Ankle and Foot

Key Points

• Radiographs for foot and ankle imaging should be weight bearing if a fracture does not preclude it.

• Radiographs are not necessary in all cases of suspected ankle sprain.

• Early mobilization with external supportive device usually leads to a quicker recovery from ankle sprain, although it may not affect the long-term outcome.

• Surgical repair of Achilles tendon tears leads to a reduced risk of rerupture, although surgical complications exist.

• Although corticosteroid injections can provide short-term relief of plantar fasciitis pain, no single intervention appears superior to another.

• Fractures through the watershed area of blood supply in the proximal fifth metatarsal (Jones' fracture) has a high risk of nonunion/malunion and is often best treated surgically.

The foot and ankle are complex structures that provide the foundation to the musculoskeletal system and are intimately related to a person's ability to ambulate, run, jump, and traverse unstable and variable terrain. Optimal foot and ankle function implies a higher level of function for activities of daily living. Thorough examination and imaging should consider a broad differential diagnosis of common problems, ranging from ligament sprains, stress fractures, fractures and avulsions, chronic tendinopathies, and tendon ruptures. A more expansive differential diagnosis includes nerve entrapment, circulatory dysfunction, and systemic disease, as well as congenital and developmental problems. All x-ray imaging of the foot and ankle for pain should be weight-bearing views in the absence of suspicion of a fracture, to allow a more accurate clinical picture because the patient usually experiences pain when weight bearing and not at rest (Stiell et al, 1992, 1993).

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