DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND...
Transcript of DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND...
![Page 1: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/1.jpg)
DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST
BARBARA COOPER, MDDEBORAH OMORI, MD
JOAN RITTER, MDLAURA SESSUMS ,MD
![Page 2: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/2.jpg)
OVERVIEW
INTRODUCTION: 5 MINUTES REVIEW OF ANATOMY, TERMS: 15
MINUTES SMALL GROUPS: 50 MINUES WRAP-UP AND EVALUATION
COMPLETION: 15 MINUTES
![Page 3: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/3.jpg)
The Consensus Report of theAlliance for Academic Internal MedicineEducation Redesign Task Force
“Ambulatory education for internal medicine residents should be improved.”
“The disconnect between education and practice continues to challenge teaching institutions to provide more relevant educational experiences.”
As clinician-educators, we realize that faculty development is necessary if we are to become facilitators of residency redesign.
![Page 4: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/4.jpg)
Why are the foot and heel important?
Foot and ankle pain represent 20% of all musculoskeletal (MS) complaints.
20,000 people sprain their ankle each day in the US – it’s an epidemic!
Foot and ankle provide a base while standing & a lever while walking or running.
If we are encouraging patients to become increasingly active, we need to be familiar with the musculoskeletal consequences.
![Page 5: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/5.jpg)
Why are the foot and heel important?
Disorders of the foot & ankle can be associated with pain/dysfunction of other joints, especially the knees.
Pain in the foot and ankle with weight bearing can lead to changes in gait with resultant back, hip or knee pain.
![Page 6: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/6.jpg)
FOREFOOT
MIDFOOT
REARFOOT
![Page 7: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/7.jpg)
![Page 8: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/8.jpg)
SUBTALAR JOINT: TRIPHASIC JOINT • SAGITTAL PLANE: DORSIFLEXION AND PLANTAR FLEXION• TRANSVERSE PLANE: ADDUCTION AND ABDUCTION• FRONTAL PLANE: INVERSION AND EVERSION
![Page 9: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/9.jpg)
Mechanics of Normal Pronation
1. Foot rolls inward2. Height of the
arch decreases3. Leg rotates
internally as foot reaches its internal edge.
![Page 10: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/10.jpg)
Valgus and Varus
VARUS: the inward angulation of the distal segment of a bone or joint.
Varus deformity of the knee – “bow legged.”
VALGUS: the outward angulation of the distal segment of a bone or joint.
Valgus deformity of the knee – “knock-kneed.”
![Page 11: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/11.jpg)
Arch Types
![Page 12: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/12.jpg)
Ankle Anatomy: Bones
![Page 13: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/13.jpg)
Bones of the Foot and Ankle: Lateral View
![Page 14: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/14.jpg)
Ankle Anatomy: Ligaments
![Page 15: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/15.jpg)
Tendons of the Medial Ankle
![Page 16: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/16.jpg)
Tendons of the Lateral Ankle
![Page 17: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/17.jpg)
Achilles Tendon
![Page 18: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/18.jpg)
Anatomy: Nerves
![Page 19: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/19.jpg)
Anatomy: Nerves
![Page 20: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/20.jpg)
Anatomy: Plantar Fascia
![Page 21: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/21.jpg)
![Page 22: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/22.jpg)
Bursae of Ankle, Foot and Toes
![Page 23: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/23.jpg)
Gait: Normal
![Page 24: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/24.jpg)
Gait: Overpronation
![Page 25: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/25.jpg)
Gait: Underpronation
![Page 26: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/26.jpg)
Physical Exam of the Foot and Ankle Expose both limbs above the knees. Begin with patient standing.
– Observe alignment from the front.– Observe arch height and pronation. – View foot from the back to see axis of
alignment, valgus/varus deformity.– Have patient stand on toes – should
convert to varus alignment of the heel.
![Page 27: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/27.jpg)
Physical Exam of the Foot and Ankle Examine the vascular structures. Check for bunions, hammer toes, callus
(callus pattern shows where patient bears weight).
Sensory exam, including compression of metatarsals.
Evaluate flexion, extension, inversion and eversion (passive and active) as well as circumduction.
Palpate for areas of tenderness.
![Page 28: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/28.jpg)
Tips for Teaching
Build a foundation in: – Anatomy– Mechanics
Teach using models and orthotics. Emphasize adequate physical exam. Encourage residents to consider foot/ankle
issues in the setting of hip/back/knee pain.
![Page 29: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/29.jpg)
RESOURCES
http://www.foothealthfacts.org/footankleinfo
http://orthoinfo.aaos.org http://www.scribd.com/doc/20917113
/Sports-Medicine-Specialists-Rehabilitation-Protocols
![Page 30: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/30.jpg)
RESOURCESAnkle Sprain: Orthotics: u-shaped ankle support, Levamed ankle support (soft); lace-up ankle supports >semi-rigid
ankle supports > elastic bandagesExercises: Achilles tendon stretch, plantar/dorsiflex, foot circles, inversion/eversion, alphabet exercise, toe towel curls, marble pickups, heel/toe walks then proprioceptive training (circle wobble board, walking on different surfaces) then activity specific training such as runningPatient Ed materials (including exercises): http://orthoinfo.aaos.org/topic.cfm?topic=A00150http://www.aofas.org/Scripts/4Disapi.dll/4DCGI/cms/review.html?Action=CMS_Document&DocID=57http://www.scribd.com/doc/20917113/Sports-Medicine-Specialists-Rehabilitation-Protocols
Ankle Fracture: IF Unimalleolar, nondisplaced and no ligamentous injury; may be splinted with the ankle at 90 degrees
(neutral position -usually short leg posterior splint), bulky dressing if swelling to allow for increased swelling. Patient Ed materials: http://orthoinfo.aaos.org/topic.cfm?topic=A00391
Achilles Tendonitis: Exercises: stretching (including hamstrings), strengthening, gait analysis, review of footwear
Orthotics: Achilles trainer, Levamed ankle support (soft), U shaped ankle support, 3/8 heel lift, heel wedgePatient Ed materials: http://orthoinfo.aaos.org/topic.cfm?topic=a00147http://www.scribd.com/doc/20917113/Sports-Medicine-Specialists-Rehabilitation-Protocols
![Page 31: DISORDERS OF THE FOOT AND ANKLE FOR … Library/SGIM/Resource Library...DISORDERS OF THE FOOT AND ANKLE FOR THE INTERNIST BARBARA COOPER, MD DEBORAH OMORI, MD JOAN RITTER, MD LAURA](https://reader031.fdocuments.in/reader031/viewer/2022022118/5ccb5d7c88c993fa708cfdcc/html5/thumbnails/31.jpg)
RESOURCES
Hammertoe: http://www.foothealthfacts.org/footankleinfo/hammertoes.htm Bunion: http://www.foothealthfacts.org/footankleinfo/bunions.htm Corn: http://www.foothealthfacts.org/what-is/ns_corns.htm Callous: http://www.foothealthfacts.org/what-is/ns_callus.htm OA: http://www.foothealthfacts.org/footankleinfo/osteoarthritis.htm Gout: http://www.foothealthfacts.org/footankleinfo/gout.htm Orthotics and footwear: www.footsmart.com