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Foot and ankle disorders
Published in Maneesh Bhatia, Tim Jennings, An Orthopaedics Guide for Today's GP, 2017
Once you have excluded infection (normal C-reactive protein [CRP]) and gout (normal uric acid), the most common cause of acute onset of pain and swelling of the foot is a stress fracture usually involving a metatarsal. The clinical examination will reveal swelling and marked bony tenderness. It can take 2–3 weeks for a stress fracture to show up on x-rays. Sometimes, x-rays do not show stress fractures, but there is persistent swelling and pain. In these cases, an MRI scan shows stress response or bone marrow oedema of a metatarsal or tarsal bone. Treatment is rest in a walking boot or plaster. In cases of recurrence, it is important to check Vitamin-D levels, conduct a DEXA scan to rule out osteoporosis or osteopenia and make sure that there is no significant foot deformity. A severe hindfoot varus can cause a stress fracture of the fifth metatarsal base, whereas a severe hallux valgus can lead to a stress fracture of the second or third metatarsals.
Lower extremity fractures
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Megan M. May, Vinitha R. Shenava
There is a wide spectrum of tibial shaft fractures encountered in children. The “toddler’s fracture” occurs most frequently in children under 3 years old during a relatively benign twisting mechanism that often is not witnessed by parents and leaves the child limping. X-rays may initially be normal or may show a nondisplaced spiral fracture of the distal tibial metaphysis [76]. These are stable injuries and are treated with immobilization in a weight-bearing cast or walking boot for 3–4 weeks.
Achilles tendon rupture
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Manuel Monteagudo, Pilar Martínez de Albornoz
The benefits of early motion and early protected weight-bearing have been well documented in animal models (15). Mechanical loading of a healing Achilles tendon induces the stimulation of fibroblasts which produces a stronger tendon repair. Protocols for functional rehabilitation involve immobilisation in a plaster cast with maximum passive plantarflexion and non–weight-bearing for the initial 2 weeks (14). The patient is then placed in a walking boot with around 40° heel wedges and protected weight-bearing with crutches is allowed. Functional treatment should ideally be supervised by a physiotherapist and an orthopaedic surgeon so as to improve patient compliance, which is the key to a good outcome. From the 3rd to the 6th week patients are advised to progress with weight-bearing and a heel wedge is removed every week from the 3rd week. Commercially available specialist hinged boots are now available, which allow the physiotherapist/surgeon to adjust and lock the ankle at varying (reducing) angles, as required. A detailed protocol of functional rehabilitation following non-surgical and surgical treatments is outlined in Table 14.3. Patients are advised to match the height of the boot on the uninjured side to reduce stress on other joints. Appropriate thromboprophylaxis should be prescribed for the first 4 weeks to avoid deep venous thrombosis. It is very important to avoid dorsiflexion beyond 90° during the first 4 months and that the patient understands that the Achilles will still be vulnerable within those first 4 months and that any sudden loading may end up in a re-rupture. From the 10th to the 16th week post rupture, the two most important complications – elongation and re-rupture – may be more common because of the patient returning to previous daily activities out of the boot.
The clinical application of pain neuroscience, graded motor imagery, and graded activity with complex regional pain syndrome—A case report
Published in Physiotherapy Theory and Practice, 2020
Mark Shepherd, Adriaan Louw, Jessie Podolak
The patient was a 57-year-old female (1.75 m and 79 kg) referred to outpatient PT four months after she tripped down her home staircase causing a right ankle inversion sprain and avulsion fracture of her right talus. The patient was immobilized with a hard cast at this time and progressed to a controlled ankle motion (CAM) walking boot. While in the CAM boot, the patient was unable to bear weight due to increased pain, therefore a knee scooter was used for mobility. During this time, the patient continued to develop progressive sensitivity of her right foot that spread to her ankle. The week prior to the PT evaluation, she was told that she had developed CRPS by her physician. Following this, the patient searched the Internet for CRPS and reviewed pictures and websites that highlighted the negative effects of this condition.
Beach tennis injuries: a cross-sectional survey of 206 elite and recreational players
Published in The Physician and Sportsmedicine, 2020
Marco Berardi, Pascal Lenabat, Thierry Fabre, Richard Ballas
Two injuries required surgical treatment: an anterior cruciate ligament tear in the knee and a dislocation of the metatarsophalangeal joint in the hallux. The dislocations of hallux were reduced on-site in two cases and by closed reduction in the emergency room in the other two cases. The dislocations and sprains of hallux were all treated non-surgically by immobilizing the foot in a walking boot for 1 month.
Dehydrated human amnion and chorion allograft versus standard of care alone in treatment of Wagner 1 diabetic foot ulcers: a trial-based health economics study
Published in Journal of Medical Economics, 2020
To simplify cost calculations all offloading devices were assumed to be the removable diabetic offloading cam-walkers (boots) used in the trial as true total contact casting rarely occurred. In group 1, 29/40 of wounds (72.5%) were offloaded, while in group 2, 31/40 of wounds (77.5%) were offloaded. A new walking boot was provided 4 times a year.