Ankle

Question 1

Posterior Tibial Tendon

Answer 1

behind medial malleolus attaching to navicular bone

gives support to medial longitudinal arch of foot

Question 2

Posterior Tibial Tendon dysfunction

Answer 2

rupture or weakness of the tendon causing a flat foot/loss of the arch

Question 3

Posterior Tibial Tendon dysfunction epidemiology

Answer 3

obese, middle aged women > 55

DM, HTN, steroid use/injections

Question 4

Posterior Tibial Tendon dysfunction pt presentation

Answer 4

pain and swelling on MEDIAL ankle
“weak ankle”
pain moves to lateral as progression of disease

Question 5

PE Posterior Tibial Tendon dysfunction

Answer 5

“Too many toes sign” / valgus of the heel

edema of medial ankle, tenderness, unable to stand on toes

Question 6

Dx studies Posterior Tibial Tendon dysfunction

Answer 6

weight bearing AP and Lateral XR

MRI to asses tendon health

Question 7

prevention Posterior Tibial Tendon dysfunction

Answer 7

control of RF (Weight, HTN, DM)

proper foot wear (medial arch support)

Question 8

Tx Posterior Tibial Tendon dysfunction

Answer 8

SLWC for 4 weeks with RX (tendonitis)
Surgical repair if ruptured

NSAID (NO STEROIDS – increased rupture risk)

Question 9

ganglion of ankle

Answer 9

herniation of synovial fluid from joint or tendon sheath

Question 10

ganglion of ankle hx

Answer 10

non painful, 2/2 weakness of tissue or minor trauma

location on lateral side

Question 11

PE ganglion of ankle

Answer 11

affected ankle and compare w/other 2-3 mm mass

not fixed with palpitation

Question 12

dx study ganglion of ankle

Answer 12

AP and Lateral XR

r.o tumors and or bone loose bodies

Question 13

ganglion of ankle tx

Answer 13

aspiration (3 times before sx)

fluid is straw colored, NSAIDs if needed

Question 14

tibial nerve

Answer 14

posterior leg around medial malleolus and into medial arch of foot

Question 15

tarsal tunnel syndrome

Answer 15

impinged tibial nerve by inflamed synovial shell of tibial tendon/flexor digitorium or hallucis longus

Question 16

tarsal tunnel syndrome hx

Answer 16

burning type pain, tingling or numbness in distal tibial nerve distribution

worse after walking or exercise

MC idiopathic

Question 17

PE tarsal tunnel syndrome

Answer 17

posterior malleolus edema and arch collapse
tenderness of tarsal tunnel
postive tines sign

Question 18

dx study tarsal tunnel syndrome

Answer 18

EMG not effective
AP and lateral XR
MRI if mass found

Question 19

tarsal tunnel syndrome prevention

Answer 19

proper foot wear, good arch support
avoid tightness around medial ankle

CRPS may develop

Question 20

tx of tarsal tunnel syndrome

Answer 20

relieve tension on tibial n., RICE, good foot wear and arch support
NSAID

NOT often go to sx

Question 21

Achilles tendon

Answer 21

attaches to gastroc-soleus complex to calcaneus of hind foot for powerful plantar flexion during jumping or walking

Question 22

Achilles tendon tear hx

Answer 22

“kicked me in heel”
stop and go sports
acute pain resolves within couple of hours

MC middle aged men

Question 23

PE Achilles tendon tear

Answer 23

edema of achilles tendon and ecchymosis

feel entire length of tendon from bell to heel for hap in tendon

+ Thompson (calf contraction w.o plantar flexion)

Question 24

Achilles tendon tear prevention

Answer 24

proper warm up and stretch

if untreated then weak plantar flexion and push off in sports or walking

Question 25

non sx tx Achilles tendon tear

Answer 25

Equinus (point down) cast x 6 weeks then progressive cast to neutral position (x 6 more weeks) more likely to re rupture

Question 26

Achilles tendon tear sx tx

Answer 26

cast x 6 weeks | faster recovery

Question 27

rx tx Achilles tendon tear

Answer 27

AVOID NSAIDS mild narcotic x 2-3 days post op

Question 28

which type of ankle sprain is MC?

Answer 28

lateral ankle sprain anterior talofibular and calcaneofibular ligaments

Question 29

anterior tibiofibular ligament sprain

Answer 29

conjunction with others = high ankle sprain takes longer to heal

Question 30

ankle sprain hx

Answer 30

sudden inversion of foot when weight bearing immediate pain and pop inversion with ER of body MOI for high sprain

Question 31

ankle sprain PE

Answer 31

ankle edema and antalgic gait HIGH sprain suggested = squeeze test and external rotation test

Question 32

dx study of ankle sprain

Answer 32

tenderness over bone = need XR AP, Lateral, Mortise view

Question 33

mortise view ankle sprain for syndesmosis

Answer 33

med. mortis > 4 mm | tibial/fib space > 5 mm

Question 34

XR proximal leg to rule out in ankle sprain

Answer 34

rupture of intraosseous membrane and Maisonneuve fx

Question 35

ankle sprain prevention

Answer 35

ankle strengthening and proprioception prophylactic bracing or taping prior to participation

Question 36

tx ankle sprain

Answer 36

NSAIDS RICE, WBAT or crutches for short term severe = 2-4 weeks of cast brace for ligament protection and PT

Question 37

Ottawa criteria only x ray if (ANKLE) (only need 1)

Answer 37

1. bone tenderness at posterior edge or tip of lateral OR medial malleolus 2. inability to weight bear both immediately and in ED

Question 38

ottawa criteria only Xray if (FOOT) (only need 1)

Answer 38

1. bone tenderness at base of 5th metatarsal 2. bone tenderness at navicular 3. inability to weight bear both immediately and in ED

Question 39

ankle fracture mc where?

Answer 39

lateral ankle (distal fibula)

Question 40

Bimalleolar ankle fx

Answer 40

medial malleolus and fibula

Question 41

trimalleolar fracture

Answer 41

posterior malleolus + medial malleolus + fibula

Question 42

dx studies ankle fx

Answer 42

AP, lateral, mortise of ankle MAY need proximal fibula radiograph and for radiograph

Question 43

weber A ankle fx = what tx?

Answer 43

SLWC or boot x 4weeks

Question 44

weber B ankle fx = what tx?

Answer 44

Surgery

Question 45

weber C ankle fx = what tx?

Answer 45

surgery

Question 46

Maisonneuve fracture

Answer 46

spiral fracture of proximal third of fibula - tear of distal tibuolofibular sndesmosis and interosseous membrane