1. Foot & Ankle Exam
Gait – Guarded, antalgic, steppage, waddling, NWB, PWB
Skin – Temp, tropic changes, nails, ulcer, keratosis, hair growth
Vascular – DP, PT, cap refil, edema, varicosities
MSK – Ext/Flex/Eve/Inv, DTR, ROM, MS
Neuro – Protective Sensation (Vib, monofiliment), DTR

2. Foot & Ankle Exam Normal Gait. Neurovascular status grossly intact.
Protective Sensation intact. Dry Supple skin.
There is no sign of infection. There is no edema. There is no erythema.
There is no ecchymosis. There is no bony point tenderness.
Rectus foot type. ROM of ankle is 20° df and 45° pf.
STJ ROM is 30° inversion and 20° eversion.
ROM of 1st MTPJ is 70° df and 25° pf. MS is 5/5.
There is no proximal tenderness. The calf is supple and nontender.
There is no anterior draw. Radiographs 3 views weightbearing of
the ankle show no acute fracture or degenerative changes.

3. Foot & Ankle Landmarks
Ankle Joint Injection

4. Foot & Ankle Landmarks
1st MTP Joint Injection
EHL

5. Foot & Ankle Landmarks
PT nerve block

6. Foot & Ankle Landmarks
PT nerve block

7. Foot Intrinsics Stabilizers of the arch, digits, plantar fascia
Tibial Nerve – Med, Lat plantar nerve, calcaneal branch
Post Tib artery

8. Anterior Compartment Extensors Deep Fibular Nerve (L4, L5)
Ant Tib artery

9. Posterior Compartment
Flexors
Tibial Nerve (L4, L5, S1, S2)
Post Tib artery

10. Posterior Compartment
Flexors
Tibial Nerve (L4, L5, S1, S2)
Ant Tib artery

11. Medial Ankle
Flexors
Tibial Nerve (L4, L5, S1, S2)
Ant Tib artery

12. Medial Ankle
Flexors
Tibial Nerve (L4, L5, S1, S2)
Ant Tib artery

13. Lateral Compartment Evertors Sup Fib Nerve (L5, S1, S2)
Peroneal artery and Post Tib perf

14. Lateral Ankle
Flexors
Tibial Nerve (L4, L5, S1, S2)
Ant Tib artery

15. Cutaneous Innervation

16. Cutaneous Innervation

17. Neuro

18. Vascular

19. Plantar Fasciitis

20. Plantar Fasciitis RICE, NSAIDS Cushioned supportive Walking shoes
Orthotics, night splint, bracing
HEP, PT
Injections, x2, PRP
Xrays, U/S, MRI
Sx – Deformity corrction, fasciectomy (topaz)

21. Ankle Sprain Grade 1 – Stretch of ligament, able to wt bear
Grade 2 – Partial Tear of ligament, PWB
Grade 3 – Complete Tear, unable to wt bear
ATFL
CFL
Deltoid
AITFL (High ankle sprain)

22. Ankle Sprain G1 – RICE, Early ROM, HEP 1-3 weeks
G2 – Add ankle brace with early D/C as tolerated, then PT
3 - 6 weeks
G3 - Add NWB in cast or boot
6 weeks
MRI
Instability, osteochondral lesion, peroneal tendon tear, occult fx

23. Ankle Sprain
29m, WC, left ankle inversion injury treated for 6 months with no improvement with RICE, NSAID, PT, HEP, cam boot, PWB crutches, injection. Complains of posterior lateral, and anterior lateral pain. + ant draw, + tender along peroneals
MRI shows complete tear of ATFL and split tear of peroneus longus tendon. No OCD.
Left ankle peroneal tendon repair and ATFL recon.

24. Ankle Sprain

25. Arthritis
Ankle
TMT
1st MTPJ

26. Arthritis RICE, NSAIDS, cane, walker Walking shoes AFO bracing HEP, PT
Injections, PRP, stem cell
Xrays, CT, MRI
Sx – Deformity correction, arthroscopy, fusion, joint replacement

27. Ankle Arthritis

28. TMT Arthritis

29. 1st MTPJ arthritis
Hallux limitus, Hallux rigidus

30. 1st MTPJ Arthritis
45m, WC injury in the past, c/o great toe joint pain stiffness, decreased ROM, has done treatments of PT, HEP, NSAIDs, orthotics, injections.
Right 1st MTPJ fusion

31. 1st MTPJ Arthritis

32. Achilles Tendonopathy
Rupture
Tendonosis
Partial tears
Enthesopathy, Bone spurs
Bursitis

33. Achilles Tendonopathy
RICE, NSAIDS, cane, walker
Cushioned supportive Walking shoes
Orthotics, AFO bracing
HEP, PT
Injections, PRP
Xrays, U/S, MRI
Sx – Repair, spur resection

34. Acute Rupture Achilles Tendon
45m, 3 weeks ago playing basketball felt pop to back of Left ankle. Thought sprained ankle and would heal its on own. CityMD refereed to Community Rad for MRI. Works for ZocDoc.
Primary Repair of Achilles tendon.

35. Acute Rupture Achilles Tendon

36. Posterior Calcaneal Heel Spur
Bursitis, tendonosis, heel spur, partial tears
RICE, bracing, PT, HEP, NSAIDs
Injection into bursa

37. Posterior Heel Spur
34m, WC, left ankle injury 1 year ago, c/o back of ankle pain. MRI shows partial tear of achilles tendon at insertion with associated bursitis, and bone spurs with in the tendon
Left ankle achilles tendon repair with ostectomy and bone spure removal

38. Posterior Heel Spur

39. Posterior Heel Spur

40. Pes Planus Abducto Valgus Deformity
Posterior Tibialis Tendon Dysfunction

41. Pes Planus Abducto Valgus Deformity
Flat foot deformity
55f with chronic pain and deformity to RT foot.
Dx:
Chronic pain
Chronic plantar fasciitis
Anterior Lateral Ankle impingement
Chronic PT tendonitis/tendonosis
Flat foot deformity
Sinus Tarsi Syndrome
Left PPAV (flat foot) reconstruction

42. Pes Planus Abducto Valgus Deformity Flat foot deformity

43. Pes Planus Abducto Valgus Deformity Flat foot deformity

45. Diabetic / Charcot Foot
Skin – Dry/Keratosis, ulcers, infection
Neuro – Neuropathy, decreased protective sensation (monofiliment, vib), decreased DTR
Vasc – Decreased micro/macro vasculature
MSK – Weak intrinsics, PPAV

46. Diabetic / Charcot Foot
Dx:
DM with complications
LE neuropathy
PVD
G1 ulcer
Keratosis
Fall Risk
Osteoarthropathy
Valgus ankle deformity

47. Diabetic / Charcot Foot

48. Tarsal Tunnel Syndrome
Neuroma
Drop foot
RSD/CRPS
Coalition
Lisfranc (Midfoot, TMT) Injury
Metatarsalgia
Hallux Valgus (Bunion)
Hammer toe
Sesamoiditis
Turf Toe