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Physician Assistant Exam: Conditions of the Foot

You should know about several medical conditions affecting the feet that may pop up on the Physician Assistant Exam (PANCE). Your feet are your friends — they get you where you need to go — and you should care about your friends.

The soft tissues of the foot

Sprains and strains of the foot are common, especially among athletes. For example, football players can sprain the first metatarsophalangeal (MTP) joint, a condition commonly known as “turf toe.” Recall that the first MTP joint is the one most usually affected by gout.

You see chronic sprain and strains in the foot more often in the older population. Different grades of sprains affect the foot.

Ottawa rules for the foot state that a radiograph should be obtained in the following circumstances:

  • The affected person feels pain in the middle of the foot and can’t bear weight on the foot immediately after an injury (or at the time of examination by a medical professional).

  • The affected person has tenderness either at the fifth metatarsal (the most lateral bone of the foot) or at the navicular bone (the most medial).

Stress fractures

Stress fractures are common causes of injury, especially for runners and people in sports like tennis and basketball. What do these have in common? A lot of running back and forth; sudden starts, stops, and pivots; and a lot of force and trauma to the foot and ankle with each step. Just having the foot strike the ground is a contributor. Playing on a hard surface doesn’t help much, either.

Continued repetition and overuse, plus or minus bad footwear, contribute to the development of stress fractures. The most common location for stress fractures is the metatarsals, predominantly the second and third metatarsal. Other places can include the calcaneus and the navicular bones.

You need to order radiographs to evaluate the severity of a stress fracture in the foot. Depending on where the fracture is, the treatment can involve stabilization (immobilization) or surgery to reduce the fracture.

The bottom of the foot: Fascia

A common medical problem affecting the bottom of the foot is plantar fasciitis. The affected person feels pain along the bottom of the foot, especially with the first few steps after long periods of rest, such as early in the morning.

Common reasons for the inflammation include poor footwear, flat feet, high arches, intense exercise, and obesity. Plantar fasciitis is more common in men than women. The patient usually has a point of maximal tenderness at the anteromedial region of the calcaneus.

The treatment for plantar fasciitis can involve losing weight, getting arch supports or better footwear, and taking anti-inflammatories and pain medication. Gentle massage to the area can help as well.

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