20: Approach To Ankle And Foot Complaint Flashcards
Three possible injuries with a positive talar tilt test
- Lateral ankle sprain
- Calcaneofibular L injury
- Anterior talofibular L injury
What does a positive anterior drawer test signify?
Lateral ankle sprain
Possible injury with a positive eversion test
Medial ankle sprain (deltoid L)
Two possible injuries with a positive squeeze test
- High ankle sprain
2. Distal tibiofibular syndesmosis injury
Positive Homan’s sign signifies?
DVT
Three main types of ankle sprains
- Lateral
- Medial
- Syndesmotic
Most common type of ankle sprain
Lateral ankle sprain, Anterior talofibular L
Mechanism of injury for a lateral ankle sprain
Foot inversion and/or plantarflexed
Medial ankle sprain mechanism
Forced eversion
Ligament injured in medial ankle sprain
Deltoid L (but takes a lot of force to actually tear it)
Other name for syndesmotic ankle sprain
High ankle sprain
Most likely ligament torn in high ankle sprain
Tibiofibular syndesmosis
Mechanism for syndesmotic ankle sprain
Forced external rotation of a dorsiflexed ankle
Three “grades” of ankle sprains
- Grade 1: no laxity, minimal ligament damage
- Grade 2: Mild/moderate laxity
- Grade 3: complete ligament disruption
Treatment for the three grades of ankle sprains
All of them: manage conservatively with NSAIDs, RICE, PT. Grade 3 requires immobilization for 3 weeks, and surgery if unstable
Largest tendon in the body
Calcaneal tendon
Achilles tendinitis MOI
Repetitive motions -> microtears in tendon -> inflammation (common in athletes)
S/S of Achilles tendinitis
Pain/stiffness at tendon insertion, recent increase in activity level, worse with activity
Associated test with Achilles tendinitis
NEGative Thompson test
Achilles rupture MOI
80% occur during high impact sports
S/S of Achilles rupture
Popping sensation at the heel, +/- pain
Associated test with Achilles rupture
Positive Thompson test
Sever’s disease
Calcaneal apophysitis - inflammation/stress injury to area around apophysis in heel
S/S of sever’s disease
Chronic heel pain related to increased activity and growth, pain reproduced over apophysis
Four things that can cause a tibiotalar effusion
Injury, arthritis, infection, hemearthrosis
Pes planus
Flat feet - loss of longitudinal arch
Pes cavus
Exaggeration of longitudinal arch of foot
Hammer toe vs claw toe
Hammer toe: flexion at PIP, extension at DIP
Claw toe: flexion at PIP and DIP
Hallux valgus
Lateral deviation of big toe that can lead to a prominence on the medial aspect of the MP joint (bunion)
What worsens the pain of plantar fasciitis?
First few steps in the morning, prolonged standing, forced dorsiflexion
Morton’s neuroma
Inflammation/thickening of tissue surrounding nerves between toes
S/S of Morton’s neuroma
Sensation of walking on a marble, palpable in web space -> replicates burning pain with radiation and numbness in toes
Associated test with Morton’s neuroma
Mulder’s sign: palpable clicking sensation between third web space as transverse arch is compressed
Where is fibular nerve most commonly compressed
Where it wraps around the lateral aspect of the fibular head
What can cause fibular nerve compression?
Prolonged lying, crossing legs, ankle sprain, prolonged immobilization in a cast
S/S of fibular nerve compression
Weak dorsiflexion and eversion, steppage gait, sensory loss of dorsal foot and lateral shin
Charcot foot
Mid arch deformities and collapse of longitudinal arch due to chronic foot inflammation
What causes Charcot foot?
Neuropathy, often diabetic
What causes diabetic neuropathy
Chronic elevated blood sugar damages peripheral nerves
S/S of Charcot foot
Visible collapse of longitudinal arch, warmth, redness, edema, Hx minor trauma
What causes gout?
Monosodium urate crystals
What joint is most susceptible to gout?
1st MTP
What foods cause gout and why?
Meat, shellfish, alcohol -> high in purines, which breaks down to create uric acid
What is seen upon joint aspiration of a gouty joint?
Negatively birefringent needle-shaped crystals
Pronation vs supination of foot: three actions that create them
Pronation: dorsiflexion, eversion, abduction (Abed)
Supination: plantarflexion, inversion, adduction (AdPI)
Where does the fibular head glide when the foot is pronated vs supinated
Pronated -> fibular head glides anteriorly
Supinated -> fibular head glides posteriorly
When the calcaneus moves into eversion/inversion, where does the talus go?
Calcaneal eversion -> talus goes anterior + medial
Calcaneal inversion -> talus goes posterior + lateral
Preference for glide for cuboid, navicular, and cuneiforms
Cuboid: eversion + plantar glide
Navicular: inversion + plantar glide
Cuneiforms: plantar glide
What are the Ottawa Ankle Rules?
Guidelines for when to order X-rays on a pt with ankle pain
Ottawa ankle rules: if patient has pain in the malleolar zone
Must have one of the following
- Bony tenderness at posterior tip of medial or lateral malleolus
- Unable to bear weight immediately after injury + unable to walk 4 steps in clinic
Ottawa Ankle rules: if pt has pain in midfoot region
Must have at least one of the following for an x-ray
- Bony tenderness at fifth metatarsal or navicular
- Unable to bear weight immediately after injury + unable to walk 4 steps in clinic
