Foot and Ankle Surgery
Core rules
- Ankle fracture stability depends on the mortise and ligaments, not fracture size alone; Weber classification and stress views guide fixation.
- Achilles tendon rupture presents with a palpable gap, weak plantarflexion and positive Thompson test; treatment is non-operative or surgical based on patient factors.
- Diabetic foot ulcers need offloading, infection control and vascular assessment; Charcot arthropathy requires immobilization to prevent collapse.
- Lisfranc injury can be subtle; weight-bearing radiographs or CT help when midfoot pain and instability persist.
- Hallux valgus surgery is for pain and function, not cosmetic appearance alone.
Worked example
A 58-year-old diabetic presents with a warm swollen midfoot but no ulcer. Reasoning: suspect Charcot neuroarthropathy, offload in a total-contact cast, assess perfusion and infection, and avoid immediate weight bearing. Missing this leads to rocker-bottom deformity.
Traps
Do not treat every ankle fracture with a cast. Do not miss Lisfranc instability. Do not ignore vascular status in diabetic foot disease.
Key points are listed separately.