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MS of Foot and Ankle
Clinical Medicine II-Spring 2012
| Question | Answer |
|---|---|
| What type of joint is the ankle joint? | hinge, only flexion/extension, no inversion or eversions with the ankle itself |
| What are three lateral ligaments | Ant. And Post, talo-fibular, and calcaneo-fibular: prevent from “rolling”the ankle |
| What ligament is on the medial ankle surface | deltoid ligament |
| What ligament has 3 names in the ankle joint | tibofibular ligament, or interosseous ligament, or syndesmotic |
| Which ligament maintains the integrity of the mortise joint | tibofibular ligament |
| Where are the extensors and flexor ligaments | e: ant. Foot AKA dorsiflexors, flex: posterior to medial malleolusAKA plantar flexors |
| Extensor (dorsiflexors) of the foot | Extensor digitorum longus, extensor hallucis longus, tibialis ant, peroneus fibularis |
| Flexors (plantarflexors) of the foot | Tibialis post, flexor dig long, flexor hallucus long |
| What tendons evert the ankle | peroneals, past posterior to lateral malleolus |
| What is the primary flexor of the foot | Achilles tendon: allows to jump ad climb stairs |
| Fibrous bands that hold tendons in place | retinacula: medial and lateral sides |
| MC ankle injury, | ankle sprains d/t inversion, and is a ligamentous injry |
| Which ligaments are most affected by ankle sprains | lateral ligaments |
| How do ligaments tear | from anterior to posterior: ant. Talo-fibular lig. First to tear, then deltoid, then tib-fib |
| Signs/sxs of ankle sprain | pain, swelling, may be in a talar tilt: ligament tear, |
| Two tests for a ankle sprain | inversion stress, drawer test: usually for f/u to test strength |
| Who needs an ankle XR w/ a sprain | Ottawa Rules: Bony tenderness along distal 6cm of tib or fib, bony tenderness @ 5th metatarsal, inability to bear wt. both post injury and in ER |
| What are the ankle sprain classifications | 1st degree: ligament stretch 2nd: severe stretch/partial tear: abnl stress test 3rd: complete rupture, can’t bear wt abnl stress test |
| Tx ankle sprains | conservative, ice elevation, immobilize w/splint w/ maybe crutches if can’t bear wt |
| Types of ankle fractures | malleolar,bimalleolar, trimalleolar: posterior pt of the tibia |
| What does disruption of tib-fib ligament mean | disruption of the mortise joint: surgery |
| What are the classifications of ankle fractures | Weber classification A: fibular below syndesmosis, B: fibular at syndesmosis, sometimes tear ligament C: above syndesmosis, always tearing ligament, always disrupt mortise |
| Which type of ankle fracture doesn’t usually disrupt the mortise joint | Weber A, fracture at distal fibula |
| Clinical signs of an ankle fracture | looks like a sprain, but inability to bear wt, ↑swelling |
| How do we read an XR | follow the cortex down in’s smooth contours, any disruption is usually a fracture |
| What are the XR views of an ankle | 3 view series, AP, Lateral, Mortise |
| Ankle fracture tx | reduction, immobilization, elevate, surgery if mortise disrupted, cast 6-8wks either way |
| What happens if mortise is not fixed | arthritis development almost guaranteed |
| MOI of a calcaneus fracture | fall from height MC, Car accidents, head on collisions |
| What other injuries are often associated w/ calcaneus fracture | 10% lumbar fx, and 26% other extremity injury |
| Dx and tx of calcaneus fx | std foot films, consider calcaneal view, tx: surgical often communated fx |
| MOI of talar fx | hyper plantarflexion of foot , driving the talus into tibia, fx at dome, neck, or body of bone |
| Problem w/ dome talus fx | disruption of cartilage blood supply to the tendon |
| What will a pt present as w/ talus frx | looks like an ankle sprain, pain in ANT. FOOT, where tib meets talus. |
| Dx of talus fracture | foot films, not ankle, and PE, pain on ant foot, unable to walk, intense pain |
| Tx of talus fx | immobilize, non wt bearing, refer to ortho, surgery if displaced, conservative if not |
| MOI of cuboid fx | crush injury, usually w/ navicular or cuneiform injuries |
| Tx of cuboid fx | foot XR, conservative in non-displaced, ORIF if displaced |
| MC metatarsal fx | 5th metatarsal fx |
| MOI of proximal 5th metatarsal fx | inversion of ankle: sprain, the peroneus brevis tendon inserts at prox. 5th metatarsal: avulsion fx |
| Tx of prox 5th metatarsal fx | conservative, immobilize, crutches 4-6 wks |
