Enhance your knowledge with our comprehensive guide and curated study materials.
History: A 72-year-old woman slips in her bathroom and cannot stand. The limb is shortened and externally rotated.
Interpretation:
The likely diagnosis is a fracture of the neck of the femur.
Mechanism: osteoporosis weakens the neck, which lies inside the capsule.
Anatomical correlation:
The retinacular arteries (branches of the medial circumflex femoral artery) that supply the femoral head run along the neck.
These vessels are torn in intracapsular fractures → avascular necrosis of the head.
Clinical takeaway:
Intracapsular fractures heal poorly and need hip replacement, while extracapsular fractures heal faster.
History: A 15-year-old runner complains of a tender swelling just below the patella.
Interpretation: Osgood–Schlatter disease (osteochondritis of the tibial tuberosity).
Anatomical correlation:
Occurs at the site of patellar ligament attachment on the tibial tuberosity.
Repetitive pull of quadriceps femoris causes micro-fractures of the secondary ossification centre.
Management: Rest, physiotherapy, and anti-inflammatory measures.
History: A middle-aged man playing badminton feels a sharp pain at the back of the heel.
Interpretation: Rupture of the Achilles (tendo calcaneus) tendon.
Anatomical correlation:
The tendo calcaneus inserts on the posterior surface of the calcaneus.
Rupture leads to loss of plantar flexion, making it impossible to stand on toes.
Management: Surgical repair or immobilization with foot plantar flexed.
History: A patient struck on the lateral side of the leg below the knee develops foot drop and loss of sensation on dorsum of foot.
Interpretation: Common peroneal nerve injury at fibular neck.
Anatomical correlation:
The nerve winds around the neck of fibula, making it superficial and prone to injury.
Loss of dorsiflexors (tibialis anterior, EHL, EDL) → foot drop.
Management: Splinting and physiotherapy; surgical decompression if entrapment present.
History: A 45-year-old woman has sharp heel pain that eases after walking for some time.
Interpretation: Calcaneal spur with plantar fasciitis.
Anatomical correlation:
Due to chronic traction of the plantar aponeurosis on the medial process of the calcaneal tuberosity.
Bony outgrowth (spur) irritates plantar fascia and nerves.
Management: Heel pads, physiotherapy, corticosteroid injection.
History: A long-distance runner presents with tenderness over the navicular tuberosity.
Interpretation: Accessory navicular bone inflammation (os tibiale externum).
Anatomical correlation:
Tibialis posterior inserts on the navicular tuberosity.
An accessory ossicle at this site can cause friction and pain due to footwear pressure.
Management: Padding, orthotics, or surgical excision if symptomatic.
History: A twisting injury causes pain, deformity, and swelling around ankle.
Interpretation: Pott’s fracture.
Anatomical correlation:
Caused by forced eversion of foot.
Deltoid ligament pulls medial malleolus → fracture.
Body of talus pushes laterally → fracture of fibular shaft or lateral malleolus.
Clinical sign: Foot appears abducted and everted.
History: Hiker feels pain near the cuboid region with no visible fracture on X-ray.
Interpretation: Cuboid syndrome (subluxation).
Anatomical correlation:
Subluxation of cuboid at calcaneocuboid joint due to pull of peroneus longus tendon running through its groove.
Produces lateral foot pain and altered gait.
Treatment: Manual manipulation (“cuboid whip”), taping, rest.
History: 25-year-old worker kneeling long hours develops anterior knee swelling.
Interpretation: Prepatellar bursitis (“Housemaid’s knee”).
Anatomical correlation:
The prepatellar bursa lies between the patella and skin.
Repeated friction and trauma cause inflammation and fluid accumulation.
Treatment: Rest, aspiration, antibiotics if infected.
History: 8-year-old boy with hip pain and limp; X-ray shows collapse of femoral head.
Interpretation: Perthes disease (avascular necrosis of femoral head).
Anatomical correlation:
Epiphyseal blood supply to femoral head is poor in children.
Thrombosis or trauma to medial circumflex femoral artery → ischemic necrosis.
Treatment: Rest, traction, orthosis, or surgery.
History: A shopkeeper complains of foot pain and fatigue after standing all day.
Interpretation: Collapse of medial longitudinal arch (flatfoot).
Anatomical correlation:
Weakness of spring ligament, tibialis posterior, and abductor hallucis.
The head of talus descends, pressing the navicular bone downward.
Management: Footwear with medial arch support, exercises.
History: Middle-aged woman feels burning pain below 2nd and 3rd metatarsal heads.
Interpretation: Metatarsalgia.
Anatomical correlation:
Pressure over the transverse arch of foot causes irritation of digital nerves between metatarsal heads.
Treatment: Soft insoles, metatarsal pads.
History: A 6-month-old baby has both feet turned inward since birth.
Interpretation: Congenital talipes equinovarus (clubfoot).
Anatomical correlation:
Talus and calcaneus are medially rotated and inverted.
Associated shortening of tendo calcaneus and tibialis posterior.
Treatment: Gradual correction by Ponseti casting or surgery.
History: Twisting ankle during sports, pain on lateral side.
Interpretation: Sprain or fracture at base of 5th metatarsal (Jones fracture).
Anatomical correlation:
Caused by traction of peroneus brevis tendon attached to styloid process of 5th metatarsal.
Management: Immobilization or screw fixation.
History: After a fall on knee, patient unable to straighten leg.
Interpretation: Transverse fracture of patella.
Anatomical correlation:
Upper fragment pulled upward by quadriceps, lower by patellar ligament.
Disruption causes loss of active extension.
Treatment: Tension-band wiring or partial patellectomy.
These problems emphasize anatomical reasoning behind clinical findings — the essence of clinicoanatomical correlation in the study of bones of the lower limb.
Get the full PDF version of this chapter.
Continue with Google