1. Managing Minor Musculoskeletal Injuries and Conditions First Edition. David Bradley. © 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd. Companion website: www.wiley.com/go/bradley/musculoskeletalwww.wiley.com/go/bradley/musculoskeletal

2. The foot

3. Foot 1 What do you see? What does the yellow arrow point to? Read my comments below in the notes section when you have thoroughly looked at the film.

4. Foot 2 Twisted while playing football. Do you see anything? When ready, read my comments below.

5. Foot 3 In this lateral view of the ankle, I want you to first have a general look at the film. To which bones are the yellow and white arrows pointing to? When complete, look at the next slide.

6. Foot 3 – my comments On the previous slide, the yellow arrow points to the base of the fifth MT where so many fractures occur. The white points to the navicular bone. There are no fractures in the film. However, the main feature that I wanted you to notice was a calcaneal spur on the heel (arrowed red). This is commonly seen in patients who have plantar fasciitis. Not that it is the cause of the problem, but, once present, can make the clinical features worse.

7. Foot 4 Anything shown here? The patient had a wheel run over his foot. Read my notes below, then follow to the next slide.

8. Foot 4 – enlarged view Look at the normal sweep of the neck of the first MT, drawn in yellow. Compare this with the angles of the third and fourth (arrowed). They are both fractured and this would be confirmed by palpation. Follow the notes below.

9. Foot 4 – marked up Note that this is the same as in the earlier slide Foot 4, just cropped and enlarged a little. Note the lines I have drawn as normal on the left (AP) view and the right oblique view. These are used as guides to notice Lisfranc injuries. Note: After your study of this book is complete, this would be another valuable area to read in more depth and therefore increase your knowledge. But, for the time being, so long as your history is detailed and your physical examination thorough, you should be safe. Refer all patients with findings that you cannot understand or explain.

10. Foot 5 Patient twisted his foot. Can you see anything? Read my notes below when you have completed examining the X-ray.

11. Foot 5 – marked up The yellow arrow points to the ossicle. Now would be a good time to look up some of the many other accessory ossicles in the foot.

12. Foot 6 One of the sesamoids is either bipartate (most likely) or fractured, but you would have to have patient MOI knowledge to go further. Note: Did you note the small oval ossicle at the side of the cuboid?

13. Foot 7 A twisted ankle. Pain on the outside of the foot. What do you see? See notes below.

14. Foot 7 – enlarged view There is an epiphysis that has almost fused at the base of the fifth MT. The only significance of this is that it may be confused with a fracture. In general, epiphyses are vertical and fractures horizontal.

15. Foot 7 – marked up Note how the first MT is in varus and that the patient has a hallux valgus. Very, very common.