| Name of 5th metatarsal fx of diaphysis, NOT avulsion | Jones fracture |
| What is the problem w/ Jones fracture | has higher incidence of non-union, may need surgery! |
| MC location of foot stress fx, cause? | 2nd and 3rd MT, d/t excessive stress over time: running |
| Tx stress fx | conservative, usually need to lay off the training, rest, can’t always see it, f/u 2-3 wks later |
| MOI of complete MT fx | usually crushing, occasionally d/t twisting of foot, usually more than one MT involved |
| Tx of complete MT fx | ice, immobilize, w/ plaster/fiberglass |
| Dx and tx of forefoot fx | phalanges, usually dislocated→reduce, don’t NEED XR, immobilize (buddy tape-dynamic splinting), wear stiff sole shoes, (post-op shoe) (walking boot for big toe-refer to ortho) |
| Causes of metatarslagia | wt gain, hallux valgus, flat foot, transverse arch becomes depressed, gout, rheum, arthritis |
| Inflammation of nerve bifurcation b/w toes | morton’s neuroma MC bw 2nd and 3rd toes |
| Where is morton’s neuroma seen? | middle-aged women d/t ill-fitting shoes, unilateral |
| Sharp attack of sharp or burning pain radiating to toes, usually when walking, later at rest | Morton’s neuroma |
| Clinical dx of morton’s neuroma | H&P, localized webspace tenderness, sm mass in webspace d/t inflammation |
| Tx morton’s neuroma | steroid/lidocain injection, later: surgical excicsion |
| Stiffness of MTP joint of great toe, cause | hallux rigidus, d/t arthritis, local trauma, gout M>F |
| MC joint affected by gout | MTP joint of big toe |
| Clinical dx and tx of Hallux Rigidus | pain w/ walking, tender MTP joint, and pain w/ dorsiflexion, XR: arthritic changes, Tx: rocker-soled shoes, NSAIDS, surgery: fusion or joint replacement |
| MC foot deformity, often familial | Hallux Valgus: bunions |
| Tx of hallux valgus | wide, padded shoes, corrective osteotomy |
| PIP joint is fixed in flexion, DIP extended | Hammertoe: MC in 2nd toe callous develops on DIP joint |
| Tx Hammertoe | Operative joint excision and fusion |
| Pes Planus | Flat foot, d/t collapsed medial arch |
| Two types of pes planus | flexible: arch goes up when lift foot, Rigid: anatomical arch is always flat |
| Causes of rigid pes planus | congenital vertical talus, or spasmodic peroneal muscles Other: congenital, polio, RA, OA, tendon rupture |
| Dx and Tx of pes planus | aching w/ walking/standing, look at shoes, flat foot when standing on floor, tx: arch support tx underlying cond |
| Causes of plantar fasciitis | overuse injury, running, occupation, RA, OA, gout |
| What is usually associated w/ plantar fasciitis, tx | periostitis of calcaneus, tx rest, NSAIDS, arch support, stretching, night splints of fibers |
| Dx of plantar fasciitis | pain over plantar surface, relief w/ rest, tender over ant. Calcaneus |
| Dx peroneal tendonitis | tender to palpation post lat malleolus, worse with dorsi/plantar flexion conservative tx/rest steroid injections |
| Entrapment of posterior tibial n. by flexor retinaculum | tarsal tunnel syndrome, inflammation of tibial n. |
| Predispositions of TTS | repetitive activity, RA, preggo, Acute trauma |
| Signs sxs of TTS, tx | numbness, pain of sole of foot, Rest, NSAIDS, immobilize, Surgery |
| Occurs after injury that disrupts peroneal retinaculum, stretching | subluxing peroneal tendons |
| Signs of subluxing peroneal tendons | everting the foot dislocates tendons over lateral malleolus Tx: surgical |
| Cause and signs of Achilles tendonitis | overuse of calf muscle, pain over tendon and dorsiflexion, rest, NSAID, immobilize |
| If Achilles tendonitis becomes chronic, tx | surgery to divide fascia, remove scar tissue over the tendon |
| Cause of Achilles tendon rupture | forced dorsiflexion of ankle: initiating sprint, slip on stair, trauma: lac, or MC in middle aged men |
| Sxs and exam of Achilles tendon rupture | sudden pain, “snap”, difficulty stepping off (TDH still there) , Swelling at distal calf, palpable tendon defect (not smooth) +Thompson test |
| Thompson test | passively squeezing calf muscle, with plantarflex the foot +test means foot doesn’t move |
| Tx Achilles tendon rupture | splint in equinus, non wt bearing, surgical tx |
| Location of foot bursae | b/w calcaneus and achilies, b/w achillies and skin |
| Cause of hindfoot bursitis | poorly-fitting shoes, overuse, rest pain NSAIDS |
Created by:
streetsmarts
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