Foot Pain

Foot Pain
dr. Elizabeth Budiani
Supervisor : dr. Sumariyono, SpPD, K-R, MPH

Anatomy, Biomechanics, and
Function of the Feet
2
Ankle and Foot
3
Moore KL, DalleyAF, AgurAMR. Lower Limb. In: Clinically Oriented Anatomy. 8th ed. Wolters Kluwer.
Neumann DA. Ankle & Foot. In: Kinesiology of the Musculoskeletal System Foundations for Rehabilitations. 3rd ed. Elsevier;
Functional Area of Foot
Hindfoot/Rearfoot
• Talus + calcaneus
• First part of the foot that contacts the ground
Midfoot
• Navicular, cuboid, 3 cuneiform
• Provide stability and mobility
Forefoot
• 5 metatarsals + all the phalanges
• Adapts to the level of the ground
4
Joints of the Foot
Ankle Joint
Talocrucral joint (tibia, fibula, and talus)
allows dorsiflexion (0-300) and plantarflexion (0-50 0)
Lower Ankle Joint

Subtalar joint, transverse tarsal joint
allows inversion and eversion
Forefoot Joint
Tarsometatarsal (TMT) joint, metatarsophalangeal (MTP)
joint, IP, PIP, DIP joint
MTPJ midfoot and forefoot stabilization in push-off
5
Ligaments of the Foot
6
Foot Function
1 Support 4 Adjustment to irregular

surfaces
2 Control & stabilization 5 Elevation of the body
3 Shock absorption 6 Compensation of formal

alignment or pathomechanics
7
S SITE
O ONSET
C CHARACTERISTIC
Pain R RADIATION
Assessment A ASSOCIATED SYMPTOMS
T TIME/DURATION
E EXACERBATING OR RELIEVING FACTORS
S SEVERITY
8
Musculoskeletal Structure Healing Time
9
Kirkby Shaw K, Alvarez L, Foster SA, Tornlinson JE, Shaw AJ, Pozzi A. Fundamental principles of rehabilitation and musculoskeletal tissue healing. Vet Surg 2020 Jan; 49(1):22-32
Ankle Pain
10
11
GrantC,HerreraJE.ManualofMusculoskeletalMedicine.LWW;2008
Ankle Sprain
Stretching or tearing of the ligaments of the ankle
● 85% of ankle sprain  lateral ankle sprain
● Injured ligament :
1. Anterior talofibular ligament (ATFL)
2. Calcaneofibular ligament (CFL)
3. Posterior talofibular ligament (PTFL)
● Mechanism of injury : inversion on a plantar-flexed foot
(“rolling over” the ankle)
Anterior drawer test Talar tilt External rotation test Squeeze test
12
CuccurulloSJ.PhysicalMedicineandRehabilitationBoardReview.SpringerPublishingCompany;2020;.WyssJF,PatelAD.TherapeuticProgramsforMusculoskeletalDisorders.BarryB, editor.NewYork:DemosMedicalPublishing;2013.
MelansonSW, Shuman VL. Acute Ankle Sprain. [Updated 2022 May 29]. In: StatPearls[Internet]. Treasure Island (FL): StatPearlsPublishing; 2022 Jan-.
Ankle Sprain – Diagnostic Examination
Ankle radiograph – Ottawa ankle rules
MRI is not routinely indicated
 Should be considered if the symptoms
persist >6 weeks despite of aggressive
conservative treatment
13
SyrowatkaA. Understanding the Role of the Ottawa Ankle Rules in Physicians' Radiography Decisions: A Social Judgment Analysis Approach. 2012
MelansonSW, Shuman VL. Acute Ankle Sprain. [Updated 2022 May 29]. In: StatPearls[Internet]. Treasure Island (FL): StatPearlsPublishing; 2022 Jan-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK459212/.php
Ankle Sprain – Treatment
Grade 1 and 2 Grade 3
● Acute phase Conservative vs surgical

