Ankle Flashcards

1
Q

What is the groove that the posterior tibialis and flexor digitorum longus tendon pass thru?

A

malleolar groove
also have the medial malleolus that articulates with the talus, and the fibular notch on the distal tibia that articulates with the fibula

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2
Q

What tendon is the lateral malleolus of the fibula important for?

A

contains the malleolar fossa which is the attachment for the posterior talofibular ligament

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3
Q

What is the largest and second largest tarsal bones?

A

calcaneus, then talus
both referred to as the hind foot

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4
Q

What mechanism does the anterior ankle have, and how often is it involved in injuries?

A

extensor mechanisms of the foot, seldom involved in injuries

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5
Q

What are the tendons of the anterior ankle?

A

tibialis anterior tendon: largest and most medial
extensor hallicus longus tendon: lateral to TA, inserts on big toe
extensor digitorum longus tendon: lateral to EHL, splits into 4 and inserts on toes

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6
Q

What part of the ankle is most often involved in injuries?

A

lateral ankle from inversion injuries

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7
Q

What are the ligaments of the lateral ankle?

A

anterior talofibular ligament: weakest and 1st to be injured
anterior tibiofibular ligament
calcaneofibular ligament

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8
Q

What is the most common injury of the ankle?

A

ankle sprain
80% involve lateral ligament complex caused by inversion with the foot in plantar flexion

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9
Q

What is a grade 1 ankle sprain?
grade 2?
grade 3?

A

1- mild, microscopic without stretching seen
2- moderate, macroscopic stretching but ligament is intact
3- severe and complete rupture of ligament

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10
Q

What are the ligaments most commonly affected in ankle sprains from most commonly affected to least?

A

anterior talofibular ligament
calcaneofibular ligament
tibiofibular ligament: high sprains and most serious

causes chronic instability in 20% of sprains

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11
Q

What are the tendons of the lateral ankle?

A

peroneus longus tendon: longest tendon insertion in the body, wraps under the foot
peroneus brevis tendon: both responsible for eversion of foot, share protective sheath
superior fibular retinaculum: holds peroneus tendons in place and prevents subluxation

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12
Q

What are some pathologies of the lateral ankle tendons?
how does it appear?

A

tendinosis, rupture with retraction, subluxation and dislocation

thickening with fluid in sheath, hypoechoic sections, tears or complete rupture, or in abn location

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13
Q

What is the saying for the medial ankle tendons?
what mechanism does the medial ankle have?

A

Tom, Dick and a very nervous Harry
flexor mechanism of foot

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14
Q

What is Tom?

A

posterior tibialis tendon: has insertion on all tarsals except talus and calcaneus
weakness causes flat foot and dorsiflexed talus

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15
Q

What is Dick?
what can happen if PTT is ruptured?

A

flexor digitorum longus tendon: inserts on plantar surface of 4 toes
if PTT is ruptured, FDL may slide medially into that spot

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16
Q

What does a very nervous stand for?

A

refers to the neurovascular bundle on posterior aspect of medial ankle
posterior tibial artery, paired veins and tibial nerve

17
Q

What does Harry mean?

A

flexor hallicus longus tendon: most posterior, inserts on big toe

18
Q

What is the flexor retinaculum?

A

dense band of fibrous tissue that forms the roof of the tarsal tunnel, from medial malleolus to medial calcaneus

protects tibialis, FDL and FHL, tibial artery, veins and nerve

19
Q

What is the most commonly affected tendon of the medial ankle from pathology?

A

PTT: associated with systemic diseases such as RH arthritis (mostly in obese females)
stretching can cause flatfoot
less frequently tarsal tunnel syndrome

20
Q

What is tarsal tunnel syndrome?

A

when posterior tibial nerve becomes compressed where it passes under the flexor retinaculum

21
Q

What can cause tarsal tunnel syndrome?

A

flat feet: strains the nerve
varicose vein/ganglion cyst/bone spur
ankle sprain
systemic disease (diabetes or arthritis)

22
Q

What is the largest and strongest tendon in the body?

A

Achilles, 14-15cm long, 5.4-6.2mm AP
consists of fibers from the gastroc (lateral aspect) and soleus (medial aspect) muscles, broad insertion on posterior calcaneus

23
Q

Where is the minimally vascularized area of the Achilles?
Where is the retrocalcaneal bursa?
Kagers fat pad?

A

2-6cm prox from insertion on calcaneus (pathological if vascular)
- posterior surface of Achilles near calcaneus
- deep to Achilles and superior to calcaneus

24
Q

What can cause tendon path in the posterior ankle?

A

systemic disease: gout and diabetes

25
Q

When is retrocalcaneal bursitis seen?
(measurement)

A

enlargement over 2mm of fluid

26
Q

What is Paratenon disease? what does it look like

A

inflammation of Peratenon, becomes hypoechoic and hypervascular
no loss of fibular pattern in Achilles

27
Q

What is plantar fascia composed of? What is the primary function?

A

3 cords, medial, central (thickest and most commonly affected) and lateral

distribution of weight, arch support and assistance in gait

28
Q

How is plantar fasciitis defined by?

A

inflammation of plantar fascia where it inserts on calcaneus over 4mm AP
shows hypervascularity, and causes intense heel pain