Assessment and management of ankle osteoarthritis in primary care

Dear Editor,

McCarron et al offer a generally comprehensive review, and mention both weight management and orthotics as management options, but omit several simple and important elements of physical examination:

1. GAIT:
Assuming the consultation is face-to-face, personally calling the patient from the waiting room and observing their journey to the consultation room is very informative. (It also 'breaks ice', and provides a very useful 'scene changer' for the clinician.)

2. SHOE WEAR:
Gait is best observed with shoes and socks both on and off. A quick comparison of the sole and heel wear of left and right shoes indicates whether posture and weight bearing are normally symmetrical, or not.

3. WEIGHT/BMI
Progress in weight management cannot be measured without a baseline. To weigh a patient takes minimal time: history taking can continue concurrently, It also provides a useful baseline against other presentations. For those patients who weigh more than the maximum reading on one set of scales, placing one foot on each of two scales and adding the readings together.

4. OBSERVATION AND PALPATION
Scars may be visible from previous surgery, and metalwork from internal fixations may be palpable. Examine the patient flat footed and on tiptoe: the lie of tendons will be revealed and such injuries as extensor retinaculum rupture (associated with the Maisonneuve fracture), will be evident.

Yours,

Dr V H Needham FRCGP, Past Provost Wessex Faculty RCGP
Andover