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Orthopedics and Rheumatology > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

1
Q

Joint responsible for:

  • flexion/extension?
  • inversion/eversion?
A

tibiotalar joint

calcaneotalar joint

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2
Q

Ligaments

A

Lateral

  • Anterior talo-fibular
  • Calcaneo-fibular
  • Posterior talo-fibular

Medial
- Deltoid ligament

Interosseus

  • interosseus, syndesmosis or tibofibular ligament
  • maintains integrity of mortise joint
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3
Q

Ankle Sprains

MOI
Sxs
PE
Rad
Classification 
Tx
A

MOI

  • MC’ly inversion mechanism, involving lateral ligaments tearing in sequence from anterior to posterior
  • Deltoid ligament sprain from eversion mechanism and usually associated with fibula fx

Sxs

  • pain, swelling
  • +/- inability to bear weight
  • +/- talar tilt (inverted foot)

PE

  • Drawer test
  • inversion stress increases pain

Rad

  • x-ray (will be normal)
  • Ottawa Ankle Rules – order only if:
  • -bony tenderness along distal 6cm of tibia or fibula
  • -bony tenderness at base of 5th metatarsal
  • -inability to bear weight in ED and immediately after injury

Classification:

  • First degree: ligament stretching, local tenderness, minimal swelling
  • Second degree: severe stretching/partial tearing; more tenderness and swelling; abnormal stress tests
  • Third degree: complete rupture, can’t bear weight; may require surgical repair

Tx

  • RICE
  • immobilize, consider crutches
  • third degree sprains may need surgery (rare)
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4
Q

Ankle Fxs

Path
Classification (name for classification)
Signs/sxs
Tx

A

Path

  • can be malleolar, bimalleolar, trimalleolar
  • often disrupt tib-fib ligament, thus disrupting mortise joint

Weber Classification

  • Weber A: fib fx below syndresmosis; mortise usually intact
  • Weber B: fib fx at level of syndesmosis; often tears ligament, disrupts joint
  • Weber C: fib fx above syndesmosis; always tears ligament and disupts joint

Signs/Sxs

  • pain, swelling, bruising, inability to bear weight
  • significant deformity if dislocation present

Tx

  • if dislocated, reduce
  • immobilize in splint; cast 6-8 weeks
  • elevate
  • surgery if mortise disrupted
  • arthritis likely if poorly aligned joint surface
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5
Q

Calcaneus Fx

MOI
Signs
X-ray
Tx

A

MOI

  • usually from compression i.e. fall from height or MVA
  • sometimes associated with lumbar fx and other extreme injuries b/c requires significant force

Signs
- swelling, pain, ecchymosis

X-ray

  • standard foot films
  • consider calcaneal views

Tx
- surgery

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6
Q

Talar fx

MOI
Signs/Sxs
Rad
Tx

A

MOI

  • usually due to foot hyper-planter flexion
  • may involve dome, neck or body
  • talus covered with cartilage so has tenuous blood supply may –> avascular necrosis

Signs/Sxs

  • intense pain
  • inability to bear weight
  • localized tenderness and swelling
  • loss of normal foot contour (bulge on ant. ankle)

Rad

  • foot x-rays
  • easily missed – caution of ankle sprain misdx

Tx

  • ice, elevation, immobilization
  • non surgical if non displaced minor chip fx. of dome
  • surgical if displaced or fx. of neck or body
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7
Q

Cuboid Fracture

MOI
Signs
Rad
Tx

A

MOI

  • usually due to crush injury
  • associated with navicular or cuneiform injuries

Signs
- pain/swelling/tenderness

Rad
- foot x-ray

Tx

  • if non-displaced: conservative tx
  • if displaced ORIF
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8
Q

Proximal 5th metatarsal fx

MOI
Tx

A

MC metatarsal fx

MOI

  • occurs with lateral ankle sprain; usually due to inversion/avulsion of proximal bone by peroneus brevis tendon
  • always check for tenderness at base of 5th MT when evaluating ankle sprain

Tx

  • usually conservative
  • immobilize, crutches
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9
Q

Jones Fracture

A
  • involved diaphysis of 5th metatarsal

- has higher incidence of non-union or delayed union

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10
Q

Stress Fxs of Forefoot

which MT’s involved?
MOI
Rad
Tx

A

Involve midshaft metatarsals
- usually 2nd and 3rd which are relatively fixed

MOI
- due to excessive stress over time

Rad
- may not appear on x-ray for 2-3 weeks. Repeat after this time frame.

