Glossary

Arch - The arch of the foot is the area of the bottom of the foot between the heel pad and toe pad.

Acrokeratosis verruciformis - a hereditary dermatosis characterized by the presence of numerous flat wart-like papules on the dorsal aspect of the hand, foot, elbow, and knee.

Ankle - the part of the leg just above the foot; the joint between the leg and the foot. It is a hinge joint formed by the junction of the tibia and fibula with the talus, or ankle bone. The bones are cushioned by cartilage and connected by a number of ligaments, tendons, and muscles that strengthen the joint and enable it to be moved. Because it is in almost constant use, the ankle is particularly susceptible to injuries, such as sprain and fracture. It is also often one of the first joints to be affected by arthritis or gout.


Ankle clonus - a series of abnormal reflex movements of the foot, induced by sudden dorsiflexion, causing alternate contraction and relaxation of the triceps surae muscle.

Athlete's foot - a fungal infection of the skin of the foot; called also tinea pedis. It causes itching and often blisters and cracks, usually between the toes. Causative agents are Candida albicans, Epidermophyton floccosum, and species of Trichophyton, which thrive on warmth and dampness. If not arrested, it can cause a rash and itching in other parts of the body as well. It is likely to be recurrent, since the fungus survives under the toenails and reappears when conditions are favorable. Although Athlete's foot is usually little more than an uncomfortable nuisance, its open sores provide excellent sites for more serious infections. Early treatment and health care supervision insure correct diagnosis and prevention of complications. Specific diagnosis is made by microscopic examination or culture of skin scrapings for the fungus.

A-P(Antero-Posterior) - A look from front to back view.

AFO - An Ankle Foot Orthosis . A "U X-Section" splint used to control the position of the foot relative to the tibia.

Arthritis - A destructive process effecting a joint. This may result in pain, deformity, restricted function. It may also be asymptomatic. There are many different causes ranging from an initial injury to a joint, to infection, to autoimmune conditions (where the bodies natural defence system turns on joints and destroys them).

Arthroscopy - Minimally invasive surgery to a joint performed using a small telescopic camera and special Instruments. Articular surface

Bunion - Also known as hallux (big toe) valgus (a deviation away from the midline of the body). The components of the deformity are a widening of inner border of the foot, medial prominence of first metatarsal head and an angular deformity of toe.

Bunionette - A mirror image of a bunion deformity, effecting the little toe. The components are a widening of the outer border of the foot and an angling of the little toe towards the midline of the midline of the body.

Cartilage - A complex tissue which has various different types. Perhaps most importantly it forms the smooth lining of most joints, allowing low friction motion. It is assisted in this by synnovial fluid, a thick biological lubricant present in most joints. As a result little wearing out occurs in normal joints.

 Charcot joint - A severe and often rapid destuctive process affecting joints and surrounding soft tissue. There is always underlying neurological dysfunction, often secondary to diabetes. In the foot and ankle may present as an acute flat foot. Chondral defect

Debridement - The surgical removal of damaged or infected material.

Deep Vein Thrombosis (DVT) - A blood clot which usually develops in the calf veins. This may produce pain and local swelling. If a portion of the clot breaks free it can be carried up to the blood vessels in the lung and may produce severe chest pain cardiac arrest and rarely death. There are various ways to reduce the chance of complication such as limiting any period of Immobilisation and using prophylactic medications such as Heparin, Warfarin or Aspirin. These act by thinning the blood and making it less likely to clot.

Dislocation - Describes the situation when the two articulating bones forming a joint are no longer in contact with each other. Femoral block .

Fusion - The permanent joining together of two bones which normally articulate upon each other as a joint. Bone is stimlated to grow across the joint space from both sides by removing all cartilage lining the joint and exposing the bleeding inner surface of the bone. These surfaces are then compressed (usually by placing screws across them). This compression can hold the ideal position as fusion is occurring and the compressive force also stimulates the process. The time taken for fusions to knit together soundly varies. A big toe (MTP) joint will on average require 6 weeks compared to twelve weeks for an ankle. Once fusion is complete the two bones are effectively one bone. Fusion is a common procedure for arthritis and results in the loss of movement of the joint

Gait - Describes the pattern of walking.

Haemarthrosis - Blood within the joint. May result following Injury, surgery or in some conditions(eg Haemophilia) spontaneously.

HSMN - Hereditary Sensory and Motor Neuropathy (known generically as Charcot-Marie-Tooth after one of its variants). An inherited progressive condition. It exists in various forms.

Intermetatarsal block - A nerve block of the common digital nerves located between the metatarsal bones in the sole of the foot.

Intra-articular block - A direct injection of local anaesthetic Into a joint. Used just as post-operative pain relief.

Lateral - A side on view of the area

Ligament - A tough, stabilising soft tissue structure which connects bones either side of a joint .

Ligament reconstruction - A reforming of deficient ligament/s This can be done with soft tissue transferred from the immediate area(for example a portion of a tendon)or transferred from elsewhere.