-Rest, ice, compression, elevation (RICE), ● 6-month trial of rehabilitation and bracing
analgesics, immobilization ● Ligament repair, tenodesis of peroneus brevis
-Early mobilization ● For high performance athlete which fails in
● Conservative : rehabilitation conservative treatment  surgical
-PT : ROM exercise, strengthening, reconstruction can be considered as early as 3
proprioceptive exercise, taping, orthosis months post injury
(brace) ● Indication for surgery : large bony avulsion,
-Modalities : US, SWD, contrast bath, severe ligamentous damage on medial or lateral
moist heat, warm whirlpool side of ankle, severe recurrent injuries
14
Cuccurullo SJ.Physical Medicine and Rehabilitation Board Review.Springer Publishing Company; 2020
Peroneal Tendon Injury
Mechanism of injury :
● Tenosynovitis or rupture
Repetitive forceful eversion  inflammation or degeneration of tendon or
synovium (behind lateral malleolus to the insertion point)
● Subluxation or dislocation
Sudden dorsiflexion of ankle  subluxation or dislocation of peroneal tendon
(skiing injury)
15
Peroneal Tendon Injury
Clinical manifestation
● Painful swelling at lateral retromalleolar area
● Sudden weakness + inability to actively evert the foot (for suspected subluxation/dislocation
● Popping sensation in lateral aspect of ankle
● Provocative test : Pain with resisted dorsiflexion and eversion
Diagnostic studies
● No need of imaging, MRI if indicated
● US with ankle in dorsiflexed and everted position may help visualize peroneal tendon
subluxation
Treatment
● Tenosynovitis : same as lateral ankle sprain
● Rupture/subluxation/dislocation  orthopedic evaluation  immobilize for 4-6 weeks in plantar flexed
position
16
Anterior Ankle Impingement
Ankle impingement : chronic painful mechanical limitation of the ankle caused by soft tissue or
osseus abnormalities
● Anterior : most commonly related to bone spurs of anterior tibial plafond
 Typically seen in athletes with repetitive, forced dorsiflexion (e.g. dancer)
● Anterolateral : entrapment of hypertrophic soft tissue or torn and inflamed ligaments in
lateral gutter and anterolateral ankle joint
 due to mechanical factors, traction, trauma, recurrent microtrauma, and/or ankle
instability
● Anteromedial : repeated microtrauma followed by synovitis and capsular thickening,
anteromedial spurs may exist due to bony injury and cartilage damage
17
Nery C, Baumfeld D. Anterior and posterior ankle impingement syndrome: arthroscopic and endoscopic anatomy and approaches to treatment. Foot Ankle Clin N Am. 2021; 26:155-72
Grant C, Herrera JE. Manual of Musculoskeletal Medicine. LWW; 2008
VaseenonT, Amendola A. Update on anterior ankle impingement. CurrRev MusculoskeletMed. 2012 Jun;5(2):145-50. doi: 10.1007/s12178-012-9117-z. PMID: 22403038; PMCID: PMC3535150.
Anterior Ankle
Treatment
Impingement ● PRICE
Clinical presentation ● For athlete/dancer patients: assess the
● Anterolateral, anterior, or anteromedial technique, ensure to not place undue stress
tenderness, swelling, pain on single leg squat, on the anterior ankle
pain on ankle dorsiflexion and eversion/inversion ● Antraarticular steroid and anesthetic
● Snapping and popping may occur during injection  ideally performed under USG
dorsiflexion guidance
● Occasionally, place the patients in the
walking boots
Diagnostic studies ● Surgical intervention may be necessary in
● Radiograph may be helpful resistant cases
● MRI has low sensitivity, but may ● Arthroscopic excision of any offending
be helpful to exclude other osteophyte and/or debridement of the
potential pathologies capsule
18
VaseenonT, Amendola A. Update on anterior ankle impingement. CurrRev MusculoskeletMed. 2012 Jun;5(2):145-50. doi: 10.1007/s12178-012-9117-z. PMID: 22403038; PMCID: PMC3535150.
Ankle Osteoarthritis
Degeneration of cartilage within the tibiotalar joint
Etiology : wide range of causes, most commonly due to post traumatic
degenerative joint disease (75% secondary to periarticular fracture, 13% due to
chronic unresolved ligament instability)
Clinical features :
● Gradually increasing pain in ankle joint, primarily in anterior ankle, pain
exacerbated with weight bearing
● Ankle stiffness and swelling
● History of ankle trauma
Physical examination : antalgic gait, mild effusion, ROM often reduced
Diagnostic studies :
● Plain radiograph (AP/lateral view with weight bearing) : sufficient in later
stages of the disease
● MRI : may show damage to articular cartilage and joint effusion in earlier
course of the disease
19
Grant C, Herrera JE. Manual of Musculoskeletal Medicine. LWW; 2008.
Herrera-Pérez M, González-Martín D, Vallejo-Márquez M, Godoy-Santos AL, ValderrabanoV, TejeroS. Ankle Osteoarthritis Aetiology. J Clin Med. 2021 Sep 29;10(19):4489. doi: 10.3390/jcm10194489. PMID: 34640504; PMCID: PMC8509242.
Ankle Osteoarthritis
Management
● Initial : pain relief, reduce inflammation (NSAID, simple analgesic)
● Orthosis (medial/lateral wedge, AFO): maintain correct alignment, limit mobility
For patients using AFO  exercise should be continued to maintain
joint flexibility
● Walking stick or cane
● Mobilization, stretching techniques, ROM exercises  may help alleviate pain and
stiffness
● Strengthening of surrounding muscle group and proprioceptive rehabilitation 
enhance stability
● Intra articular steroid injection (preferably USG-guided or fluoroscopic-guided)
When aggressive conservative care in insufficient  consider surgical option (ankle
arthrodesis and total ankle replacement)
20
Tejero S, et al. Conservative treatment of ankle osteoarthritis. J Clin Med. 2021 Oct; 10(19):4561
Achilles Tendonitis
Mechanism of injury Management

