Acute Foot and Ankle Pain Flashcards
Where are the malleoli of the ankle?
Medial: tibia
Lateral: fibula
Posterior: posterior distal tibia
What are the ligaments of the ankle?
ATFL: anterior talofibular ligaments (inversion)
PTFL: posterior talofibular ligament
CFL: calcaneal fibular ligaments (dorsiflexion)
PTTL: posterior tibiotalar ligament
TCL: tibiocalcanela ligament
ATTL: anterior tibiotalar ligament
TNL: tibionavicular ligament
Ankle sprain history
Rolled Felt pop Swelled quickly Hurts to walk Stepped off curb wrong Twisted rounding a base Stepped on players foot
Ankle sprain PE
Swollen, bruised, limping, pain along ligaments
Posterior lateral malleolus, posterior medial malleolus pain and inability to bear weight
Ankle sprain test
Anterior Drawer: tibia forward
Talar Tilt: adduct and invert calcaneous to a varus position
Syndesmosis: squeeze tibia and fibula
Ankle sprain imaging
X-rays: AP, Lateral, Mortise
MRI usually not done
Ankle sprain classification
I: ATFL
II: ATFL and CFL, mild laxity in one or both
III: ATFL and CFL, significant laxity in both
ALL NONOPERATIVE unless recurrent sprains in ADLs
Ankle fracture history
Twisting/rotation of ankle Low energy Pop Swelling Inability to bear weight Bruising
Ankle fracture PE
Swelling, bruising, crepitus to palpation of malleoli, deformity
Ankle fracture imaging
x-rays
Ankle fracture treatment
nonop in isolated lateral malleolus fracture with joint congruent - cast or walking boot
op in bimalleolar or trimalleolar - ORIF
Base of the 5th Metatarsal Fracture is what kind of fracture and usually occur after what
Avulsion fractures that occur after adduction injury to the forefoot (twisting of foot)
5th metatarsal fracture treatment
hard soled shoe (avulsion or transverse diaphysis), nonweightbearing for 6 to 8 weeks in a jones, hardly ever results in nonunion but that would be treated with ORIF
5th MT fracture PE
pain lateral foot, midfoot swelling, bruising
5th MT fracture imaging
x-rays: AP, lateral, oblique
Three types of 5th MT fractures
- Avulsion fracture of a variably sized portion of tuberosity (can involve joint between cuboid and 5th)
- JONES fracture, intermetatarsal joint (MD jxn)
- transverse fracture of the proximal metatarsal diaphysis
why must you not miss a Jones fracture?
lack of blood supply can cause it not to heal and need for surgery
achilles tendon rupture hx
active men/women that are weekend warrior
sudden forced dorsiflexion while gastroc is contracting
sudden pain after push off or changing direction
immediate weakness
fall to ground
achilles rupture PE
weak plantar flexion
thompson test: examiner squeeze calf and foot doesnt move = + test
bruising
gap in back of leg
achilles rupture imaging
x-rays to make sure no bony injury MRI confirmatory (esp for partial tears)
achilles rupture treatment
nonop: sedentary, diabetics, high chance of re-rupture so use plantar flexed cast
op: younger, re ruptured, HEALING PROBLEMS
