Ankle/Foot pain
COVID-19 clinical presentation
<div class="redbox">
<p style="text-size:12px;">COVID-19 can present with a myriad of symptoms so should probably be on most differential diagnosis lists during the pandemic</p>
<li><a href="https://productivemedic.com/covid-remote-assessment/" target="_blank">COVID assessment, DDx and complications</a></li>
<li><a href="https://www.google.com/imgres?imgurl=https%3A%2F%2Ff6publishing.blob.core.windows.net%2F2ab0884c-0618-4586-aaf1-41004e6ad656%2FWJCC-8-3956-g002.png&imgrefurl=https%3A%2F%2Fwww.wjgnet.com%2F2307-8960%2Ffull%2Fv8%2Fi18%2F3956.htm&tbnid=I0G0VvXcx_akPM&vet=12ahUKEwj1_43FsrnuAhUH-YUKHSoZAFQQMygYegUIARCwAQ..i&docid=IBDQMbzRItpvKM&w=3307&h=2168&q=covid%2019%20presentation&safe=strict&ved=2ahUKEwj1_43FsrnuAhUH-YUKHSoZAFQQMygYegUIARCwAQ" target="_blank">Clinical presentation summary infographic</a></li>
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*Common causes
*Must not miss!
- Ankle / Foot Bone fracture
- Achilles tendon rupture
- Septic arthritis
- Acute limb ischaemia
<div style="text-align:center;"> <a href="https://www.bmj.com/content/360/bmj.j5842" target="_blank">Peripheral artery disease</a><br> <a href="https://www.bmj.com/content/bmj/suppl/2018/02/01/bmj.j5842.DC1/morr041877.wi.pdf" target="_blank">BMJ infographic</a> </div> - Non-venous ulceration
- Diabetic foot
<div style="text-align:center;"> <a href="https://www.bmj.com/content/359/bmj.j5064" target="_blank">Diabetic foot</a><br> <a href="https://www.bmj.com/content/bmj/suppl/2017/11/16/bmj.j5064.DC1/chas041916.ww1.pdf" target="_blank">BMJ inforgraphic</a> </div> (painless) - Osteomyelitis
*Easily missed
- Morton's neuroma
- March fracture
- Painful Peripheral neuropathy
- Diabetic foot
<div style="text-align:center;"> <a href="https://www.bmj.com/content/359/bmj.j5064" target="_blank">Diabetic foot</a><br> <a href="https://www.bmj.com/content/bmj/suppl/2017/11/16/bmj.j5064.DC1/chas041916.ww1.pdf" target="_blank">BMJ inforgraphic</a> </div> (painless)
Red flags
- Not weight-bearing
- Cold pulse-less leg
- Loss of bladder or bowel control
- Hot/painful/swollen joint with little movement
- Sudden severe achilles pain with foot drop
- Ulceration/cellulitis
- Systemic symptoms (fever, weight loss)
Investigations to consider
- FBC, CRP/ ESR, serum glucose
- Auto-antibody screen, Rheumatoid factor +/- anti-CCP antibodies
- Serum uric acid
- Local X-ray
- Blood culture
- MRI scan
- Nerve conduction studies
- Bone scan
- ABPIs
- Angiography