● Relative rest, ice, anti-inflammatory
Repetitive eccentric overload 
● Rehabilitation : short-term immobilization using
inflammation and microtears of tendon
splinting or bracing, stretching and strengthening,
heel lift exercise
Clinical presentation
● Do not inject corticosteroid into Achilles tendon
● Posterior ankle pain, swelling
 risk of rupture
● Pain elicited on push off
 corticosteroid decrease metabolic
● If the location of maximal tenderness is rate of chondrocytes and
adjacent to tendon attachment  consider fibrocytes weakened structural
retrocalcaneal bursitis integrity of tendon and articular
cartilage
21
Achilles Tendon Rupture
Mechanism of injury Management
● Inflammatory : inflammation & ● Conservative : immobilize ankle
degeneration  series of microruptures or (casting program) in mild plantar
breakdown in collagen fibers flexion gradually move to neutral
● Vascular : inadequate vascularization 2-6 cm position; followed by physical therapy :
proximal to tendon insertion site focused on gentle stretching and
● Mechanical : sudden push-off with foot in
strengthening
extension position (e.g. landing from a jump)
● Surgery : more appropriate for younger,
active patients who wish to return to
competitive sport
Sudden audible sound, swelling, echymosis,
plantar flexion weakness, Thompson’s test (+)
22
Posterior Ankle Impingement
Compression of soft tissues between posterior process of calcaneus and
posterior tibial border during plantarflexion of the ankle
● Common in dancers and athletes who perform in plantarflexion position
(e.g. ballet dancer with en ponte and demi pointe position)
● Prominent os trigonum can cause additional bony impingement
Clinical features
Tenderness over the inferior edge of fibula
Pain exacerbated when ankle is moved into plantar flexion position while maintaining compression over
inferior fibula and calcaneus
Treatment
PRICE, steroid/anesthetic injection (preferable USG-guided) in area between os. Trigonum and talus and/or
calcaneus
Surgical treatment in resistant cases
23
Tarsal Tunnel Syndrome
Compression of posterior tibial nerve within tarsal
tunnel (under flexor retinaculum of medial
malleolus)
Etiology
● Diffuse medial ankle pain
● Extrinsic causes : poorly-fitted shoes, anatomic-
● Paresthesia (incl. Burning, tingling, and/or
biomechanical abnormalities, trauma, post
numbness) commonly occur over medial ankle
surgical scarring, generalized lower extremity
over tarsal tunnel and radiates into the arch of
edema, etc
foot
● Intrinsic causes : space-occupying lesion
● Symptoms exacerbates with running or other
(ganglion cyst, lipoma, varicose vein),
activities, relieve with rest
tendinopathy, tenosynovitis, osteophyte,
● Nighttime pain may also be found
hypertrophic retinaculum, etc
● Occasionally, the pain and paresthesia may
radiate to distal lower leg
24
Kiel J, Kaiser K. Tarsal Tunnel Syndrome. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513273/
Tarsal Tunnel Syndrome
Physical Findings
● Positive Tinel test
● Atrophy of intrinsic muscles in severe cases
● Numbness may be detected over the medial and posterior
calcaneus and/or arch of the foot
Diagnostic Studies
Electromyography : confirm the diagnosis and rule out other potential pathologies
Management
● Analgesic, anti-inflammatoric agent, neuropathic pain medications
● Calf stretching, nerve gliding, US, kinesiotaping, tibialis posterior muscle strengthening
● Orthosis (orthotic shoes, medial heel wedge)  correct biomechanical abnormalities, reduce traction
● Steroid and anesthetic injection (preferable USG guided) unto the tunnel can be effective
● If aggressive conservative treatment cannot eliminate the symptoms  surgical decompression may be needed
25
Kiel J, Kaiser K. Tarsal Tunnel Syndrome. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513273/
Flexor Hallucis Longus Tendonitis
Inflammation of flexor hallucis longus tendon (which act as great toe plantar flexor)  due to repetitive push-off
