Acute Foot and Ankle Pain

Question 1

Where are the malleoli of the ankle?

Answer 1

Medial: tibia
Lateral: fibula
Posterior: posterior distal tibia

Question 2

What are the ligaments of the ankle?

Answer 2

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

Question 3

Ankle sprain history

Answer 3

Rolled
Felt pop
Swelled quickly
Hurts to walk
Stepped off curb wrong
Twisted rounding a base
Stepped on players foot

Question 4

Ankle sprain PE

Answer 4

Swollen, bruised, limping, pain along ligaments

Posterior lateral malleolus, posterior medial malleolus pain and inability to bear weight

Question 5

Ankle sprain test

Answer 5

Anterior Drawer: tibia forward
Talar Tilt: adduct and invert calcaneous to a varus position
Syndesmosis: squeeze tibia and fibula

Question 6

Ankle sprain imaging

Answer 6

X-rays: AP, Lateral, Mortise

MRI usually not done

Question 7

Ankle sprain classification

Answer 7

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

Question 8

Ankle fracture history

Answer 8

Twisting/rotation of ankle
Low energy 
Pop
Swelling
Inability to bear weight
Bruising

Question 9

Ankle fracture PE

Answer 9

Swelling, bruising, crepitus to palpation of malleoli, deformity

Question 10

Ankle fracture imaging

Answer 10

x-rays

Question 11

Ankle fracture treatment

Answer 11

nonop in isolated lateral malleolus fracture with joint congruent - cast or walking boot
op in bimalleolar or trimalleolar - ORIF

Question 12

Base of the 5th Metatarsal Fracture is what kind of fracture and usually occur after what

Answer 12

Avulsion fractures that occur after adduction injury to the forefoot (twisting of foot)

Question 13

5th metatarsal fracture treatment

Answer 13

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

Question 14

5th MT fracture PE

Answer 14

pain lateral foot, midfoot swelling, bruising

Question 15

5th MT fracture imaging

Answer 15

x-rays: AP, lateral, oblique

Question 16

Three types of 5th MT fractures

Answer 16

1. Avulsion fracture of a variably sized portion of tuberosity (can involve joint between cuboid and 5th)
2. JONES fracture, intermetatarsal joint (MD jxn)
3. transverse fracture of the proximal metatarsal diaphysis

Question 17

why must you not miss a Jones fracture?

Answer 17

lack of blood supply can cause it not to heal and need for surgery

Question 18

achilles tendon rupture hx

Answer 18

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

Question 19

achilles rupture PE

Answer 19

weak plantar flexion
thompson test: examiner squeeze calf and foot doesnt move = + test
bruising
gap in back of leg

Question 20

achilles rupture imaging

Answer 20

x-rays to make sure no bony injury
MRI confirmatory (esp for partial tears)

Question 21

achilles rupture treatment

Answer 21

nonop: sedentary, diabetics, high chance of re-rupture so use plantar flexed cast
op: younger, re ruptured, HEALING PROBLEMS