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Functional Medicine® Assessment

🔴 Notice: As part of our Acute Injury Treatment Practice, we now offer Functional Medicine Integrative Assessments and Treatments within our clinical scope for chronic degenerative disorders.  We first evaluate personal history, current nutrition, activity behaviors, toxic exposures, psychological and emotional factors, in tandem genetics.  We then can offer Functional Medicine Treatments in conjunction with our modern protocols.  Learn More

Functional Medicine Explained

Ankle & Foot Diagnostic Imaging Arthritis & Trauma II| El Paso, TX.

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Lisfranc Fracture-Dislocation

  • M/C dislocation of the foot at tarsal-metatarsal articulation (Lisfranc joint). Direct impact or landing and plantar or dorsal flexing the foot. Lisfranc ligament holding 2nd MT base and 1st Cu is torn. Manifests with or w/o fracture-avulsion.
  • Imaging: 1st step: foot radiography in most cases sufficient to Dx. MSK US may help: show disrupted Cu1-Cu2. ligament and widened space > 2.5mm. MRI may help but not essential. Weight-bearing view aids Dx.
  • 2-types: homolateral (1st MTP joint i contact) and divergent (2-5 MT displaced laterally and 1st MT medially)
  • Management: operative fixation is crucial
  • N.B. Atraumatic Lisfranc dislocation is a frequent complication of a diabetic Charcot foot

Osteochondral Injury of the Talus (OCD)

  • Common. Non-traumatic found in superior-medial talar dome. Traumatic may affect supero-lateral dome.
  • Clinically: pain/effusion/locking. Imaging is crucial.
  • 1st step: radiography may reveal focal radiolucent concavity/halo, fragment.
  • MRI helpful esp. if OCD is cartilaginous and to demonstrate bone edema.
  • Management: non-operative: short-leg cast/immonbilization-4-6 wk. operative: arthrocsopic removal.
  • Complications: premature 2nd DJD

Metatarsal Injuries

  • Acute & Stress fractures are common: m/c 5th MT & 2nd, 3rd MT.
  • Jones Fx: extra-articular Fx of proximal metaphysis of the 5th MT. prone to non-union. Often fixed operatively.
  • Pseudo-Jones: intra-articular avulsion of 5th MT styloid/base by eccentric contraction of Peroneus brevis M. Managed conservatively: boot-cast immonbilization. Both Jones & Pseudo-Jones Dx by foot series radiography.
  • Stress Fx. Calcaneus, 2nd, 3rd, 5th MTs. Repeated loading (running) or “March foot” 2nd/3rd MT. Clinically: pain on activity, reduced by rest. Dx: x-rays often unrewarding earlier. MRI or MSK US may help. Managed: conservatively. Complications; progress into complete Fx
  • Turf toe: common athletic hyperextension of 1st MTP-sesamoid/plantar plate complex tearing. 1st MTP unstable/loose. Managed operatively.

Arthritis of the Foot & Ankle

  • DJD of the ankle: uncommon a sprimary OA. Typically develops as 2nd to trauma/AVN, RA, CPPD, Hemophilic arthropathy, Juvenile Idiopathic Arthritis etc. manifests as DJD: osteophytes, JSL, subcohnodral cysts all seen on x-rays
  • Infalmmatory Arthritis: RA may develop in the ankle or any synovial joint. Will typically  presents with symmetrical Hands/feet RA initially (2nd, 3rd MCP, wrists, MTPs in feet) typically with erosion, iniform JSL, juxta-articular osteopenia and delayed subluxations.
  • HLA-B27 spondyloarthropathies: commonly affect lower extremity: heel, ankle esp in Reactive (Reiter). Erosive-productive bone proliferation is a key Dx.
  • Gouty Arthritis: common in the lower extremity. Ankle, mid-foot foot esp 1st MTPs. Initial onset: acute gouty arthritis with ST effusion and no erosions/tophi. Chronic tophacious gout: peri-articular, intra-osseous punched-out erosions with over-hanging edges, no initial JSL/osteopenia, ST. tophi may be seen.
  • Miscellaneous arthropathy: PVNS. Not common. Affects 3-4th decades of life. The result of synovial proliferation with Machrophages and multi-nucleated Giant Cells filled with hemosiderin and fatty accumulation, may lead to inflammation, cartilage damage, extrinsic bone erosions. Dx: x-rays are insensity, MRI modality of choice. Synovial biopsy. Management: operative, can be difficult.

Neuropathic Osteoarthropathy

  • (Charcot joint) Common and on the rise d/t epidemic in type 2 DM. May present with pain initially (50% of cases) and painless destructive arthropathy as late manifestation. Early Dx: delayed. Imaging is crucial: x-rays: initially unrewarding, some SF effusion is seen. MRI helps with early Dx and extremity off-loading. Late Dx: irreversible dislocations, collapse, disability. Note: Lisfrance dislocation in Charcot joint
  • M/C mid-foot (TM joint) in 40% of cases, ankle 15%. Progression: Rocker-bottom foot, ulcerations, infections, increased morbidity and mortality.
  • Early Dx: by MRI is crucial. Suspect it in patients with type 2 DM especially if early non-traumatic foot/ankle pain reported.

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