maneuvers causing inflammation of the synovium or tendon
Also known as Dancer’s tendonitis
● Tenderness along the posteromedial aspect of ankle to great toe
● Increase pain with active plantar flexion and active dorsiflexion
● Decrease ability to flex the great toe
Physical Examination
● Weakness in 1st MTP during plantarflexion
● Symptoms elicited during standing on affected foot while repeatedly plantarflexing the foot
● Usually no tenderness in tarsal tunnel area because the tendon runs deeply in the tunnel
26
Flexor Hallucis Longus Tendonitis
Diagnostic Studies : USG and/or MRI may be helpful to confirm the diagnosis and rule
out other pathologies
Management
● PRICE, activity modification
● Strengthening exercise
● Orthosis for patients with flat foot or hyperpronated foot
● Injection of steroid and anesthetic agent in the tarsal tunnel (preferably USG-guided)
● If the symptoms persist after aggressive conservative management  surgical debridement
27
Foot Pain
28
29
Plantar Fasciitis
Medial plantar heel pain due to inflammation of plantar fascia
Etiology :
● Increase tension on plantar fascia (e.g. due to pes cavus, pes planus, obesity, tight
Achilles tendon, bone spur)
 Increase subtalar joint pronation  stretch plantar fascia
 Pes planus  rigid foot type, cannot absorb shock at heel strike  places more
stress limited dorsiflexion
● Associated with HLS-B27, seronegative spondyloarthropathy
Clinical manifestation :
● Pain over medial aspect of heel and entire plantar fascia, worsen in the morning or at
the beginning of weight-bearing activity after period of inactivity, decrease during
activity or at rest
● Walking for long distances may also exacerbate symptoms
30
Delisa JA, frontera WA. Delisa’s physical medicine & rehabilitation principl es and practice. 5 ed. Vol. 1. Philadelphia: LIPPINCOT WILLIAMS & WIL KINS; 2010.
CuccurulloSJ.Physical MedicineandRehabilitationBoardReview.SpringerPublishingCompany;2020;
Plantar Fasciitis
● Point tenderness over medial calcaneal tuberosity that reproduce
patient’s symptoms
● Passive dorsiflexion may also be painful
● Positive windlass test
Treatment
● NSAID, ice, stretching of plantar fascia and Achilles tendon
● Orthosis : shoe modifications (heel pads, cushion, lift), night splint
to hold ankle in dorsiflexion
● ESWT, kinesiotaping, laser
● Injection
31
CuccurulloSJ.Physical MedicineandRehabilitationBoardReview.SpringerPublishingCompany;2020;
Pes Planus (Flat Foot)
Foot deformity which defined by loss of medial longitudinal arch of foot
Etiology
● Congenital : due to ligamentum laxity or lack of neuromuscular control
● Acquired : posterior tibial tendon dysfunction (PTTD), trauma to midfoot
or hindfoot, arthropaties
 Can be caused by abnormalities, such as excessive internal rotation of tibia
causing pronation of foot or malalignment of calcaneus
Management
● Symptomatic relief of pain by controlling excess pronation of the foot
● Orthosis : medial arch support, Thomas heel extension
32
Raj MA, Tafti D, Kiel J. Pes Planus. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430802/
Pes Cavus
● Foot deformity characterized by elevation of the longitudinal
plantar arch of the foot
● Excessive pressure along the heel and metatarsal head areas 
causing pain
● The high point of arch is located at talonavicular joint
● Orthosis : the lift is extended to metatarsal head area to help
distribute and alleviate pressure over the metatarsal weight-
bearing area
33
Hallux Valgus (Bunion)
Lateral deviation of great toe > normal angle (15 0) between tarsus and
metatarsus  leads to painful prominence of medial aspect of MTP 1
● Prominence over 1st metatarsal head, often painful
● Pain aggravates while wearing certain shoes, relieved by taking off the
offending shoes
● Patient may occasionally complain of concomitant burning, numbness,
and/or tingling sensation over dorsal aspect of prominence  due to
