The EM Educator Series: Ankle and Foot can’t-miss diagnoses

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case 1:

A 19-year-old male presents with left ankle pain after an ankle inversion injury sustained while playing soccer. His ankle is swollen and tender along the lateral malleolus.

Case 2:

A 44-year-old female presents with severe mid-foot and plantar surface pain after stepping down from a horse she was riding. You find significant plantar surface bruising and pain to palpation.

Considerations:

• What are important features of the history and exam for patients with foot or ankle injury?
• What comprise the Ottawa ankle/foot rules?
• How can patient with a ruptured Achilles tendon present, and what are important exam and imaging findings?
• What are important considerations in patients with ankle fractures or suspected dislocation?
• How do you interpret foot and ankle x-rays?
• What are features of a syndesmosis injury? Why are these important to diagnose?
• What comprises a Maisonneuve fracture?
• How can a calcaneus fracture present? What other injuries should you consider? What imaging should you obtain?
• Why are talus fractures often missed? When should they be considered?
• What is a Lisfranc fracture? What are the exam features, and what should you look for on radiograph?
• What is the difference between a pseudo-Jones and Jones fracture?
• What are several types of foot infections found in diabetic patients? How should these be managed?
• What is a Charcot joint?

Suggested Resources:

• Articles:
  • ALiEM – Ankle exam
  • MD Calc – Ottawa ankle rule
  • CORE EM –Achilles Tendon Rupture
  • CORE EM –Ankle Fractures
  • Ortho Bullets –Ankle Fractures
  • ALiEM –Ankle Dislocation
  • Emergency Medicine Cases –Commonly Missed Ankle Injuries
  • Don’t Forget the Bubbles –Ankle X-rays
  • ALiEM – Traumatic Foot X-ray
  • ALiEM – Traumatic Ankle X-ray
  • CORE EM – Calcaneus fractures
  • Ortho Bullets – Calcaneus fractures
  • Ortho Bullets – Talus fractures
  • CORE EM – Lisfranc Injuries
  • CORE EM – Jones Fractures
  • EM@3AM – 5^th metatarsal fractures
  • emDocs – Diabetic Foot Infections
  • emDocs – Osteomyelitis
  • emDocs – Charcot Joint
• Journal Articles
  • Emergency Medicine Clinics of North America – Foot and Ankle Pain