L

labelled leukocyte scan sensitive diagnostic test for acute osteomyelitis and soft-tissue infections

laceration torn/jagged cut/wound

laces positive shoe gear-retaining medium; reduces unwanted foot movement against inner surface of shoe; laces should be tightened from distal to proximal with ankle joint in 45° dorsiflexion and hindfoot well seated into heel area of shoe, in order to minimize shoe pressure on toes; shoe facings should fit foot snugly (shoe tongue may require pad to prevent overlap of facings and prevent trauma to dorsal tissues)

Lachman’s test see test, anterior drawer

laevodopa; levodopa; L-dopa biologically active form of dopamine (used to control symptoms of Parkinson’s disease)

lamellar splits see nail

lamina flat layer of tissue, e.g. arrangement of dorsal horn of spinal cord)

Lamisil see terbinafine

lance drain pus from an abscess, by perforation of overlying tissue

lancet small, sharp-pointed, two-edged blade; used to incise an abscess

lancinating sharp, shearing, shooting pain

Langerhans cells population of dendritic cells within epidermal stratum granulosum; function as antigen-presenting cells

Langer’s lines lines of skin stress, relating to vectors of movement of underlying tissues; surgical incisions should be placed along or parallel to local Langer’s lines

lanolin; hydrous wool fat sheep wool sebum; contains 25–30% water; used as water-absorbable ointment base

lansoprazole; Zoton see proton pump inhibitors

lapidus procedure surgical fusion of first metatarsal–medial cuneiform joint; stabilizes medial column of a hypermobile foot with marked metatarsus primus varus and associated marked hallux abductovalgus

larval therapy; microsurgery treatment of chronically infected (including meticillin-resistant Staphylococcus aureus [MRSA]), heavily sloughed or necrotic wounds by application of sterile greenbottle fly maggots (Lucilia sericata); maggots reduce wound pain and odour (by ingesting necrotic and infected tissue) and promote wound healing (by altering wound pH, secreting antimicrobial substances and promoting growth factor release)

laser acronym for light amplification by stimulated emission of radiation; device concentrates high-frequency electromagnetic energy into a (constant or pulsed) beam of monochromatic light (wavelength 660–950 nm); therapeutic action (burning, cutting or tissue stimulation) is dependent on device specification; tissue effects are inhibited by non-steroidal anti-inflammatory drugs and steroids

laser thermometer highly accurate skin temperature recording device; >2°C difference in temperature between feet indicates inflammation or infection (warmer foot) or ischaemia (colder foot)

Lasonil topical preparation (0.8% heparinoid in white soft paraffin) to disperse severe bruising and haematoma

last wooden or plastic model over which shoe upper and sole are formed during manufacture (see Tables C22 and F7)

latency time period between stimulus delivery and evoked response

lateral opposite to medial, i.e. away from central sagittal plane

lateral clip see Table O4

lateral collateral ligaments of ankle three ligamentous structures supporting ankle joint, i.e. superficial and deep portions of deltoid ligament, tibiofibular ligaments and lateral ligament complex (itself made up of anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligament); note: subtalar joint ligaments, lateral talocalcaneal ligament and ankle syndesmosis also support ankle joint

lateral collateral ligament of first metatarsophalangeal joint; 1 MTPJ lateral focal thickening within 1 MTPJ capsule; articulates with first metatarsal capital cartilage; forms lateral aspect of ‘socket’ (i.e. with 1 MTPJ medial collateral ligament and base of hallux proximal phalanx) of first metatarsal head articulation

lateral column calcaneum, cuboid, fourth and fifth metatarsals and respective digital phalanges; see medial column

lateral compartment of lower leg see compartments of the lower leg; Table O8, Figure C2

lateral cuneiform most lateral cuneiform; lies within medial column; see cuneiform, lateral

lateral cutaneous nerve see sural nerve

lateral (fibular) sesamoid ligament ligament suspending lateral side of lateral sesamoid; blends with fibres of first metatarsophalangeal joint lateral collateral ligament

lateral gutter space between talar lateral articular surface and fibular malleolus medial articular surface

lateral longitudinal arch low-profile lateral border bony arch; ‘keystone’ formed by cuboid

lateral medio-oblique projection see Table R1

lateral plantar artery terminal branch of posterior tibial artery adjacent to lateral plantar nerve; forms plantar arcade, giving plantar metatarsal arteries to each intermetatarsal space (each of which unites with corresponding dorsal metatarsal artery via perforating artery at proximal intermetatarsal space) terminating as proper plantar digital arteries

