Chapter 41: The Foot and Ankle

A patient with diabetes presents to the Accident and Emergency Department with a hot swollen foot with no breaks in the skin. How should this be managed?

A patient with diabetes presents to the Accident and Emergency Department with a swollen foot with a small superficial ulcer following an insect bite 2 days previously. How should this be managed?

A 40-year-old man felt his ankle give way 3 weeks ago running at soccer and now has calf pain and is struggling to run or climb stairs. On examination by you in the Accident and Emergency Department, he has no Ottawa signs around his ankle but has a swollen calf. You send him for a deep vein thrombosis (DVT) ultrasound scan, which comes back as negative. His Simmonds test is weakly negative (normal). What do you do now?

A patient presents with plantar fasciitis and is really struggling with low back pain that he thinks is secondary to his limp. He struggles with anti-inflammatories because of psoriasis and his foot is so sore even his toes are swollen and painful. How would you manage him?

A 22-year-old Army recruit has pain in his instep (with flat feet) that really is stopping him from running. He does not want anyone in the Army to know in case he fails to complete selection. He can single-leg tiptoe and he retains full power of inversion but he is sore in his midfoot. How would you manage him?

A 45-year-old woman presents with a persistent ulcer on the sole of her foot over her metatarsal heads that she has had debrided by the podiatrist for years. It came on after she had trodden on a piece of glass 5 years before. What do you do?