Foot & Ankle Exam

1. Foot & Ankle Exam Gait – Guarded, antalgic, steppage, waddling, NWB, PWB Skin – Temp, tropic changes, nails, ulcer, keratosis, hair growth Vascular – DP, PT, cap refil, edema, varicosities MSK – Ext/Flex/Eve/Inv, DTR, ROM, MS Neuro – Protective Sensation (Vib, monofiliment), DTR

2. Foot & Ankle Exam Normal Gait. Neurovascular status grossly intact. Protective Sensation intact. Dry Supple skin. There is no sign of infection. There is no edema. There is no erythema. There is no ecchymosis. There is no bony point tenderness. Rectus foot type. ROM of ankle is 20° df and 45° pf. STJ ROM is 30° inversion and 20° eversion. ROM of 1st MTPJ is 70° df and 25° pf. MS is 5/5. There is no proximal tenderness. The calf is supple and nontender. There is no anterior draw. Radiographs 3 views weightbearing of the ankle show no acute fracture or degenerative changes.

3. Foot & Ankle Landmarks Ankle Joint Injection

4. Foot & Ankle Landmarks 1st MTP Joint Injection EHL

5. Foot & Ankle Landmarks PT nerve block

6. Foot & Ankle Landmarks PT nerve block

7. Foot Intrinsics Stabilizers of the arch, digits, plantar fascia Tibial Nerve – Med, Lat plantar nerve, calcaneal branch Post Tib artery

8. Anterior Compartment Extensors Deep Fibular Nerve (L4, L5) Ant Tib artery

9. Posterior Compartment Flexors Tibial Nerve (L4, L5, S1, S2) Post Tib artery

10. Posterior Compartment Flexors Tibial Nerve (L4, L5, S1, S2) Ant Tib artery

11. Medial Ankle Flexors Tibial Nerve (L4, L5, S1, S2) Ant Tib artery

12. Medial Ankle Flexors Tibial Nerve (L4, L5, S1, S2) Ant Tib artery

13. Lateral Compartment Evertors Sup Fib Nerve (L5, S1, S2) Peroneal artery and Post Tib perf

14. Lateral Ankle Flexors Tibial Nerve (L4, L5, S1, S2) Ant Tib artery

15. Cutaneous Innervation

16. Cutaneous Innervation

17. Neuro

18. Vascular

19. Plantar Fasciitis

20. Plantar Fasciitis RICE, NSAIDS Cushioned supportive Walking shoes Orthotics, night splint, bracing HEP, PT Injections, x2, PRP Xrays, U/S, MRI Sx – Deformity corrction, fasciectomy (topaz)

21. Ankle Sprain Grade 1 – Stretch of ligament, able to wt bear Grade 2 – Partial Tear of ligament, PWB Grade 3 – Complete Tear, unable to wt bear ATFL CFL Deltoid AITFL (High ankle sprain)

22. Ankle Sprain G1 – RICE, Early ROM, HEP 1-3 weeks G2 – Add ankle brace with early D/C as tolerated, then PT 3 - 6 weeks G3 - Add NWB in cast or boot 6 weeks MRI Instability, osteochondral lesion, peroneal tendon tear, occult fx

23. Ankle Sprain 29m, WC, left ankle inversion injury treated for 6 months with no improvement with RICE, NSAID, PT, HEP, cam boot, PWB crutches, injection. Complains of posterior lateral, and anterior lateral pain. + ant draw, + tender along peroneals MRI shows complete tear of ATFL and split tear of peroneus longus tendon. No OCD. Left ankle peroneal tendon repair and ATFL recon.

24. Ankle Sprain

25. Arthritis Ankle TMT 1st MTPJ

26. Arthritis • RICE, NSAIDS, cane, walker • Walking shoes • AFO bracing • HEP, PT • Injections, PRP, stem cell • Xrays, CT, MRI • Sx – Deformity correction, arthroscopy, fusion, joint replacement

27. Ankle Arthritis

28. TMT Arthritis

29. 1st MTPJ arthritis Hallux limitus, Hallux rigidus

30. 1st MTPJ Arthritis • 45m, WC injury in the past, c/o great toe joint pain stiffness, decreased ROM, has done treatments of PT, HEP, NSAIDs, orthotics, injections. • Right 1st MTPJ fusion

31. 1st MTPJ Arthritis

32. Achilles Tendonopathy Rupture Tendonosis Partial tears Enthesopathy, Bone spurs Bursitis

33. Achilles Tendonopathy RICE, NSAIDS, cane, walker Cushioned supportive Walking shoes Orthotics, AFO bracing HEP, PT Injections, PRP Xrays, U/S, MRI Sx – Repair, spur resection

34. Acute Rupture Achilles Tendon 45m, 3 weeks ago playing basketball felt pop to back of Left ankle. Thought sprained ankle and would heal its on own. CityMD refereed to Community Rad for MRI. Works for ZocDoc. Primary Repair of Achilles tendon.

35. Acute Rupture Achilles Tendon

36. Posterior Calcaneal Heel Spur Bursitis, tendonosis, heel spur, partial tears RICE, bracing, PT, HEP, NSAIDs Injection into bursa

37. Posterior Heel Spur 34m, WC, left ankle injury 1 year ago, c/o back of ankle pain. MRI shows partial tear of achilles tendon at insertion with associated bursitis, and bone spurs with in the tendon Left ankle achilles tendon repair with ostectomy and bone spure removal

38. Posterior Heel Spur

39. Posterior Heel Spur

40. Pes Planus Abducto Valgus Deformity Posterior Tibialis Tendon Dysfunction

41. Pes Planus Abducto Valgus Deformity Flat foot deformity 55f with chronic pain and deformity to RT foot. Dx: Chronic pain Chronic plantar fasciitis Anterior Lateral Ankle impingement Chronic PT tendonitis/tendonosis Flat foot deformity Sinus Tarsi Syndrome Left PPAV (flat foot) reconstruction

42. Pes Planus Abducto Valgus DeformityFlat foot deformity

43. Pes Planus Abducto Valgus DeformityFlat foot deformity

45. Diabetic / Charcot Foot Skin – Dry/Keratosis, ulcers, infection Neuro – Neuropathy, decreased protective sensation (monofiliment, vib), decreased DTR Vasc – Decreased micro/macro vasculature MSK – Weak intrinsics, PPAV

46. Diabetic / Charcot Foot Dx: DM with complications LE neuropathy PVD G1 ulcer Keratosis Fall Risk Osteoarthropathy Valgus ankle deformity

47. Diabetic / Charcot Foot

48. Tarsal Tunnel Syndrome Neuroma Drop foot RSD/CRPS Coalition Lisfranc (Midfoot, TMT) Injury Metatarsalgia Hallux Valgus (Bunion) Hammer toe Sesamoiditis Turf Toe