irritation of medial dorsal cutaneous nerve
Physical examination
● Prominence over 1st metatarsal head
● ROM may be restricted
● Inspect the skin and other toes for associated deformity
34
Frontera WR, Silver JK, Rizzo TD. Essentials of Physical Medicine and Rehabilitation Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Vol. 4. Philadelphia: Elsevier Inc.; 2019.Valderrabano ;
Grant C, Herrera JE. Manual of Musculoskeletal Medicine. LWW;2008
Hallux Valgus (Bunion)
Diagnostic studies
● Radiographic examination (WB and NWB) to assess degree of
angulation as well as any associated bony abnormalities
Treatment
● NSAID and analgesic to relieve pain
● Shoes with wide and deep toe boxes, orthotic may be considered
● Tight fitting shoes (and high heels in particular) should be avoided
● Stretching or toe spacer may be useful
● Exercise : toe spread out
● Surgical management, include osteotomy and resectional arthroplasty
(based on patient symptoms, degree of deformity, comorbidities, risks,
and patient expectations)
35
Frontera WR, Silver JK, Rizzo TD. Essentials of Physical Medicine and Rehabilitation Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Vol. 4. Philadelphia: Elsevier Inc.; 2019.Valderrabano ;
Grant C, Herrera JE. Manual of Musculoskeletal Medicine. LWW;2008
Hallux Rigidus
Hallux rigidus : osteoarthritis of 1 st MTP joint
 believed to be primarily a disease of overuse from repetitive wear &
tear and hyperextension
● Pain and stiffness in great toe
● Pain exacerbated while using tight shoes, running, or other weight
bearing activities
● Antalgic gait
● Tenderness over 1st MTP, pain increases with resisted dorsiflexion of the joint
● An osteophyte may be palpable and tender on the dorsal aspect of the joint
● Gait may be antalgic, with patient favouring unaffected side and limiting the amount of
toe off
36
Hallux Rigidus
Management
● NSAID for symptomatic relief
● Footwear modification and orthoses  limit stress at the MTP
joint
● Avoid high heels or shoes with very flexible soles (e.g.
minimalist sneakers)
37
Metatarsalgia
Metatarsalgia = pain at the ball of the foot due to abnormal biomechanics or overuse in the setting of
suboptimal footwear
Clinical presentation:
Pain over plantar aspect of forefoot, especially with weight bearing and walking
Physical Examination :
Tenderness, a callus may be seen, misalignment may be present in one or more of the toes
38
Metatarsalgia
Management :
● Metatarsal pad
● Custom-made orthotic shoes
● Ice for acute painful period
● Avoid heel shoes with pointed toes which place excess stress on metatarsal head
● Stretching
● Strengthening of intrinsic foot muscle
39
Yoo WG. Effect of the Intrinsic Foot Muscle Exercise Combined with Interphalangeal Flexion Exercise on Metatarsalgia with Morton’s Toe. Journal of physical therapy science. 2014;26(12):1997-8
Interdigital Neuroma (Morton’s Neuroma)
● Interdigital neuroma (typically between 3 rd and 4th digits)
● Compression of interdigital nerve beneath the intermetatarsal ligament 
repetitive irritation and fibrosis
● Predisposition : women, using narrow toe box shoes
Clinical manifestation
● Pain (sharp and burning sensation), possibly paresthesia in the toe adjacent to
the lesion
● Symptoms exacerbated when wearing narrow shoes
● Patient typically state that sitting, removing the shoe, and rubbing their foot
alleviate the symptoms
● Pain with squeeze test/Mulder click test
40
Interdigital Neuroma (Morton’s Neuroma)
Management
● Shoes with wide toe box and low heel may alleviate symptoms
● Metatarsal pad
● Injection of steroid and anesthetic agent into the neuroma  provide immediate
symptom relieve
● Surgical excision of neuroma if conservative treatment failed
41
Turf Toe
Sprain of 1sth MTP joint capsule due to forced hyperextension
● Pain, stiffness, swelling over 1 st MTP
● The symptoms often begin after acute injury, but may also result from repetitive strain
