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MS of Foot and Ankle

Clinical Medicine II-Spring 2012

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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