J Korean Rheum Assoc.  2010 Dec;17(4):348-359. 10.4078/jkra.2010.17.4.348.

Clinical Approach of Common Foot and Ankle Disorders

• Jung HG
• Kim TH

• KMID: 2201892
• DOI: http://doi.org/10.4078/jkra.2010.17.4.348

Abstract

Among the many regions (joints) of the human extremities, the foot and ankle area has a variety of disorders, which seem difficult to diagnose mainly because the anatomy seems rather complex. There are two main regions i.e. ankle and foot where the foot is divided into forefoot, midfoot and hindfoot. Among the many disorders, some of the most common and important disorders such as hallux valgus, osteochondral lesion of talus and lateral ankle instability are summarized in the aspect of clinical manifestations, physical examination, differential diagnosis, radiographic findings, initial treatments and the criteria for the surgery. The recent trend of surgical treatment options have also been described with related references.

Keyword

Foot; Ankle; Disorders; Clinical approach

MeSH Terms

Animals
Ankle
Diagnosis, Differential
Extremities
Foot
Hallux Valgus
Humans
Physical Examination
Talus

Figure

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  Fig. 1. Plantar aspect of the hallux valgus foot shows the plantar callus at the 1st and 2nd metatarsal heads due to pressure overload.

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  Fig. 2. Plain radiograph of hallux valgus foot with important radiographic parameters: hallux valgus angle (HVA) and intermetatarsal angle (IMA).

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  Fig. 3. (A) Preoperative gross photo and the plain radiograph of the hallux valgus foot with prominent bunion deformity. (B) Postoperative photo and radiograph showed well corrected deformity with significant pain relief.

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  Fig. 4. Enhanced MRI of ankle shows enhanced cystic osteochondral lesion of talus (OLT) at the medial dome (arrow).

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  Fig. 5. Ankle arthroscopic procedure in the operating room.

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  Fig. 6. (A) Arthroscopic view of the flap tear in the OLT. (B) Arthrosopic microfracture procedure for stimulation of the subcondral bone marrow.

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  Fig. 7. Ankle varus stress views (A) and the anterior drawer tests (B) are routinely performed for the lateral ankle instability patients using stress exertion device (Telos device, C and D).

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  Fig. 8. Talar tilt angles are measured upon the ankle varus stress radiograph estimating the chronic insufficiency of the lateral ankle ligaments.

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  Fig. 9. (A) Modified Brostrum procedure-direct lateral ligament repair with shortening. (B) Anatomic lateral ligament reconstruction with free tendon allograft.

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  Fig. 10. (A) Mulder's click test to diagnose the enlarged interdigital neuroma. (B) Ultrasonography of the forefoot shows interdigital neuroma between the metatarsal heads.

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  Fig. 11. Operative photo with dorsal incision and the excised swollen neuroma branch (arrow).

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  Fig. 12. (A) Computed tomography of the 2nd metatarsal Freiberg disease. (B) Intraoperative picture of the deformed 2nd metatarsal head due to osteochondrosis. (C, D) Dorsal closing-wedge osteotomy of the 2nd metatarsal head (X-ray and gross photo).

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