1. Ankle and Foot PainEnas Mohamed Shahine; MDAss. Prof. Physical Medicine, Rheumatology & RehabilitationFaculty of Medicine,Alexandria University,Egypt
2. Ankle jointThe ankle joint is made up of three bones: the lower end of the tibia, thefibula and the talus.
3. Foot Anatomy
4. Foot AnatomyArches of the Foot3 Arches, to absorb shock, on the Plantar Aspect• Transverse Front of calcaneus to 5th metatarsal• Metatarsal Runs along metatarsal heads• Longitudinal Calcaneus to metatarsal heads
5. Foot and Ankle AnatomyLigaments of the Lateral Ankle• Anterior TaloFibular (ATF) Most often sprained• Posterior TaloFibular (PTF) 2nd most often• CalcaneoFibular (CFL)
6. Deltoid LigamentVery strong, stronger than all lateral ligaments combined .3 bands to deltoid Anterior, Middle, PosteriorFoot and Ankle AnatomyLigaments of the Medial Ankle• Deltoid Ligament• Posterior Talocalcaneal (PTC)• Posterior Talotibial (PTT)
9. Painful foot and ankle
10. ANKLE TENOSYNOVITISInflammation of any ankle tendon and its lining synovial sheath.CausesoStrain from unusual use or overuse of muscles and tendons inthe ankle.oDirect blow or injury to the ankle.oRepeated ankle injury.oDegenerative changes or inflammatory arthritis.
11. ANKLE TENOSYNOVITIS•Symptoms and signsoConstant pain or pain with motion.oLimited motion of the ankle.oCrepitation (a "crackling" sound when the tendon moves oris touched).oHeat and redness over the inflamed tendon.•TreatmentoRestoPain medicationsoHeat applications
12. Lateral ligament sprain/ complete tearLigament is stretched and torn. The ligaments can tearpartially or completely.
13. Achilles paratendinitisRest: the tendon by keeping off their feet as much as possible;Ice: packs for 20 minutes at a time every hour for a day or two to reduceswelling;Compress: the ankle and foot with a firmly (not tightly) wrapped elasticbandage; andElevate: the foot whenever possible to minimize swelling.tissues immediately surrounding the Achilles Tendon become inflamed.Inflammation of these structures leads to swelling. The tendon feels painfulto squeezing and thickened.
14. Rupture Achilles tendonInsidious or abrupt onset with pain and swelling 2-3 cmproximal to the insertion of the Achilles tendon (partial). Pop orsnap in the back of the ankle (complete). After chronic Achillestendonitis.
15. Retrocalcaneal bursitisA bursa acts as a cushion and lubricant between tendons andmuscles sliding over bone.Excessive walking, running, or jumping.Is commonly associated withAchilles tendinitisPain may get worse when rising on the toes(standing on tiptoes)Red, warm skin over the back of the heel.
16. SEVERS DISEASE OR CALCANEALAPOPHYSITISA painful inflammation of the growth plate (apophysis) of thecalcaneus at the Achilles tendon insertion.In early teenagers, the blood supply to the growing plate is notkeeping up with the demands of growing. Pain is a deep ache orsoreness to the corner of the heel and tends to be aggravatedwith running activities.Decreasing activities for two weeks and the use of custom madefoot orthotics to help improve foot biomechanics.
17. Tender heel padPain beneath the hind part of heel (weight bearing part ofcalcaneus) on standing or walking. Local tenderness over theheel pad.Contusion (trauma), mild inflammation, uncertain.Spontaneous recovery.Corticosteroid injection.Heel cushion insole
18. CAUSES OF HEEL PAIN1. Disease of the calcaneus.2. Arthritis of the subtalarjoint.3. Ruptured calcanealtendon.4. Calcaneal paratendinitis.5. Post-calcaneal bursitis.6. Calcaneal apophysitis.7. Tender heel pad.8. Plantar fascitis.
19. Osteochondritis of the talusInjury to the talus cartilage.Trauma to the ankle or spontaneously.The blood supply to the injured cartilageis poor, giving it little potential to heal.This area of cartilage and underlyingbone can become detached from thesurrounding bone, which can becomeloose in the joint. With time, as thecartilage injury progresses, arthritis candevelop in the ankle.Pain and swelling around the ankle.
21. Plantar fasciitis and heel spur syndromePlantar Fascia is a strong inelastic band of fibers which beginsat the heel and extend into the toes.The usual cause of is excessive pulling on the Plantar Fasciafrom excessive exercise. heel spur formation occurs at the siteof where the Plantar Fascia is connected to the heel.cause pain at the bottom of the foot which is greatly exacerbatedwith stepping down the first thing in the morning.
22. Pain in the forefoot (metatarsalgia)a common overuse injury. It is associated withincreased stress over the heads of metatarsalbones (the ball of foot).Poorly fitting footwear such as narrow, highheeled shoes which force the foot into a smallspace can cause the condition. Running orjumping.A burning or aching sensation.Cushioning silicone gel insoles may providerelief. Advice regarding appropriate footwear withgood shock absorption is important.
23. Mortons metatarsalgia (interdigital neuroma)Affects the proximal part of the plantar digitalnerve and accompanying plantar digital artery.Trauma to these structures leads to inflammatoryoedema, fibrosis, and degeneration of the nerve.Gradual onset with sudden attacks of neuralgicpain or paraesthesia during walking, often in thethird and fourth toe.often occur in women.Treatment—Patients should be advised aboutsuitable footwear. Injections of local anaestheticand hydrocortisone around the nerve or surgicalexcision can be helpful.
24. Stress (march) fracture of metatarsal bonesOccurs as the result of applied load to the bone in anamount, or at a rate, that is greater than the ability ofthe bone to repair and heal itself (overuse). commonlyseen in the second and third metatarsals, lesscommon in the 4th and 5th metatarsals. Rare in the1st metatarsal.Pain on walkingLocal tenderness&Swelling.Spontaneous healing.Below knee plasterfixation for 3-4 weeks
25. CallositiesHard (localized thickening) skin is a sign ofover work in that particular area of the foot(prominent bone). The body responds to agreater stress on a skin area by increasingproduction of skin cells at the basal layer of theepidermis.Shoes can cause skin stresses. Occupation;leisure activities and foot deformities.If painful can be removed.Salicylic Acid application.
26. Planter wart (verruca plantaris)Growths that develop on the plantar aspect due to acontagious virus called Human Papillomavirus. Warts canbe flesh colored or dark, rough or smooth, can growsingly or in groups, often termed as "mosaic warts".Painful walking on warts.On walking the warts begin to flatten making them moredifficult to treat because the majority of the wart has beenpushed deeper under the skin.Keep feet dry as warts thrive in moist conditions.Wear comfortable shoes to lessen pressure on the wart.Salicylic acid plasters.Laser or Electro surgery.Cutting. Freezing methods.