Foot and Ankle Surgery
Concepts
Foot and ankle questions pair fracture patterns with weight-bearing decisions. Ankle fractures: Weber classification (A below the syndesmosis, B at the level, C above) and Lauge–Hansen mechanism (supination–external rotation is most common). Always assess the syndesmosis with squeeze and external rotation tests; widened medial or tibiofibular clear space indicates instability requiring fixation. Use the Ottawa ankle rules to decide when to image.
Trap: calling a Jones fracture a sprained ankle. A Jones fracture sits at the metaphyseal–diaphyseal junction, has precarious blood supply and a high nonunion rate; it differs from a proximal tuberosity avulsion (pseudo-Jones), which is managed symptomatically.
Other high-yield topics: Lisfranc injury (plantar ecchymosis, widened interval between the first and second metatarsal bases), Achilles rupture (positive Thompson test, palpable gap, weak plantarflexion), plantar fasciitis (first-step pain, medial calcaneal tenderness), hallux valgus, and the diabetic foot. Charcot arthropathy presents as a red, hot, swollen foot in a neuropathic patient - offload and immobilize; do not biopsy or rush to surgery.
Rule of thumb: in a diabetic patient with a warm swollen foot and no systemic signs, think Charcot before cellulitis; obtain weight-bearing radiographs and offload.
Worked example: a middle-aged athlete felt a pop and cannot perform a single-leg heel raise - Achilles rupture; a Thompson test confirms and warrants early surgical referral.