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An overview of various orthopaedic conditions affecting the lower limb, including their causes, symptoms, and diagnostic methods. Conditions covered include trauma, infection, neoplasia, arthritis, developmental disorders, and miscellaneous conditions. The document also includes X-ray appearances and references to Huckstep 1999.
Typology: Lecture notes
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Lower Limb Conditions 507
508 A Simple Guide to Orthopaedics
Classification
Aetiological
Classification
510 A Simple Guide to Orthopaedics
Aetiological
Classification
Congenital abnormalities
Neoplasia
malignant tumours such as osteogenic
Lower Limb Conditions 511
Aetiological Classification
Trauma (^) Infection
Neoplasia
Congenital
abnormalities
© Huckstep 1999 Huckstep 1999©
Huckstep 1999© Huckstep 1999©
Lower Limb Conditions 513
Aetiological Classification
Miscellaneous conditions
Paralysis
Arthritis
Huckstep 1999©
©Huckstep 1999
Huckstep 1999© ©Huckstep 1999
514 A Simple Guide to Orthopaedics
Anatomical Classification
Hip and femoral conditions
516 A Simple Guide to Orthopaedics
Lower Limb Conditions 517
Hip and Femoral Conditions
© Huckstep 1999
©Huckstep 1999
Huckstep 1999©
Lower Limb Conditions 519
Knee and Tibial Conditions
© Huckstep 1999 ©Huckstep 1999
Huckstep 1999© ©Huckstep 1999
Huckstep 1999© ©Huckstep 1999
520 A Simple Guide to Orthopaedics
522 A Simple Guide to Orthopaedics
Ankle and hind foot conditions
Tendonitis Tendonitis on the medial side of the ankle is usually due to inflammation of the tibialis posterior tendon sheath and on the lateral side to inflammation of the sheaths of the peroneal tendons. Posteriorly the sheath of the tendo calcaneus may become inflamed by overuse of the tendon, by rubbing on the back of a shoe or by minor tears of the fibres of the tendon itself. Partial or complete rupture of the tendon may also occur. Clinically there is tenderness and often swelling over the sheath of the relevant tendon and usually pain on stressing the tendon. Treatment includes ‘resting the tendon’ with an elevated heel on both shoes, the application of ice packs and elevation of the leg in the acute stage.In chronic tendon- itis deep heat, massage and sometimes injec- tions of hydrocortisone and local anaesthetic into the tendon sheath (not the tendon) may be necessary. Occasionally incision of the tendon sheath may be required. Rupture of the plantaris tendon may also occur and lead to a sudden sharp pain in the mid calf. The treatment is the same as for a tendonitis of the tendo Achillis.
Painful heel Pain under the heel is usually due to a plantar fasciitis, possibly following bruising of the heel. It may be associated with a calcaneal spur seen on X-ray but this is often unrelated to the pain. The heel sometimes becomes painful in chronic infec- tions, in rheumatoid arthritis and in other
inflammatory diseases.
Lower Limb Conditions 523
Ankle and Hind Foot
Conditions
© Huckstep 1999 Huckstep 1999©
Huckstep 1999©
Huckstep 1999©
Lower Limb Conditions 525
Ankle and Hind Foot
Conditions
Huckstep 1999© Huckstep 1999©
©Huckstep 1999 ©Huckstep 1999
526 A Simple Guide to Orthopaedics
Spastic paralysis from an upper motor neurone lesion may also require a below knee caliper, again sometimes preceded by elon- gation of the tendo Achillis.
Forefoot and toe conditions Classification of forefoot conditions can be divided into those affecting the plantar surface, the dorsum and the sides of the feet. Deformities of the toes are often as- sociated with these conditions.
Plantar surface of foot
A n t e r i o r m e t a t a r s a l g i a This is a painful area under the metatarsal heads, commonly the 2nd, 3rd, and 4th. It is usually due to weakening of the dynamic muscular structure of the foot. It is often associated with obesity, poor muscle tone, clawing of the toes and sometimes various n e u r o l o g i c a l c o n d i t i o n s s u c h a s poliomyelitis, leading to weakness of the intrinsic muscles.
Morton’s metatarsalgia (plantar n e u r o m a ) This is due to irritation followed by enlargement of a plantar digital nerve, usually between the 2nd and 3rd or 3rd and 4th metatarsal heads. The patient complains of pain in the forefoot, often at night when the feet are warm, and also while walking. The condition is often associated with an anterior metatarsalgia. During exam-ination the main tender area can usually be pinpo- inted to lie between the metatarsal heads rather than under them as is the case in anterior metatarsalgia. The pain is usually worse on lateral compression of the forefoot which compresses an enlarged neuroma between the metatarsal heads. There may also be numb- ness between the toes supplied by the relevant
cutaneous nerve.