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
What is the special test for Achilles tendon rupture?
Thompson test
How is the Thompson test performed?
Pt lies prone as the doc squeezes the gastrosoleus complex
What indicates a + Thompson test?
Pt can’t plantar flex
What imaging is used in a Achilles Tendon rupture?
- X-ray: r/o boney injuries or avulsions
- MRI: Confirmatory
What is the mech of injury in Achilles tendon rupture?
Mechical overload→ eccentric contraction of gastrosoleus complex
Who do Achilles tendon ruptures occur in?
30-50 yo who are insufficently conditioned
Tx for Achilles Tendon Rupture
- Nonop: sedentary, possible wound problems (DM or high risk), higher chance of rerupture→ plantar flexed cast
- Op: younger pts, those that re-rupture
What is the primary risk of repair to Achilles tendon?
Wound healing problems (5%)
Inc risk in DM or peripheral vascular dz
Which nerve is at risk during surgery to repair a Achilles tendon rupture?
Sural (short saphenous) nerve
What is the #1 nonop tx risk for Achilles Tendon rupture?
Re-rupture
What are the indications of surgical repair of Achilles Tendon rupture?
- Active patients
- Cases of re-rupture
- Chronic injury over 2 weeks
- Lower risk of re-rupture
What are the indications of non-surgical tx of Achilles tendon rupture?
- Sedentary
- Inc risk of wound complications (DM or PVD)
- Multiple comorbidities
- Patient doesn’t want surgery
What class of medications have been linked to tendon ruptures like Achilles tendons?
Fluoroquinolones
What is the MC injured ankle ligament?
Anterior Talofibular Ligament