Tx
- rest, possibly immobilize

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11
Q

Comple midshaft metatarsal fx

MOI
Tx

A

MOI

  • usually crush injury
  • occasionally twisting
  • often more than one involved

Tx
- ice, immobilize with cast

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12
Q

Phalangeal fxs

MOI
PE
Tx

A

MOI

  • usually direct trauma or hyperextension
  • often seen fx-dislocation

PE

  • pain/swelling
  • deformity if dislocated

Tx

  • reduce if necessary
  • dynamic splinting (buddy taping)
  • stiff soled shoes
  • if great toe involved may need walking cast b/c bears 1/3 weight
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13
Q

Metatarsalgia

Sxs
Etiology
Tx

A

Sxs
- nagging forefront pain over middle metatarsal heads

Etiology

  • faulty weight distribution –>metatarsal heads bear disproportionate amount of weight
    • e.g. weight gain, hallux valgus, flat foot
  • also: gout, RA

Tx

  • sx’tic
  • directed at cause
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14
Q

Morton’s Neuroma

Etiology
Sxs
PE
Tx

A

Etiology

  • neuropathy of interdigital nerve proximal to bifurcation b/c nonspecific inflammation of nerve with proliferative connective tissue
  • ususally supplying 2nd and 3rd toes
  • MC in middle aged women

Sxs

  • sudden attacks of sharp or burning pain radiating to the toes
  • at first pain only with walking–>pain at rest

PE

  • localized webspace tenderness, reproduces pain
  • may palpate small mass

Tx

  • initial: steroid injection
  • definitive: surgical excision
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15
Q

Hallux Rigidus

etiology
sxs
rad
tx

A

Etiology

  • stiffness of MTP joint of great toe
  • caused by arthritis, local trauam, gout
  • MC in men

Sxs

  • pain with walking
  • tender MTP joint, pain with dorsiflexion

Rad
- x-ray: arthritic changes

Tx

  • rocker soled shoes
  • NSAIDs
  • possibly surgery: joint replacement/fusion
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16
Q

Hallux Valgus

A 
MC foot deformity 
 - prominent bunion
 - red, swollen 
Great toe angles inward (valgus)
Often familial

Management

  • conservative: wide, padded shoes
  • corrective surgery
17
Q

Hammertoe

A

PIP joint fixed in flexion, DIP extended
MC’ly in 2nd toe from bad footwear
Shoe pressures may produce corns/calluses on dorsum of toe

Tx:
- surgical joitn excision

18
Q

Pes Planus

AKA
Patho
Tx

A

Flat foot

Patho

  • collapsed medial arch
  • can be congenital or acquired (polio, RA, tendon rupture)
  • flexible MC
  • rigid (congenital or spasmodic peroneal muscles)

Tx

  • small kids: none
  • older kids/adults: arch supports
  • tx underlying condition if applicable
19
Q

Plantar fasciitis

etiology
sxs
tx

A

Etiology

  • overuse injury (running, standing occupations, RA, gout)
  • strain of fascial fibers causes periostitis of calcaneus

Sxs

  • pain over plantar surface
  • worse with activity, relieved by rest
  • tender to palpation over anterior calcaneus
  • pain with passive dorsiflexion

Tx

  • rest, NSAIDs
  • heel and arch supports
  • steroid injection if refractory
20
Q

Posterior tibial tendonitis

etiology
tx

A

Etiology

  • acts as a flexor of the foot, passes posterior to medial malleolus
  • overuse injury

Tx

  • rest, NSAIDs
  • +/- steroid injection, immobilization
21
Q

Peroneal tendonitis

etiology
tx

A

Etiology

  • pass posterior to lateral malleolus; act to resist varus force
  • overuse injury

Tx

  • rest, NSAIDs
  • +/- steroid injection, immobilization
22
Q

Tarsal tunnel syndrome

etiology
sxs
tx

A

Etiology

  • entrapment of posterior tibial nerve by flexor retinaculum (medial malleolus)
  • Due to inflammation (repetitive activity, RA, pregnancy, acute trauma/soft tissue swelling)

Sxs
- numbness, pain of sole of foot

Tx

  • rest, NSAIDs
  • immbolization
  • possibly surgery
23
Q

Subluxing peroneal tendons

A
  • occurs after injury that disrupts peroneal retinaculum
  • acute or chronic
  • tendons sublux or actually dislocate over lateral malleolus
  • seen best with foot eversion
  • tx surgically
24
Q

Achilles tendonitis

etiology
sxs/signs
acute vs. chronic management

A

Etiology
- overuse of calf muscles

Sxs/Signs
- tenderness, inc’d pain with dorsiflexion

Acute management
- rest, ice, NSAIDs, immobilization

Chronic management
- surgery to divide fascia

25
Q

Achilles tendon rupture

MOI
Sxs
PE
Tx

A

MOI

  • forced dorsiflexion
    • initiating sprint/slipping on stair
  • direct trauma
  • -blow to taut tendon or laceration
  • MC middle aged men

Sxs

  • sudden pain
  • may hear snap
  • difficult stepping off

PE

  • swelling of distal calf
  • palpable tendon defect
  • positive Thompson test

Tx

  • initially splint equinus (toe pointed)
  • refer to ortho
  • can tx conservatively (casting X8weeks + PT) or surgically (esp. for younger, athletic pts)
26
Q

Hindfoot bursitis

bursae (2)
etiology
sxs
tx

A

Two bursae:

  • b/w calcaneus and achilles
  • b/w achilles and skin

Etiology
- Overuse injury; often poorly-fitting shoes

Sxs
- Inflammation, pain on motion

Tx

  • rest, NSAIDs, properly fitting shoes
  • consider steroid injection

Orthopedics and Rheumatology (8 decks)

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