lateral plantar nerve terminal division of sciatic nerve, subserving plantar sensation; its first branch forms Baxter’s nerve; see Table H11; its deep branch innervates adductor hallucis, lateral three lumbricals, medial two plantar interossei and medial three dorsal interossei

lateral projection lateral radiograph of foot; X-ray tube is angled at 90° to sagittal plane with beam centred on hindfoot (see Table R1)

lateral sole wedges wedges to evert foot, or support whole-foot valgus; fixed between insole and outsole of the shoe, or added to an insole

lateral support padding soft splintage/strapping applied as medial support padding (see Figure M2) + individual straps applied to maintain heel eversion; short-term therapeutic management of lateral ankle pain or trauma

lateral talocalcaneal ligament; LTCL an ankle joint collateral ligament

laterality preferred foot/hand in relation to contralateral cerebral dominance

lateromedial oblique projection see Table R1

latex sensitivity progressive reactive dermatitis triggered in sensitized individuals by latex contact

latex shields; latex digital shields; latex dips reusable, protective, digital devices; i.e. ‘latex skin’ formed on cast of toe/joint (positive cast dipped 5–6 times into liquid latex); trauma reduction (incorporation of sponge pad, or a liquid silicone-filled blister); latex seal (2–3 further latex dips)

latex technique orthoses see latex shields

lavage wound flushing with e.g. “Warmasol”

law principle or rule

layer tissue sheet of uniform thickness

epidermal layers see epidermis; skin

LDL see low-density lipoprotein

lead-pipe rigidity initial resistance followed by gradual compliance, on passive limb movement; characteristic of Parkinson’s disease

leather dermatitis hypersensitivity and inflammation of foot skin following a ‘moccasin’ pattern; caused by chemical residues in leather; treatment includes removal of the cause and short-term (e.g. 3 days) application of 1% hydrocortisone cream

Leeds Foot Impact Scale; LFIS validated, foot-specific outcomes measure, used to assess impact of rheumatoid disease

leflunomide; Arava long-acting disease-modifying antirheumatic drug of similar efficacy to methotrexate and sulfasalazine; acts on the immune system, is bone marrow-toxic, and increases patient predisposition to infection and malignancy

leg injuries in athletes overuse, stress and traumatic injuries, e.g. chondromalacia patellae; chronic leg pain; tibial fasciitis/shin splints; tibial stress fracture; acute and chronic compartment syndrome; muscle soreness; muscle cramps; muscle herniations; posterior tibia dysfunction in the athlete; posterior tibial tendinitis; peroneal (fibular) tendinitis; patellofemoral problems; iliotibial band syndrome; popliteus tendinitis; hamstring tendinitis; groin injury

leg length discrepancy; LLD true leg length inequality (i.e. >1 cm difference in adult), or apparently unequal length (secondary to e.g. spinal scoliosis or pelvic tilt, so that legs function as in LLD)

leg pain see chronic leg pain

Legg–Calvé–Perthe’s disease see disease, Legg–Calvé–Perthe’s

leiomyoma vascular smooth-muscle-derived benign neoplasm; firm, smooth subcutaneous nodule with associated local stabbing pain; treated by local excision

leishmaniasis infection with Leishmania species (endemic in Asia, the Middle East, Africa, southern Europe and Latin America) transmitted by bite from female sandfly; causes initial pruritic papule (e.g. of plantar skin), thence nodule formation, then inflammation and ulceration 6-8 weeks later; healed lesions show pigmented scarring; patients should be referred for specialist advice

lemniscus bundle of nerve fibres ascending from spinal cord sensory nuclei to the thalamus

lentigo regularly bordered brown macules (resembling large freckles) common on dorsum of hands in the elderly

lepra cells tissue histiocytes that engulf leprosy bacilli (Mycobacterium leprae)

leproma discrete circumscribed focus of granulomatous inflammation, caused by Mycobacterium leprae infection

lepromin tissue extract infected with Mycobacterium leprae, used in classification of Hansen’s disease

leprosy; Hansen’s disease see disease, Hansen’s

lesion wound, injury or pathological tissue changes

lesser metatarsalgia pain (due to a range of causes) in lesser metatarsals area, affecting any tissue within that area (see Table M11)

lesser rays columns of bones + associated joints forming the forefoot (except first ray)

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