Light weight cast - A cast made out of fibre glass composite. This is lighter, more durable and resistant to the effects of water once set, compared with traditional plaster of paris.

Metatarsalgia - This is simply pain under the metetarsal heads (the "ball of the foot"). This not a specific diagnosis as there are many potential causes.

MRI - Magnetic Resonance Imaging. This is away of imaging tissues without exposing them to the low dose radiation associated with x-rays. The technique involves a high magnetic field. This can be contra-indicated if you have a metal implant (eg a joint replacement) and certainly if you have a pacemaker. It is a technique which gives dynamic information about the state of tissues. It is the best way of imaging soft tissue (ie non bony tissue).

Muscle - A soft tissue which contracts when stimulated by its nerve supply, producing movement across a joint.

Nerve block/blockade(regional anaesthetic)

A way of making a limb pain free by injecting local anaesthetic close to the nerves which supply it. This can be used instead of a general anaesthetic or to provide pain relief following a general anaesthetic. Depending on the exact nerve block the "motor nerves" which stimulate movement of the limb may also be effected, producing an expected and temporary paralysis.

PCA Pump - Patient controlled analgesia pump.

Periosteum - A tough "membrane" of variable thickness which covers bone and is firmly and directly attached to it.

Polio - A disorder of the nerves supplying skeletal muscles, secondary to infection with the polio virus. In the lower limb this manifests as a maller limb with joint contractures and a high arched (cavus) foot.

Portals - Small stab incisions to allow access into a joint for minimally invasive surgery.

Rheumatoid arthritis - A specific type of arthritis which often effects many joints and can also effect non musculo-skeletal tissues.

RSD - Reflex Sympathetic Dystrophy also known as regional pain syndrome. This is a condition which results following surgery or an injury. It is characterised by significant pain (often burning in nature and widespread) which is present most of the time and may be worsened by extremes of temperature. The skin often becomes red, swollen and hypersensitive. Light pressure over an effected area may result in very severe and immediate pain. Joints in the area will become stiffened and may develop contractures. If this complication occurs it requires early and aggressive treatment with mobilisation of the effected joint and often nerve blocks to reduce the action of the nerves which are driving the process.

Sciatic block - A nerve block at the level of the sciatic nerve, usually behind the knee. Most effectively used in conjunction with a femoral block.

Sclerosis - A thickening of bone which occurs under various circumstances. Examples are after bone infection or around the margins of an osteoarthritic joint.

Sprain - An injury to the ligament(s) stabilising a joint. It can range from some minor bruising to a complete disruption leading to the joint becoming unstable.

Stability - The ability of a structure to withstand physiological

Subluxation - Describes the situation when the two articulating bones forming a joint move beyond their normal range. Further displacement may lead to dislocation. This can also be applied to tendons starting to displace beyond their normal "line of pull".

Synovitis – Inflammation of the synnovium. May occur after Injury or be a part of a generalised joint problem such as rheumatoid arthritis.

Synovium - A soft tissue present in varying quantities in normal healthy joints. It produces synnovial fluid, a biological lubricant.

Tarsal coalition - A progressive loss of movement of midfoot joints occurring due to a spontaneous union between them. The tissue uniting the bones may be bone or tough cartilaginous tissue. This usually starts during adolescence and presents as a non-correctable flat foot.

Tendon - The 'business end' of a muscle. This tough unyielding tissue allows a muscle (of varying length ) to excert its pull across a joint.

Tendon transfer - Detaching the insertion of a tendon and moving it to another neighbouring site. The reason is either to correct a deformity or to substitute it for a more important but failed tendon. This procedure usually weakens the strength of the transferred tendon.

Tendonitis – Inflammation of the outer layers of a tendon. The underlying tendon may be entirely healthy.

Tendonosis - Wear and tear/degenerative changes existing throughout the substance of a tendon. The tendon Is unhealthy and maybe more prone to rupture.

Thermoplastic splint - A splint constructed from a lightweight and precisely mouldable heat sensitive plastic. Generally this Is made to form both a front and a back section, which fit reversibly together. This allows easy access to the limb and can be self removed if need be. The back section alone can be used to rest the limb in, for example at night.

Total contact cast - A specially constructed and closely conforming plaster cast. Used for the treatment of ulceration and Charcot arthropathy.

UHMWPE - UltraHigh Molecular Weight PolyEthelyne. This is a plastic commonly used to line joint replacements due to its excellent durability.

Union - The successful joining together of two previously separate bones/parts of bones. The same process occurs when a fracture heals or a fusion is successful.

Avascular necrosis - The loss of the normal blood supply to a bone, leading to the destruction of part or all of The effected bone. In the foot and ankle most common in the talus and second metatarsal head.

Backslab plaster - A temporary plaster cast which has no plaster of paris at the front of the cast. This allows a degree of swelling to occur comfortably, for example immediately post-operatively. A complete cast allows no such increase in size of the limb and can lead to pain and a restiction in blood supply due to swelling in the rigid cast.