● Typically, patients report having participated in athletic event on artificial turf
● Pain at the end of ROM of 1st MTP hyperextension
● Tenderness, stiffness, and swollen over the 1 st MTP, ecchymosis may also be present
42
Turf Toe
Diagnostic Studies
● Radiograph examination can be obtained to rule out bony abnormality
● Clinical presentation of turf toe may be similar to gout arthritis. Gout should be suspected if the
patient has no acute injury/has not recently compete in athletic event on artificial turf/has a history of
gout
Management
● PRICE for acute painful period
● Taping the toe in plantar-flexed position may also be helpful
● Footwear that supports the foot adequately
● Rigid turf-toe orthotics may be helpful
● Surgical intervention only indicated if the radiographs reveal an associated
fracture (e.g. avulsion fracture)
43
Arthropaties Affecting
the Ankle and Foot
44
Rheumatoid Arthritis
● A systemic autoimmune inflammatory disorder of unknown etiology affecting multiple organ
system
● Male to female ratio 1:2
● Ankle involvement : 15-20% in newly diagnosed RA
Ankle deformities
● Ligament weakness  hindfoot pronation
● Tarsal tunnel syndrome
Foot deformities
● Hammer toe deformities
● Claw toe deformities
● Hallux valgus deformity
45
Rheumatoid Arthritis
Management
● Education : joint protection, home exercise program
● Exercise :
In acute inflamed joint  splinting for immobilization
Passive ROM exercise twice a day to prevent contracture
In mild disease (moderate synovitis)  isometric exercise
● Modalities : superficial moist heat, other superficial heating paraffin, cryotherapy for
acute inflamed joint
46
Gout Arthritis
● Acute inflammatory reaction in response to articular deposits of monosodium urate
● Male >> female, age 30-50 years old
● Provocative factors : trauma, alcohol, drugs
Monoarticular
● Most common site : 1st MTP. Other sites : midfoot, ankle, heel, knee
● Fever, chill, malaise
Chronic tophaceous gout
● Tophi  structural damage to articular cartilage and adjacent structure
Polyarticular gout
● Site of involvement : olecranon bursae, wrists, hands
47
Gout Arthritis
Diagnosis
Laboratory studies : hyperuricemia
Radiologic studies :
● Acute gout arthritis : soft tissue swelling around joint, most frequently MTP joint
● Chronic tophaceous gout : tophi as nodule in lobulated soft tissue masses, bone erosion develop
near the tophi
Management
Goal : pain relieve, prevent acute attack, tophi dan joint destruction
Rehabilitative management :
● Rest with topical application of ice packs
● Maintenance of ROM, strength, and functional exercise routine, weight management
48
Osteoarthritis
● Non erosive, non inflammatory progressive disorder of the joint  deterioration of articular
cartilage and new bone formation at the joint surfaces and margins
● Prevalence 70% in population >65 years old, equal female to male ratio
Clinical presentation (lower extremity)

● Sites of primary OA : knee, MTP, DIP, carpal metacarpal joint
● Dull aching pain that increased with activity, relieved by rest
● Joint stiffness for <30 minutes
● Crepitation on ROM
49
Osteoarthritis
Radiologic findings
● Asymmetrical narrowing of joint space, osteophyte
● No erosive changes seen on x-ray
Management
● Education : weight loss, activity modification
● Physical therapy : ROM and strengthening exercise
● Pharmacotherapy : analgetic (acetaminophen, NSAID)
● Intraarticular injection : beneficial in acute flares
50
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dr. Elizabeth Budiani

Supervisor : dr. Sumariyono, SpPD, K-R, MPH

Lower Ankle Joint

1 Support 4 Adjustment to irregular

3 Shock absorption 6 Compensation of formal

E EXACERBATING OR RELIEVING FACTORS

● Acute phase Conservative vs surgical

Mechanism of injury Management

Clinical presentation (lower extremity)

CREDITS: This presentation template was created by Slidesgo, and includes

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