Ankle Flashcards
Posterior Tibial Tendon
behind medial malleolus attaching to navicular bone
gives support to medial longitudinal arch of foot
Posterior Tibial Tendon dysfunction
rupture or weakness of the tendon causing a flat foot/loss of the arch
Posterior Tibial Tendon dysfunction epidemiology
obese, middle aged women > 55
DM, HTN, steroid use/injections
Posterior Tibial Tendon dysfunction pt presentation
pain and swelling on MEDIAL ankle
“weak ankle”
pain moves to lateral as progression of disease
PE Posterior Tibial Tendon dysfunction
“Too many toes sign” / valgus of the heel
edema of medial ankle, tenderness, unable to stand on toes
Dx studies Posterior Tibial Tendon dysfunction
weight bearing AP and Lateral XR
MRI to asses tendon health
prevention Posterior Tibial Tendon dysfunction
control of RF (Weight, HTN, DM)
proper foot wear (medial arch support)
Tx Posterior Tibial Tendon dysfunction
SLWC for 4 weeks with RX (tendonitis)
Surgical repair if ruptured
NSAID (NO STEROIDS – increased rupture risk)
ganglion of ankle
herniation of synovial fluid from joint or tendon sheath
ganglion of ankle hx
non painful, 2/2 weakness of tissue or minor trauma
location on lateral side
PE ganglion of ankle
affected ankle and compare w/other 2-3 mm mass
not fixed with palpitation
dx study ganglion of ankle
AP and Lateral XR
r.o tumors and or bone loose bodies
ganglion of ankle tx
aspiration (3 times before sx)
fluid is straw colored, NSAIDs if needed
tibial nerve
posterior leg around medial malleolus and into medial arch of foot
tarsal tunnel syndrome
impinged tibial nerve by inflamed synovial shell of tibial tendon/flexor digitorium or hallucis longus
tarsal tunnel syndrome hx
burning type pain, tingling or numbness in distal tibial nerve distribution
worse after walking or exercise
MC idiopathic
PE tarsal tunnel syndrome
posterior malleolus edema and arch collapse
tenderness of tarsal tunnel
postive tines sign
dx study tarsal tunnel syndrome
EMG not effective
AP and lateral XR
MRI if mass found
tarsal tunnel syndrome prevention
proper foot wear, good arch support
avoid tightness around medial ankle
CRPS may develop
tx of tarsal tunnel syndrome
relieve tension on tibial n., RICE, good foot wear and arch support
NSAID
NOT often go to sx
Achilles tendon
attaches to gastroc-soleus complex to calcaneus of hind foot for powerful plantar flexion during jumping or walking
Achilles tendon tear hx
“kicked me in heel”
stop and go sports
acute pain resolves within couple of hours
MC middle aged men
PE Achilles tendon tear
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)
Achilles tendon tear prevention
proper warm up and stretch
if untreated then weak plantar flexion and push off in sports or walking
non sx tx Achilles tendon tear
Equinus (point down) cast x 6 weeks then progressive cast to neutral position (x 6 more weeks)
more likely to re rupture
Achilles tendon tear sx tx
cast x 6 weeks
faster recovery
rx tx Achilles tendon tear
AVOID NSAIDS
mild narcotic x 2-3 days post op
which type of ankle sprain is MC?
lateral ankle sprain
anterior talofibular and calcaneofibular ligaments
anterior tibiofibular ligament sprain
conjunction with others = high ankle sprain
takes longer to heal
ankle sprain hx
sudden inversion of foot when weight bearing
immediate pain and pop
inversion with ER of body MOI for high sprain
ankle sprain PE
ankle edema and antalgic gait
HIGH sprain suggested = squeeze test and external rotation test
dx study of ankle sprain
tenderness over bone = need XR AP, Lateral, Mortise view
mortise view ankle sprain for syndesmosis
med. mortis > 4 mm
tibial/fib space > 5 mm
XR proximal leg to rule out in ankle sprain
rupture of intraosseous membrane and Maisonneuve fx
ankle sprain prevention
ankle strengthening and proprioception
prophylactic bracing or taping prior to participation
tx ankle sprain
NSAIDS
RICE, WBAT or crutches for short term
severe = 2-4 weeks of cast
brace for ligament protection and PT
Ottawa criteria
only x ray if (ANKLE) (only need 1)
- bone tenderness at posterior edge or tip of lateral OR medial malleolus
- inability to weight bear both immediately and in ED
ottawa criteria
only Xray if (FOOT) (only need 1)
- bone tenderness at base of 5th metatarsal
- bone tenderness at navicular
- inability to weight bear both immediately and in ED
ankle fracture mc where?
lateral ankle (distal fibula)
Bimalleolar ankle fx
medial malleolus and fibula
trimalleolar fracture
posterior malleolus + medial malleolus + fibula
dx studies ankle fx
AP, lateral, mortise of ankle
MAY need proximal fibula radiograph and for radiograph
weber A ankle fx = what tx?
SLWC or boot x 4weeks
weber B ankle fx = what tx?
Surgery
weber C ankle fx = what tx?
surgery
Maisonneuve fracture
spiral fracture of proximal third of fibula - tear of distal tibuolofibular sndesmosis and interosseous membrane
