- SlidesCaseload 9Lateral Ankle Sprain (ATFL/CFL)The most common injury in sport, and the one most often dismissed. The rule that rules out fracture, the examination that works better on day five, and why a simple sprain often isn't.
- SlidesCaseload 10Achilles TendinopathyTwo conditions in one name. Where the pain sits decides the loading rules, and the honest version of the loading evidence is more interesting than the one you were taught.
- SlidesChronic Ankle InstabilityDefined by what the patient reports, not what your hands find. The anterior drawer runs at +LR 1.2, and 43% of these ankles have no mechanical component at all.
- SlidesFracture / Osteochondral Lesion / Infection — the ankle safety screenThe screen that sits in front of every ankle sprain you will ever treat. Three branches — a fracture you have to exclude on day one, an osteochondral lesion that declares itself weeks later when the sprain won't settle, and an infection that changes the pathway entirely. None of the three is excluded by a normal X-ray alone.
- SlidesFreiberg's Disease (2nd metatarsal head osteonecrosis)Dorsal forefoot pain over the second metatarsal head in an adolescent, classically a dancer. Rare, and it is here because getting it wrong means loading a dying bone.
- SlidesGout (1st MTP — and beyond)A single hot, red, exquisitely tender joint overnight. Here not because gout is dangerous but because you cannot tell it from septic arthritis, which is.
- SlidesHallux Rigidus (1st MTP Osteoarthritis)Dorsal first MTP pain and stiffness with jamming at terminal dorsiflexion, worse on push-off, hills and sprinting, and better in a stiff-soled or rocker shoe. The whole management logic is one idea — reduce painful end-range dorsal compression while keeping the capacity that gets them through push-off. Which is why forcing dorsiflexion is the wrong move.
- SlidesHallux Valgus (Bunion)Pain and a medial prominence at the first MTP with lateral deviation of the great toe, worse in narrow shoes and better in wide ones. The deformity is three-dimensional and progressive; the decision is not. Treat what limits comfort and function, use footwear as mechanics rather than advice, build the intrinsics — and be honest that conservative care changes symptoms more than it changes angles.
- SlidesInfection / Osteomyelitis / Ulcer — the hot footA hot, red, swollen foot in someone with diabetes, neuropathy, immunocompromise or recent surgery — with or without an ulcer, and often with far less pain than it deserves. Neuropathy removes the alarm that would normally bring the patient in early, so absence of severe pain is the trap, not the reassurance.
- SlidesMedial (Deltoid) Ankle SprainThe ankle sprain that is usually not the whole story. An eversion or high-energy mechanism with medial tenderness and swelling — and a genuine obligation to screen the lateral ligaments, the syndesmosis and the bones before you call it a sprain. The rehabilitation is familiar; the suspicion threshold is not.
- SlidesMetatarsalgiaAching or burning under the metatarsal heads, worse with walking, running and high heels, often described as walking on pebbles. It is a load-distribution problem — and it is also a symptom label that hides plantar plate injury, neuroma, bursitis, stress fracture and Freiberg's disease. Offload it while you find out which.
- SlidesMidfoot Sprain (Lisfranc / Cuneiform)Midfoot pain and swelling after a twist or an axial load, with difficulty weight-bearing and push-off. The clinical problem is not treating it — it is finding it. Subtle ligamentous instability is easy to miss, plain films can be normal, and a delayed diagnosis buys chronic pain, arch collapse and post-traumatic arthritis.
- SlidesMorton's Neuroma (Interdigital Nerve Entrapment)Sharp, burning webspace pain radiating into the toes with numbness, classically third-fourth, worse in tight shoes and relieved by taking them off. It is a compressive nerve problem rather than generic forefoot overload — and the first treatment is mechanical decompression, not an injection.
- SlidesPeroneal Tendon DisordersThe differential the chronic ankle instability page names — and it co-occurs with instability rather than competing with it. 77% at surgery. No physical test has ever been measured.
- SlidesPlantar FasciopathyIt is not self-limiting, the Windlass test is 32% sensitive and mostly loads a nerve, and the two largest blinded trials found exercise added nothing to good advice.
- SlidesPosterior Ankle Impingement (PAIS)Deep posterior ankle pain that comes on with forced plantarflexion — pointe work, kicking, jumping, push-off. The os trigonum gets the blame and often deserves only part of it, and in dancers and high-load athletes the MRI findings are common in ankles that don't hurt. Which means the diagnosis is made by symptom reproduction and load history, not by a picture.
- SlidesSesamoiditisLocalised bruised or sharp pain under the ball of the great toe, worse on push-off, running, jumping and in high heels, eased by offloading and a stiff sole. Treat it as plantar first MTP load intolerance — and treat the label as provisional, because persistent focal pain here can be a stress fracture, a nonunion, avascular necrosis or a plantar plate injury.
- SlidesSever's Disease (Calcaneal Apophysitis)Gradual posterior heel pain in an active 8–14 year old, worse with running and jumping, often bilateral, with a positive calcaneal squeeze and a tight calf. The diagnosis is clinical and the condition is self-limiting — so the real skill is screening the atypical presentations out, and then explaining it to a family in a way that keeps the child playing.
- SlidesSinus Tarsi SyndromeDeep pain in the hollow below the lateral malleolus, months after a sprain. The sprain that never finished, and the reason a 'simple' lateral ankle keeps coming back.
- SlidesStress Fracture (Metatarsal / Navicular / Calcaneal)Gradual, focal, load-related bone pain with no specific trauma, after a change in training volume, intensity, surface, footwear, nutrition or recovery. The diagnosis is a load-capacity mismatch. The thing that actually matters is WHERE — because navicular and proximal fifth metatarsal are high-risk sites where a delayed diagnosis buys nonunion, prolonged recovery and surgery.
- SlidesSyndesmotic (High Ankle) SprainIt travels with the lateral sprain rather than competing with it — 38% of acute ankle injuries involve the syndesmosis. And the decision that matters cannot be made with your hands.
- SlidesTarsal Tunnel Syndrome (Tibial Nerve)Burning, tingling or numbness from the medial ankle into the plantar foot, worse with standing, walking and tight footwear, sometimes waking them at night. No single test makes the diagnosis — it's the neuropathic quality plus the territory plus provocation on dorsiflexion-eversion, in a foot with a reason to compress the nerve. And it is routinely called plantar fasciitis first.
- SlidesTibialis Posterior TendinopathyMedial ankle and arch pain where the tendon problem and the arch-control problem are inseparable. Early it looks local — tenderness behind the medial malleolus, a painful or poor single-leg heel raise, symptoms on walking and running. The reason to catch it early is that the far end of this spectrum is a fixed deformity, and the point of the whole page is not getting there.
- SlidesTurf Toe (1st MTP Sprain)A forced hyperextension injury of the great toe with axial load, usually on turf or court during push-off or cutting. Plantar first MTP pain and swelling, sometimes a pop with immediate loss of push-off. Grade drives everything — and an under-protected Grade II or III can end up as hallux rigidus, which is the reason to take the mild-looking ones seriously.
This is a learning tool. It does not diagnose patients and does not replace your clinical educator.
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