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Sports Medicine > 6) Other Ankle Injuries > Flashcards

6) Other Ankle Injuries Flashcards

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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
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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
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3
Q

Talar dome fractures mechanism and locations

A
  • Anterior / lateral = ankle inversion with dorsiflexion

- Posterior / medial = ankle inversion with plantarflexion

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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)
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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
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6
Q

Talar dome fractures sequelae

A
  • OCD (osteochondritis dessicans): arthroscopic debridment

- Osteoarthritis: Debridment, ankle fusion, ankle implant

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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
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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)
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9
Q

Medial malleolar contusion

A
  • Immobilization 4 -6 weeks

- Medial malleolar “chip” fracture: Immobilization / surgical excision

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10
Q

Peroneal syndromes

A
  • Tendinitis
  • Tenosynovitis
  • Longitudinal split tear
  • Rupture
  • Dislocation / subluxation
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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
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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
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13
Q

Peroneal tendinitis management

A
  • Relative rest / alternative activity
  • Address biomechanical faults
  • Physical therapy (phonophoresis, massage, heat, strengthening)
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14
Q

Peroneal tendinitis management continued

A
  • Immobilization: 4 – 6 wks
  • Injectable corticosteroid (phosphate into sheath, 2 – 4 wks immobilization)
  • MRI
  • Surgical debridment / repair
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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
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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

Sports Medicine (5 decks)

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