Ankle 2 Flashcards
Remind yourself which tendons make up the achilles tendon
- Gastrocnemius
- Soleus
*Plantaris inserts into achilles tendon
State the pathophysiology of achilles tendonitis
- Repetitive action results in microtears
- Microtears lead to localised inflammation
With repeated episodes, tendon can become thickened, fibrotic and loses elasticity with repeated episodes
Describe the typical presentation of achilles tendonitis
- Gradual onset of pain & stiffness
- ^^ worse with movement
- Usually improved with mild exercise or heat application
- Tenderness over tendon on palpation
Describe the typical presentation of achilles tendon rupture
- Sudden onset of severe pain in posterior calf
- Audible popping/feeling that something ‘went’
- Weak plantar felxion
Explain why ankle plantar flexion is only weakened, not absent, in achilles tendon rupture
Peroneal muscles still intact and contribute to plantar flexion
What test can be used to assess for achilles tendon rupture?
Simmonds test
Discuss if any, and what investigations, are required for achilles tendonitis and rupture
- Both are clincial diagnoses.
- May do USS if unsure on diagnosis
Discuss the management of achilles tendonitis
Supportive
- Stop precipitating exercise
- Ice
- Anti-inflammatories e.g. NSAIDs
Chronic cases may require physiotherapy.
Discuss the management of achilles tendon rupture, consider:
- If present <2 weeks since injury
- If present >2 weeks since injury
<2 weeks
- Analgesia
- Hold (two options see below)
- Hold in full equinus for 2 weeks
- Hold in semi-equinus for 4 weeks
- Hold in netural position for another 4 weeks
**Options for holding: Either with plaster, give crutches and no weight bearing. Or with moonboot with large heel raise insert and can weight bear immediately
>2 weeks since injury or reoccurence
- Surgical fixation with end to end repair
What is meant by equinus?
- Equinus= condition in which dorsiflexion of foot is limited
- When put ankle in equinus position to treat achilles tendon rupture we are referring to holding the ankle in a position with the ankle and toes maximally pointed
What is a Lisfranc injury?
Injury to tarsometatarsal joint between the medial cuneiform and the base of the 2nd metatarsal; can be solely ligamentous injuries or involve the bony structures of the midfoot (in which case called a fracture dislocation)
Why does a lisfranc injury occur between medial cuneiform & 2nd metatarsal
- Stability of this joint comes from keystone configuration in which base of 2nd metatarsal fits into mortise created by medial & middle cuneiforms
- Multiple interosseous ligaments support this area
- The largest & strongest ligament is the Lisfranc ligament
- Lisfranc ligament goes form medial cuneiform to base of 2nd metatarsal
State the typical mechanism of injury for Lisfranc injuries
Rotational forces or axial load through plantar flexed foot
Describe typical presentation of Lisfranc injury
- Midfoot swelling
- Midfoot tenderness
- Plantar bruising
- Midfoot pain
- Piano key sign
What investigations are required for a suspected Lisfranc injury?
- Plain film radiographs (AP, lateral & oblique)
- ?CT fo pre-operative planning
- ?MRI for purely ligamentous injuries