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Differential Diagnosis of Musculoskeletal Disorders

Abnormal Foot Positions!!navigator!!

  1. FOREFOOT
    1. Varus = adduction
      = axis of 1st metatarsal deviated medially relative to axis of talus
    2. Valgus = abduction
      = axis of 1st metatarsal deviated laterally relative to axis of talus
    3. Inversion = supination
      = inward turning of sole of foot
    4. Eversion = pronation
      = outward turning of sole of foot
    5. HINDFOOT
      talipes = any deformity of the ankle and hindfoot
      [talus, Latin = ankle; pes, Latin = foot]
      1. Equinus
        = hindfoot abnormality with reversal of calcaneal pitch so that the heel cannot touch the ground
      2. Calcaneal foot
        = very high calcaneal pitch so that forefoot cannot touch the ground
      3. Pes planus = flatfoot
        = low calcaneal pitch + (usually) heel valgus + forefoot eversion
      4. Pes cavus
        = high calcaneal pitch (fixed high arch)

Clubfoot = Talipes Equinovarus!!navigator!!

Common severe congenital deformity characterized by

  • equinus of heel (reversed calcaneal pitch)
  • heel varus (talocalcaneal angle of almost zero on AP view with both bones parallel to each other)
  • metatarsus adductus (axis of 1st metatarsal deviated medially relative to axis of talus)
  1. Arthrogryposis multiplex congenita
  2. Chondrodysplasia punctata
  3. Neurofibromatosis
  4. Spina bifida
  5. Myelomeningocele

Rocker-bottom Foot = Vertical Talus!!navigator!!

  • vertically oriented talus with increased talocalcaneal angle on lateral view
  • dorsal navicular dislocation at talonavicular joint
  • heel equinus
  • rigid deformity

Associated with: Arthrogryposis multiplex congenita; spina bifida; trisomy 13–18

Talar Beak = Hypertrophied Talar Ridge!!navigator!!

  1. Talocalcaneal type of tarsal coalition
  2. Diffuse idiopathic skeletal hyperostosis (DISH)
  3. Acromegaly
  4. Rheumatoid arthritis

Heel Pad Thickening!!navigator!!

= heel pad thickening >25 mm (normal <21 mm)

mnemonic: MAD COP

  • Myxedema
  • Acromegaly
  • Dilantin therapy
  • Callus
  • Obesity
  • Peripheral edema

Soft-tissue Masses of Foot + Ankle!!navigator!!

  1. NONTUMORAL
    1. synovial proliferations
      1. Pigmented villonodular synovitis (PVNS)
      2. Giant cell tumor (GCT) of tendon sheath
    2. posttraumatic
      1. Plantar fasciitis
    3. inflammatory
    4. uncertain origin
      1. Ganglion cyst
      2. Epidermoid cyst
      3. Morton neuroma
      4. Florid reactive periostitis
      5. Rheumatoid nodules
  2. BENIGN TUMORS
    1. Plantar fibromatosis
    2. Deep fibromatosis
    3. Infantile digital fibromatosis
    4. Hemangioma
    5. Nerve sheath tumor
    6. Lipoma, angiolipoma

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