6) Other Ankle Injuries Flashcards
1
Q
Other ankle injuries
A
- Eversion ankle sprains
- Talar dome fracture
- Peroneal syndromes
- Talar lateral process fracture
- Anterior ankle impingement
- Posterior ankle impingement
- Os trigonum
- Flexor hallucis longus injury
2
Q
Talar dome fractures
A
- Chondral or osseous fracture
- Commonly mis-diagnosed
- Usually not visible via standard radiography
- Common cause of chronic or latent ankle pain
- Ankle pain may be anywhere
- Frequently secondary to a lateral ankle inversion sprain or ankle fracture
3
Q
Talar dome fractures mechanism and locations
A
- Anterior / lateral = ankle inversion with dorsiflexion
- Posterior / medial = ankle inversion with plantarflexion
4
Q
Berndt and Hardy classification
A
- Type 1: Area of chondral depression
- Type 2: Partially detached fragment
- Type 3: Completely detached but not displaced fragment
- Type 4: Loose fragment (joint mouse)
5
Q
Talar dome fractures management
A
- Types 1 & 2: 4 wks. NWB cast; 2 – 4 wks. wb cast
Type 3: Posterior / medial: NWB cast 6 – 8 wks. - Type 3: Anterior / lateral: Cast vs. ORIF / excision with debridment
- Type 4: Surgical excision with debridment of lesion
6
Q
Talar dome fractures sequelae
A
- OCD (osteochondritis dessicans): arthroscopic debridment
- Osteoarthritis: Debridment, ankle fusion, ankle implant
7
Q
Eversion ankle sprain / medial ankle pain
A
- Medial malleolar contusion / fracture (acute)
- Medial malleolar stress fracture (insidious)
- Posterior – tibialis tendinitis
- Tarsal tunnel syndrome
- Flexor tendinitis
- Spring ligament injury
- Deltoid ligament injury
- Navicular tuberosity avulsion fracture / os tibialis externum
8
Q
Medial malleolar fractures
A
- Stress
- Traumatic
- Increased potential for non-union
- For the athlete: ORIF (increased incidence of healing, more rapid return to activity)
9
Q
Medial malleolar contusion
A
- Immobilization 4 -6 weeks
- Medial malleolar “chip” fracture: Immobilization / surgical excision
10
Q
Peroneal syndromes
A
- Tendinitis
- Tenosynovitis
- Longitudinal split tear
- Rupture
- Dislocation / subluxation
11
Q
Peroneal tendinitis
A
- Common overuse lateral leg pain
- May be acute onset / post – traumatic
- History of lateral ankle sprains
- Hard surfaces may contribute
- Shoe change may contribute
12
Q
Peroneal tendinitis physical examination
A
- Weak / painful eversion
- Pain with forced inversion
- Edema
- Limb – length discrepancy
- Rearfoot varus / forefoot valgus
- Ankle (lateral) instability
13
Q
Peroneal tendinitis management
A
- Relative rest / alternative activity
- Address biomechanical faults
- Physical therapy (phonophoresis, massage, heat, strengthening)
14
Q
Peroneal tendinitis management continued
A
- Immobilization: 4 – 6 wks
- Injectable corticosteroid (phosphate into sheath, 2 – 4 wks immobilization)
- MRI
- Surgical debridment / repair
15
Q
Peroneal tenosynovitis
A
- Inflammation and thickening of the synovial tendon sheath often with impingement (stenosis)
- History of chronic tendinitis / trauma
- MRI / tenogram diagnostic
- Injectable corticosteroid / immobilization
- Surgical debridment required
16
Q
Longitudinal split tear
A
- Most common type of “rupture”
- May be acute or chronic
- May be asymptomatic: a common incidental finding on MRI
- Conservative mgt: Immobilization 6-8 weeks followed by physical therapy
- Surgical mgt: Tubularization
17
Q
Peroneal dislocation
A
- Secondary to rapid ankle dorsiflexion from a plantarflexed position
- Most common in skiing
- Secondary to ankle inversion injury is uncommon
- Subluxation significant only if painful
18
Q
Peroneal dislocation management
A
- Immobilization: generally poor results in athletes
19
Q
Peroneal dislocation surgical management
A
- Fibular rotational osteotomy
- Calcaneofibular ligament with bone block
- Groove – deepening procedures (preserve articular surface)
- Retinacular repair
20
Q
Lateral talar process fracture
A
- AKA: “Snowboarder’s ankle” (not the most common injury in snowboarding)
- Acute lateral ankle / foot pain
- Dorsiflexion with inversion or eversion
- Non-displaced: 6-8 wks immob.
- Displaced: ORIF
- Mechanism: inversion / eversion
21
Q
Anterior ankle impingement
A
- Insidious – onset anterior ankle pain
- Pain with deep anterior ankle palpation
- Pain with forced ankle dosiflexion
- Equinus
- Radiographic spurring
- Stress – lateral radiograph
- MRI for soft – tissue impingement
22
Q
Anterior ankle impingement management
A
- Heel lift
- Injectable corticosteriod
- Massage / ultrasound
- Arthroscopic debriment
23
Q
Posterior ankle pain
A
- Posterior impingement
- Os trigonum
- Shepard’s fracture
- Retrocalcaneal bursitis
- Pre-achilles bursitis
- Flexor hallucis injury
24
Q
Posterior ankle impingement
A
- Impingement of the posterior ankle / subtalar joint
- Soft tissue impingement most common
- Retrocalcaneal bursitis
- Pain with releve: ankle plantarflexion
- Pain with rapid forced plantarflexion
25
Q
Posterior ankle pain management
A
- Injectable corticosteriods
- Joint mobilization
- Dexamethasone iontophoresis
- Surgical debridment
26
Q
Os trigonum
A
- Accessory ossicle
- Common cause of insidious - onset posterior ankle pain
- Fractured posterior lateral process: does it matter ?
- Injectable corticosteroid / immobilization / surgical excision
27
Q
Flexor hallucis longus tendinitis
A
- AKA “Dancers tendinitis”
- Common cause of posterior-medial ankle pain
- Pathology at the fibro-osseous synovium-line groove created by the talar processes
- Frequently post-traumatic
- MRI useful
28
Q
Dancer’s tendinitis management
A
- Dexamenthasome iontophoresis
- Strengthening
- Immobilization
- Injectable corticosteroid
- Surgical debridment
