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Foot And Ankle Pain

Ankle Sprain

Very common injury in athletes

The usual cause is inversion stress (see picture—>)

There is ligament injury/tear—>bleeding from torn ligament blood vessels—> swelling and bruising

Pain is diffuse and is worse with walking

Exam shows swelling and bruising on the outer side of ankle

X-rays is recommended to rule out fracture

Treatment: ankle brace ,Ice, elevate, Ibuprofen and early walking as tolerated

Gout

Gout is caused by increase in Uric Acid concentration in blood leading to deposits of its crystals in and around joints

Gout can be genetic but can be caused by kidney disease and obesity

Uric acid is a product of Purine (protein) metabolism and diet rich in protein can precipitate gout attack

Alcohol ingestion can alter Purine metabolism to produce more uric acid

Classic gout occurs at the base of big toe (1st MTP joint), it causes swelling, redness, warmth and intense throbbing pain

Almost any joint can be affected by gout

Treatment: NSAIDs, Colchicine, Steroids

For frequent gout attacks —> prevention is recommended with Allopurinol and dietary modification

Other causes of foot pain

1-Plantar Fasciitis: inflammation and degeneration of the plantar fascia at its origin in the heel bone

  • Risk factors include: excessive walking or standing, poorly cushioned footwear, obesity and running
  • Exam shows focal tenderness in the sole near the heel
  • Treatment:rest, NSAIDs, stretching exercises, better cushioned shoes.

2-Tarsal Tunnel Syndrome :is caused by posterior tibial nerve compression,

  • It causes pain and numbness at the back inner side of heel shooting to the front of sole
  • Treatment: NSAIDs,Orthotics and activity modification

3-Morton Neuroma: interdigital nerve injury causing pain between Metatarsal heads and the sensation of walking on pebbles

  • Treatment is better footwear and padding Steroid injection may provide some relief Surgery is last resort
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