Ortho Examination 4

Station 4

Yabba-dabba-YOUCH!

Start the Timer and Begin

Intro

Candidate introduces self with full name and role

Identifies patient with 2 pieces of information - eg name and date of birth

Adheres to appropriate infection control measures

Gains consent for examination then adequately exposes the patient's feet and calves

Look

Please ask the candidate to examine a real model/actor. Show the attached photos at appropriate times as directed. Please prompt the candidate to verbalise what they are inspecting for.

Tests Gait - right sided antalgic (limping) gait

Inspects the calves anteriorly, laterally, and posteriorly commenting on at least 3 of:
no bruising
no muscle wasting
no fasciculation
no scarring
no swelling
no erythema
no valgus or varus deformity

Comments on foot arch and asks patient to go onto their tip toes - this causes increased right foot pain (but arches are normal)

Inspects the feet whilst sitting, including plantar inspection commenting on 3 of:
no bruising
no muscle wasting
no fasciculation
no scarring
no swelling
no erythema
no bony deformity

Move

Full marks

Active Movement

Tests ankle dorsi and plantar flexion (5/5 power)

Tests ankle inversion and ankle eversion (5/5 power)

Tests great toe flexion and extension (5/5 power)

Passive Movement

Passive movement - feels for crepitus in the ankle joint on passive movement, normal RoM throughout

Passive movement - specifically tests for Mid-Tarsal joint movement

Special Tests

Performs Windlass test - severe pain if performed (this is honours level knowe)

Candidate concludes by offering a distal neurovascular exam and exam of the joint above

Examiner Instruction

At this point please direct the candidate to move on to diagnosis and management.

Diagnosis and Investigation

Briefly ascertains the patients current understanding and expectations regaring their condition - they have no idea what it is but would like to know

Confidently gives the diagnosis of Plantar Fasciitis (please inform the candidate of the correct diagnosis once they have given their diagnosis, regardless of whether their answer was correct or not).

Explains the diagnosis without jargon - e.g. there is a thick band of fibers on the bottom of your foot, it works like an elastic band to keep your foot in a nice arched shape. Plantar Fasciitis is when this band becomes inflammed and tender, this causes pain in the bottom of your foot.

Enquires into further questions from the patient - "what's the treatment doc?"

Management

Ignore management in final marks

Candidate recommends stretching / physiotherapy

Pain relief in particular NSAIDs

Any 2 additional treatments
Orthotics
Athletic taping
Cold compress
Activity alteration
Steroid injections
Surgical / gastrocnemius release

Submit for Scoring

Summary

Differentials for foot pain include:

Mortons neuroma (worse with mid tarsal squeeze)
osteoarthritis
achilles tendonitis
gout
stress fracture
hallux valgus (bunions)
pes planus (flat foot)

To name a few. Beware of the foot OSCE, there are many chronically stable conditions and it’s easy to find actors with these diagnoses so even though it’s niche it’s quite high yield.

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Station Written by: Dr Benjamin Armstrong

Peer Reviewed by:

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Ortho Examination 4

Station 4

Candidate Instructions

Setting:

Name: Freddie Flintstone

Tasks:

Simulated Patient Instructions

Briefing

Opening Statement

Appearance and Behaviour