Foot Basics Outpatient Orthopaedics for the Primary Care Physician

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Foot BasicsOutpatient Orthopaedics for the
Primary Care Physician

• Nancy J. Kadel, M.D.
• Department of Orthopaedics and Sports Medicine
• University of Washington
• March 8, 2003

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Anatomy

• Complex arrangement of bones (26) and joints (29)

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Foot Injuries

• 5th metatarsal fracture (shaft or avulsion)
• Symptomatic treatment
• Cam walker, post-op shoe or stiff soled shoe
• WBAT
• Xrays take 8-12 weeks

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Foot Injuries

• Jones Fracture
• Base of 5th metatarsal
• Delayed or non-union
• Treat in cast, non-weight bearing 6 weeks
• Consider ORIF for athlete

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Foot Injuries

• Lisfranc Fracture/Dislocation
• Often missed
• Serious injury!!!
• Better seen on standing film
• Metatarsal-cuneiform instability
• Severe midfoot swelling and ecchymosis
• Refer or Orthopaedic surgeon immediately

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Lisfranc Injury
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Lisfrancs Ligament
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Foot Injuries

• Stress Fractures
• Rate of microfracture exceeds rate of repair
• Metatarsals, calcaneus, tibia, fibula
• Often not visible on initial films, positive bone
  scan
• Generally point tender on exam
• Rule out pathologic process
• Usually 2 sudden increase in activity
• Treatment symptomatic and rest

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Plantar Fasciitis
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Foot Injuries

• Plantar Fasciitis
• Heel pain, predominately in morning or after
  having been at rest
• Worse with prolonged standing

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Windlass Mechanism
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Stretching Exercises
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Plantar Fasciitis

• Treatment
• Viscoelastic heel cushions
• Night splint, sole stiffener
• Heel cord stretches
• Shockwave tx
• Surgery last resort

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Night Splint
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Hallux Valgus

• Angular deformity of forefoot with prominence of
  the medial eminence and lateral deviation of
  great toe

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Hallux Valgus
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Hallux Rigidus
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Hallux Rigidus

• Stiff shoe
• Cheilectomy osteotomy of proximal phalanx
• Arthrodesis for severe arthritis

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Toe Deformities
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Corn
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Corn
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Corn
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Ingrown Toenail
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Ingrown Toenail

• Stage 1-erythema, swelling and tenderness of
  lateral nail fold
• Stage 2-increased pain and signs of infection,
  purulent drainage
• Stage 3-stages 1 2 plus granulation tissue,
  lateral wall hypertrophy

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Ambulatory Management

• STAGE 1
• Demonstrate proper nail trimming
• Warm soaks
• Antibiotics
• Open-toed shoes
• Cotton wick in lateral groove corner

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Ambulatory Management

• STAGE 2
• May require partial nail avulsion
• Use digital block
• Cut 1/4 to 1/3 of nail edge with scissors,
  protecting nail bed and matrix

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Ambulatory Management

• STAGE 3
• May require matrixectomy (permanent ablation of
  nail matrix)
• Excision of granulation tissue

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Subungual Exostosis
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Lumps and Bumps
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Lumps and Bumps