Conditions of the Ankle, Foot, and Lower Leg - An Overview
This page is a work in progress
Some common conditions of the ankle, foot, and lower leg. This page includes a brief summary of each condition covering some main points. Full condition write-ups are here: (link)
Achilles Tendon Disorder
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Achilles Tendon Rupture
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Ankle Sprain (Medial)
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Ankle Sprain (Lateral)
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Ankle Sprain (Syndesmosis)
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Anterior Compartment Syndrome
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Calcaneal Valgus (Eversion)
Description: The distal calcaneus deviates laterally at the subtalar joint leading to excess eversion and overpronation of the foot (weight would be on the inner surface of the foot)
Common Signs and Symptoms: can cause internal tibia rotation, foot pain/discomfort, and can lead to shin splints
Common Causes: ankle strains/fractures, overweight, improper footwear,
Noteworthy Details: contributes to shortened hypertonic fibularis muscles and tibialis posterior, check shoes for wear and tear patterns
Calcaneal Varus (Inversion)
Description: The distal calcaneus deviates medially at the subtalar joint leading to excess inversion and supination of the foot (weight would be on the outer surface of the foot)
Common Signs and Symptoms: foot pain/discomfort, a potential loss in eversion ROM,
*this condition may be better observed in non-weight-bearing positions
Common Causes: tight invertors, childhood postural problems, systemic neurological disorders
Noteworthy Details: can make client prone to lateral ankle sprains (lateral collateral ligament), check shoes for wear and tear patterns
Deep Vein Thrombosis
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Excess Supination
Description: The combination of adduction, plantarflexion, and inversion. (the foot is turned inward with weight being on outer surface of foot). The foot is rigid and stable in this position. Causes external rotation of the knee.
Excess Pronation
Description: The combination of abduction, dorsiflexion, and eversion. (the foot is turned outward with weight being on inner surface of foot). The foot is soft and supple in this position. Causes internal rotation of the knee.
Gout
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Hallux Valgus (Bunions)
Description: A condition that affects the 1st metatarsophalangeal joint (MTP joint). A bunion refers to the bump that forms and swells on the medial MTP joint. The big toe begins to point toward the midline of the foot while the MTP joint moves away from the midline of the foot. The irritated, swollen tissue constantly rubs between the shoe and the bone beneath the skin.
Common Signs and Symptoms: Thick callus and thickened soft tissues on the medial side of the foot at the MTP joint. The bunion is often painful.
Common Causes: Pointed shoes (high heels, cowboy boots), genetic predisposition
Noteworthy Details: a bunionectomy is often needed to resolve the problem as the bone can thicken due to constant pressure over time. Bunion pads can reduce pressure and rubbing from shoes. Toes spacers can be used to attempt to splint the big toe back into position and reverse the deforming forces.
Hammer Toes
Description: A common condition where the three middle toes appear to always be bent/ flexed at the proximal interphalangeal joint. Flexible hammer toes can be moved into neutral while rigid hammer toes cannot be moved.
Common Signs and Symptoms: pain in the top of the bent toe when putting on a shoe, corns forming on the top of the bent toes, swelling and redness in toes (rule out gout), difficulty in moving the toe joint due to pain, pain in the ball of foot under bent toes.
Common Causes: muscle imbalances, genetics, flat foot, ill-fitting shoes, arthritis
Noteworthy Details: This condition can lead to an altered gait and other foot conditions such as metatarsalgia. Hammer toes can be a serious problem in people with diabetes.
Morton's Foot
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Morton's Neuroma
Description: A compression of the plantar nerve that passes between the metatarsal heads that causes sharp, shooting pain in the forefoot and toes.
Common Signs and Symptoms: No visible signs, pain on compression, pain when wearing tight-fitting shoes, numbness or paresthesia in 3rd and 4th toes
Common Causes: Metatarsal hypermobility, tight shoes
Special Testing: Confirm with Morton's Test, Differentiate from Plantar Fasciitis with Windlass Test, Differentiate from Tarsal Tunnel Syndrome with Dorsiflexion-Eversion Test
Pes Cavus (High Arch)
Description: high, exaggerated medial longitudinal arch
Common Signs and Symptoms: callus under metatarsal heads, tight flexor muscles on the plantar surface of foot, pain in the foot at metatarsal heads with repetitive weight-bearing motions
Common Causes: posture, genetic condition, underlying neurological problem
Noteworthy Details: can lead to other conditions such as metatarsal stress fractures, Morton's neuroma, and plantar fasciitis
Pes Planus (Flat Foot)
Description: flat foot, dropped/fallen medial longitudinal arch which leads to impaired shock absorbing abilities of the foot.
*Can be structural or functional: observe from the medial side of the foot – if the foot remains flat in both weight-bearing and non-weight-bearing positions, it is structural pes planus.
Common Signs and Symptoms: dropped medial longitudinal arch is visible, everted hindfoot at the subtalar joint, can have limited active ROM with dorsiflexion, some decrease in plantarflexion and dorsiflexion with Manual Resisted Testing
Common Causes: genetic predisposition to lax ligaments, foot stress, high heels, obesity
Noteworthy Details: can lead to other conditions such as shin splints, stress fractures, plantar fasciitis, foot, ankle, or knee pain
Plantar Fasciitis
Description: Swelling and inflammation of the plantar fascia most commonly developed due to overuse and stress to the area
Common Signs and Symptoms: inflammation, swelling, and pain of plantar fascia
Common Causes: shortening of the calf muscles, sednetary lifestyle, very high or low arches in feet, footwear (high heels), obesity, pregnancy, plonged standing/walking on hard surfaces, sudden increase or intensive participation in weight-bearing activity.
Noteworthy Details: Stretching the plantar fascia and posterior leg muscles, massaging the bottom of the foot with a tennis ball/frozen water bottle, and ice after activity are all great options for client self-care.
Special Testing: Confirm with the Windlass Test, differentiate from Morton's Neuroma with Morton's Test, differentiate from Tarsal Tunnel Syndrome with Dorsiflexion-Eversion Test
Pott's Fracture
Description: A fracture in one or more of the malleoli (lateral or medial)
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Noteworthy Details: Difficult to distinguish between a fracture and a moderate to severe ligament sprain
Retrocalcaneal Bursitis
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Shin Splints
Description: Pain along the inner edge of the tibia due to repeated trauma to the connective tissue surrounding the tibia. Commonly affects athletes with running and aerobic sports and military personnel in basic training and jumping
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Common Causes: high impact exercises on hard, non-compliant surfaces (asphalt, concrete), running uphill or downhill, a sudden increase in frequency/intensity of activity, excessively tight calf muscles (which can cause excessive pronation), muscle imbalances
Noteworthy Details: Evaluate shoe wear pattern – medial side wear indicates excessive pronation.
Special Testing: Confirm with Tibialis Posterior Compression Test
Stress Fracture (Foot)
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Stress Fracture (Lower Leg)
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Tarsal Tunnel Syndrome
Description: Tibial nerve entrapment that causes pain on plantar surface of the foot and around medial ankle
Common Signs and Symptoms: No visible signs, paresthesia, numbness, or motor weakness in muscles of the foot, pain after walking or running, worse after long periods of sitting or standing,
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Noteworthy Details: Tom, Dick, and Harry muscles (tibialis posterior, flexor digitorum longus, flexus hallucis longus) pass through the tarsal tunnel (site of compresion)
Special Testing: Confirm with Dorsiflexion-Eversion Test, Confirm with Tinel's Sign, differentiate from plantar fasciitis with Windlass Test, differentiate from Morton's Neuroma with Morton's Test.
Tibial Torsion
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Varicose Veins
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