foot problems in sport (article in GP 1/2/08)

synovitis (metatarsalgia)

trauma and overuse cause metatarsalgia - pain in the forefoot, a synovitis of the mtp joints
treat - nsaid, orthotics, foot stretching exercises

turf toe

forced hyperextension of big toe
nsaid + rest

stress fractures

commonest 2nd metatarsal 9 esp. if have mortons foot - ie 2nd m/t longer than the 1st

sesamoid disorders

2 sesamoid bones in tendons of flexor hallucis brevis, damaged with jump type trauma or a wrenching up of big toe
rice/ nsaid

mortons neuroma

base 3rd + 4th toes thickened nerve tissue, causes pain and numbness of webspace, usually no pain barefoot!
confirmatory test - local in intermetatarsal space
orthotics, injection, neurolysis or excision

lisfranc injury

lisfranc ligament disruption

mid foot stress fracture

sprinting/jumping/hurdling - navicular bone

mid foot tendinopathy

overuse - local tenderness/pain on passive stretch or actice resisted movt
rice/nsaid

heel pain

avoid steroid injections for plantar fasciitis - cause fat necrosis in heel pad
physio to stretch gastrocnemius

tarsal tunnel syndrome

positive tinels test behind medial malleolus

heel contusion

fat in heel acts as a shock absorber and contusions are very painful

COPD

meeting at athelhampton house - simon crowther poole hospital

learning points
- oxygen card - i am a CO2 retainer and require controlled oxygen therapy

copd - controlled oxygen therapy 28-35% maximum
35% venturi mask is yellow

2L/minute = 24% oxygen

always check concentrator value if on 2L/minute suggests they are sensitive

DVT - clexane for 5 days as is a clot buster, warfarin just stops further clotting

clexane treatment dose versus prophylaxis

immobile 48 hours predicted clexane given via protocol

CFA new name is IPF - use salbutamol if detiorates as allows more opening

clinical knowledge summaries

www.cks.library.nhs.uk

sinding-larsen-johansson syndrome

children & adolescents 10-14 years
tenderness and soft tissue swelling over inferior pole of patellae
x rays show osseous fragmentation
usually traumatic
spotaneous resolution over 3-12 months

prostatitis

Polymyalgia Rheumatica

? normal ESR

MRC Scale of Breathlessness

1. not troubled except strenuous exercise
2. short of breath when hurrying or walking up a slight hill
3. walks slower than contemporaries on level because of breathlessness or has to stop for breath whan walking at own pace
4. stops for breath after about 100m or after a few minutes on the level
5. too breathless to leave the house, or breathless when dressing or undressing

rosacea

http://www.rosacea.org/index.php

peripheral neuropathy

peripheral neuropathy

limping child

L - leg short, lose, foreign body
I - injury, capsular damage, dislocation
M - muscle strain
P - psychological, poliomyelitis
S - slipped epiphysis (10-15 years), subluxation of hip

I - infection in groin, skin
N - neoplasia

P - perthes (5-10 years)
A - arthritis juvenalis
I - infection of joints, tuberculosis
N -nervous, cerebral palsy, dysraphism, nutritional - rickets


http://student.bmj.com/issues/06/01/education/10.php

great article

dupuytren - baron a french surgeon - first of surgeons last of men

rien n'est pas tante redouter pour un homme que la mediocrite

nothing should be feared so much for a man as mediocrity

guillain barre

guillain a french neurologist barre another

G - glanduoar fever, mycoplasma or viral
U - urti may precede
I - inflammation invasion of nerve roots
L - leg weakness, then arms and then face
L - lower motor neurone weakness
A - autonomic lesions, hypotension, retention of urine and tachycardia
I - implication of respiratory muscles
N - nerves are demyelinated, paraesthesiae occurs

B - bulbar musculature affected
A - acute or subacute polyneuropathy
R - raised protein in csf
R- residual muscle weakness may occur
E - emg show pattern changes in 3-4 weeks

2/100,000 a year

possible aetiology -rarely - trauma, surgery and malignancy

if axon damaged then regeneration impossible
3 weeks of onset of viral illnbess 60%
back pain an occasional presentation
muscle weakness evolves over 3-21 days
tendon reflexes lost plantars stay normal

5% develop chronic illness

campylobacter serology - positive titres - poorer prognosis group

death 8%
33% not recovered in 12m
median recovery time 9/12

http://www.gpnotebook.co.uk/simplepage.cfm?ID=-872022009