Acute Foot & Ankle Pain Flashcards
What is the Hx of an Ankle sprain?
- “Rolled” the ankle
- Felt pop
- Swelled pretty quickly
- Hurts to walk on it
- Stepped off curb wrong, twisted rounding a base, stepped on players foot
What will be found on PE of an Ankle Sprain?
- Swollen, bruised, limping
- Pain along ligaments
What are Ottawa Rules of X-rays?
- Tenderness over inferior or posterior pole of either malleolus
- Inability to bear wt independ in 4 steps
- Tenderness along base of 5th metatarsal or navicular bone
- *Peds pop (<18yo)→ GROWTH PLATES
- “pop,” immediate swelling
What tests are used for an Ankle Sprain?
Anterior Drawer, Talar Tilt, Squeeze test
What is a Syndesmosis?
Connection b/w tibia & fibula. Injured in a high ankle sprain
What imaging is used for an Ankle Sprain?
Plain X-rays: AP, Lateral, Mortise & stress views
What are the Classifications of Ankle Sprains?
- Mild damage to ATFL w/o instability
- Partial tear to ATFL & CFL w/ laxity in one or both joints
- Complete tear of ATFL, CFL & PTFL causing joint instability
Tx of an Ankle Sprain
- Nonop: Brace, ice, wt bearing
- Surgical: 4-6mo w/ reccurent sprains
- Repair or reconstruction of lateral ankle ligaments
What is the Hx of an Ankle Malleoli Fracture?
- Twisting/rotation of ankle
- Usually low energy
- Pop
- Swelling
- Inability to bear weight
- Bruising
What will be found on PE of an Ankle Malleoli Fracture?
- Significant swelling
- Bruising
- Crepitus to palpation of malleoli
- Deformity to ankle area
What imagining is used for an Ankle malleoli fracture?
X-rays
Tx of ankle malleoli fractures
- Nonop: some lateral malleolus fractures can be tx w/ cast or walking boot
- Op: Majority of bimalleolar or trimalleolar tx w/ ORIF
Hx of 5th Metatarsal Fractures
- Possible twisting of foot in sports or off a step/curb
- Pain lateral midfoot
- Pain w/ walking
PE of 5th Metatarsal fracture
- Midfoot swelling
- Bruising
- Pain to palpation of midfoot
Imaging for 5th Metatarsal fracture
X-rays: AP, Lateral, Oblique
What is a Jones fracture?
Fracture of the metadiaphysis junction of the proximal 5th metatarsal
Why must you not miss a Jones fracture?
Poor BS (watershed area b/w 2 BV)
Can lead to non-healing & chronic cond
What are the 3 types of 5th Metatarsal fractures?
- Avulsion (most proximal– just the tip off)
- Jones (diaphysis)
- Transverse diaphysis (commonly stress fx & most distal)
How do you tx an avulsion 5th MT fracture?
Hard sole shoe
How do you tx a Transverse diaphysis 5th MT fracture?
Hard sole walking shoe
How do you tx a Jones fracture?
Non wt bearnig short leg cast for 6-12 wks
When is surgery indicated in a Jones fracture?
High performance atheletes→ tx w/ ORIF
Hx of Achilles tendon rupture
- Active men/women 30-50 yo—recreational athlete/weekend warrior
- Basketball, racket sports, soccer, softball
- Sudden forced dorsiflexion while gastroc is contracting
- Sudden pain after push off or changing direction
- Immediate weakness
- Fall to ground
PE of Achilles Tendon rupture
- Weak plantar flexion
- Bruising
- Gap in back of leg
