerve entrapment
- Joggers foot
- Tarsal tunnel syndrome
Diabetic foot ulcers
- 2% of diabetics annually get a ulcer.
- If they have neuropathy, then this increases 8% annually
- Osteomyelitis in a diabetic foot ulcer – 2/3 will get it
- PO antibiotic regimen for osteomyelitis- clinda, levo, Bactrim, Augmentin
- IV: ancef, zosyn, vanco
Plantar warts
- Plantar wart from a corn or callus- black nucleus in the middle
ingrown toenail
Hallux valgus
- Bunion
- Bursa inflammation is the cause of the pain
9:30) Lower extremity Ortho: Knees to TOES- Patrick Cheatle, MD
- ACL
- LACHMAN and ANTERIOR DRAWER TEST
- Lachman- hold femur and then take tibia and pull anteriorly.
- Anterior Drawer Test- Knee flexed and pull the tib fib forward after sitting on foot
- MRI IS GOLD STANDARD
- LACHMAN and ANTERIOR DRAWER TEST
PCL injury
- Direct force applied to proximal anterior tibia
- + posterior drawer sign or posterior sag sign
Meniscus Tear
- TWISTING
- + effusion🡪 worse outcome
- Described as Locking or catching
- Squatting or pivoting exacerbates the pain
Patellar dislocation or subluxation
- Slips laterally
- Just push it back
Quadriceps tendon tear
- Intense anterior knee pain
- NEED TO CHECK NEUROVASCULAR STATUS WITH THESE PATIENTS
Intraarticular knee fractures
- Commonly involve the lateral plateau
- Compartment syndrome most common significant short term complication
Anterior Knee
- Osgood Schlatter’s
- Hoffa fat pad syndrome
- Quadriceps and patellar tendinopathy
- Bursitis
Posterior Knee
- Popliteal artery aneurysm or entrapment
- Bakers cyst
- Popliteus tendinopathy
Medial Knee
- Degenerative medial meniscal tear
- Saphenous nerve entrapment
Lateral Knee
- IT band syndrome and degenerative lateral meniscus tear
- + nobles compression test
10:15) Ortho Cases. Multiple Faculty
11) EM Case Presentation. Elise Venter, MD
- Thoracic Aortic Aneurysm
11:30) TRIAGE. Chiefs
- Toxicology
- Radiology
- Integument
- Radiology
- Cerebral T waves
12) Optional Board Review