Introduction Foot and ankle problems are quite common in the community. To put this in perspective at any given time 10-15% of population suffers from heel pain alone. Unfortunately, due to a number of interlinked structures it can be hard to diagnose and treat these problems. There are 26 bones, 33 joints and over 100 muscles, tendons and ligaments involving foot & ankle. It would not be realistic to expect from a GP a detailed knowledge regarding anatomy and pathology of all these structures. The objective of this chapter is to help the GP understand the management of common foot and ankle problems seen in the primary care. Fortunately, in most cases there is a well localised area of pain and tenderness. In my experience eliciting localised …show more content…
It is important to consider the diagnosis of Achilles rupture when examining a patient with calf or ankle injury. Alarm bells should ring regarding possible Achilles rupture if a patient tells you that it felt as if he/she was kicked in the calf. Examination: A gap can be palpable at the site of rupture (usually 2-6 cm proximal to insertion). However, this becomes difficult with a delayed presentation. The most reliable clinical test is calf squeeze test (also known as Simmonds or Thompson’s test). This test has sensitivity of 0.96 and specificity of 0.93. The second test to aid the diagnosis is single heel raise test. If there is plantar flexion on calf squeeze and patient is able to perform single heel raise, Achilles rupture is highly unlikely. (Fig 10.3) The other clinical finding seen in cases of an Achilles rupture is excessive dorsiflexion of the ankle on the ruptured side. What are the treatment options for Achilles rupture? Historically this injury was treated by either open surgery or non-surgically in plaster cast. Those who would favor surgery would quote high re rupture rate (13%) with the non-surgical treatment. On the other hand, wound-healing complications (5%) were reported with open surgical