Chapter 11 - The Lower Limb

Abstract

This chapter reviews the occurrence of pain and ailments in the lower limbs of a patient and remedial measures that the general practitioner can employ to deal with them. There are essentially three main parts under focus when studying orthopedic ailments in the lower limbs: (1) the hip, (2) the knee, and (3) the foot. The symptoms seen in hip are pain, stiffness, and restriction of mobility, leading to loss of independence or of the ability to work. The characteristic deformity of an ostearthritic hip is that of fixed flexion and adduction so that the patient walks with a slight stoop, bent knee, and an apparently short leg. Patients without this deformity usually have a painful limp when walking unaided—also known as the antalgic gait. The symptoms of the knee are pain, swelling, stiffness, and the mechanical complaints of locking, giving way, and feelings of instability on walking or running. In all cases, the knee must be inspected for swelling and deformity and palpated to confirm swelling; its situation in the knee must be located, and the knee must be moved actively and passively. The usual symptoms of the foot are pain, deformity, difficulty in walking, and difficulties with footwear. Some patients present with sensory symptoms in the foot such as numbness, tingling, or hyperesthesia. The foot should be examined with the patient standing, walking, and at rest on the couch.