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MSS Conditions > Acute Foot & Ankle Pain > Flashcards

Acute Foot & Ankle Pain Flashcards

1
Q

What is the Hx of an Ankle sprain?

A
  • “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
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2
Q

What will be found on PE of an Ankle Sprain?

A
  • Swollen, bruised, limping
  • Pain along ligaments
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3
Q

What are Ottawa Rules of X-rays?

A
  • 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
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4
Q

What tests are used for an Ankle Sprain?

A

Anterior Drawer, Talar Tilt, Squeeze test

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5
Q

What is a Syndesmosis?

A

Connection b/w tibia & fibula. Injured in a high ankle sprain

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6
Q

What imaging is used for an Ankle Sprain?

A

Plain X-rays: AP, Lateral, Mortise & stress views

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7
Q

What are the Classifications of Ankle Sprains?

A
  1. Mild damage to ATFL w/o instability
  2. Partial tear to ATFL & CFL w/ laxity in one or both joints
  3. Complete tear of ATFL, CFL & PTFL causing joint instability
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8
Q

Tx of an Ankle Sprain

A
  • Nonop: Brace, ice, wt bearing
  • Surgical: 4-6mo w/ reccurent sprains
  • Repair or reconstruction of lateral ankle ligaments
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9
Q

What is the Hx of an Ankle Malleoli Fracture?

A
  • Twisting/rotation of ankle
  • Usually low energy
  • Pop
  • Swelling
  • Inability to bear weight
  • Bruising
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10
Q

What will be found on PE of an Ankle Malleoli Fracture?

A
  • Significant swelling
  • Bruising
  • Crepitus to palpation of malleoli
  • Deformity to ankle area
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11
Q

What imagining is used for an Ankle malleoli fracture?

A

X-rays

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12
Q

Tx of ankle malleoli fractures

A
  • Nonop: some lateral malleolus fractures can be tx w/ cast or walking boot
  • Op: Majority of bimalleolar or trimalleolar tx w/ ORIF
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13
Q

Hx of 5th Metatarsal Fractures

A
  • Possible twisting of foot in sports or off a step/curb
  • Pain lateral midfoot
  • Pain w/ walking
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14
Q

PE of 5th Metatarsal fracture

A
  • Midfoot swelling
  • Bruising
  • Pain to palpation of midfoot
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15
Q

Imaging for 5th Metatarsal fracture

A

X-rays: AP, Lateral, Oblique

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16
Q

What is a Jones fracture?

A

Fracture of the metadiaphysis junction of the proximal 5th metatarsal

17
Q

Why must you not miss a Jones fracture?

A

Poor BS (watershed area b/w 2 BV)

Can lead to non-healing & chronic cond

18
Q

What are the 3 types of 5th Metatarsal fractures?

A
  1. Avulsion (most proximal– just the tip off)
  2. Jones (diaphysis)
  3. Transverse diaphysis (commonly stress fx & most distal)
19
Q

How do you tx an avulsion 5th MT fracture?

A

Hard sole shoe

20
Q

How do you tx a Transverse diaphysis 5th MT fracture?

A

Hard sole walking shoe

21
Q

How do you tx a Jones fracture?

A

Non wt bearnig short leg cast for 6-12 wks

22
Q

When is surgery indicated in a Jones fracture?

A

High performance atheletes→ tx w/ ORIF

23
Q

Hx of Achilles tendon rupture

A
  • 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
24
Q

PE of Achilles Tendon rupture

A
  • Weak plantar flexion
  • Bruising
  • Gap in back of leg
25
Q

What is the special test for Achilles tendon rupture?

A

Thompson test

26
Q

How is the Thompson test performed?

A

Pt lies prone as the doc squeezes the gastrosoleus complex

27
Q

What indicates a + Thompson test?

A

Pt can’t plantar flex

28
Q

What imaging is used in a Achilles Tendon rupture?

A
  • X-ray: r/o boney injuries or avulsions
  • MRI: Confirmatory
29
Q

What is the mech of injury in Achilles tendon rupture?

A

Mechical overload→ eccentric contraction of gastrosoleus complex

30
Q

Who do Achilles tendon ruptures occur in?

A

30-50 yo who are insufficently conditioned

31
Q

Tx for Achilles Tendon Rupture

A
  • Nonop: sedentary, possible wound problems (DM or high risk), higher chance of rerupture→ plantar flexed cast
  • Op: younger pts, those that re-rupture
32
Q

What is the primary risk of repair to Achilles tendon?

A

Wound healing problems (5%)

Inc risk in DM or peripheral vascular dz

33
Q

Which nerve is at risk during surgery to repair a Achilles tendon rupture?

A

Sural (short saphenous) nerve

34
Q

What is the #1 nonop tx risk for Achilles Tendon rupture?

A

Re-rupture

35
Q

What are the indications of surgical repair of Achilles Tendon rupture?

A
  • Active patients
  • Cases of re-rupture
  • Chronic injury over 2 weeks
  • Lower risk of re-rupture
36
Q

What are the indications of non-surgical tx of Achilles tendon rupture?

A
  • Sedentary
  • Inc risk of wound complications (DM or PVD)
  • Multiple comorbidities
  • Patient doesn’t want surgery
37
Q

What class of medications have been linked to tendon ruptures like Achilles tendons?

A

Fluoroquinolones

38
Q

What is the MC injured ankle ligament?

A

Anterior Talofibular Ligament

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