Ankle and Foot Flashcards
At what joint does inversion and eversion occur?
Calcaneo-talar joint
Weber classifications of fibular fxs
Weber A: fibular fx below syndesmosis
Weber B: fibular fx at level of syndesmosis often tearing ligament
Weber C: fibular fx above syndesmosis, always tears ligament and disrupts mortise
MOI for calcaneal fx
Compression (ie. falling from a height)
MOI for talar fx
Foot hyper-plantarflexion
MOI for cuboid fx
Crush injury
Can be associated with navicular or cuneiform injuries
What is a Jones Fx
Fx of the diaphysis of 5th metatarsal
NOT an avulsion fx
Most common ankle sprain and the sequence in which lateral ligaments tear
Due to an inversion MOI, the anterior talo-fibular (ATF) sprains 90% of the time.
Tear in sequence from ATF to calcaneofibular (CF) and finally posterior talofibular (PTF)
Clinical signs of ankle sprain
Pain, swelling \+/- inability to bear weight Foot may be inverted (talar tilt) Passive inversion ROM will increase pain Positive stress maneuvers (Drawer test and Inversion stress test)
Ottawa Ankle Rules
Xray only required if:
- bony tenderness along distal 6 cm of tibia or fibula
- bony tenderness at base of 5th metatarsal
- inability to bear weight, both immediately after injury and in emergency department
3 degrees of ankle sprains
First degree: ligament stretching and local tenderness with minimal swelling
Second degree: severe stretching/partial tearing; more tenderness and swelling; abnormal stress tests
Third degree: Complete rupture, can’t bear weight
Management of ankle sprain
Ice, elevation, immobilization, consider crutches; third degree may need surgery
Clinical signs of ankle fx
Pain, swelling, bruising, inability to bear weight, significant deformity if dislocation is also present
Management of ankle fx
reduce fx/dislocation
immobilize, elevate
surgery
cast
Clinical signs and tx of calcaneal fx
swelling, pain, ecchymosis;
tx w/ surgery
Clinical signs and tx of talar fx
intense pain w/ inability to bear weight,
localized tenderness and swelling
may be misdiagnosed as ankle sprain
tx w/ ice, elevation, immobilization, surgery if displaced
Tx of 5th metatarsal fx
usually conservative (ice, rest, elevation)
immobilize
crutches
MOI for 5th MT fx
inversion/avulsion of prox. bone by the peroneus brevis tendon
Stress fxs of the forefoot (where they occur most, MOI, and diagnostic)
Most occur in the 2nd and 3rd MTs
MOI: excessive stress over time
Diagnostic procedures: xray (but may not show up for 2-3 weeks) or bone scan
Complete Forefoot fxs (MOI and tx)
MOI: crush mechanism or twisting mechanism
Tx w/ ice, immobilization
Phalangeal (toes) fxs (MOI, clinical signs, and tx)
MOI: direct trauma or hyper-extension
Signs: pain/swelling, deformity if dislocated
Tx: reduce, immobilize w/ buddy taping, stiff-soled shoes, if in great toe may require a walking cast
Metatarsalgia definition and MOI
Nagging forefoot pain over middle metatarsal heads
MOI: d/t faulty weight distribution, gout, arthritis
Morton’s neuroma definition
A neuropathy of interdigital nerve, usually proximal to bifurcation
Usually of the nerves supplying 2nd and 3rd toes
Usually occurs in middle age women
Clinical signs of Morton’s neuroma and tx
Sudden attacks of sharp, burning pain radiating to toes
At first pain only occurs with walking, as injury progresses could have pain even at rest
Localized web space tenderness, reproduces pain
TX: initial: steroid/lidocaine injection
Definitive: surgery
Hallux rigidus (definition, MOI, clinical, tx)
Stiffness of the MTP joint of the big toe
MOI: caused by arthritis, local trauma, gout, occurs more often in men
Clinical: pain w/ walking, tender MTP joint, pain w/ dorsiflexion
Tx: rocker soled shoes, NSAIDs, possibly surgery
Hallux valgus (definition, tx)
Great toe angles inward (creates a bunion)
Occurs more often in females and often familial
Tx: conservative: wide, padded shoes
surgical: corrective osteotomy
Hammertoe (definition, tx)
PIP joint fixed in flexion, DIP extended
most commonly affects second toe
Tx; operative joint excision
Pes planus (definition, tx)
Due to collapsed medial arch (medial border of foot almost/does touch the ground when standing
May be congenital or acquired
usually don’t help small children, but older kids/adults use arch support or get surgical correction if there is an underlying cause
Plantar fasciitis MOI
Usually an overuse injury in runners, standing occupations, rheum. arthritis and gout
Strain of fascial fibers, friction causes periostitis of calcaneus
Plantar fasciitis Clinical signs and TX
Clinical: pain over plantar surface, increased with walking/running, relief w/ rest; tender palpation over calcaneus; pain w/ passive dorsiflexion
Tx: rest, NSAIDs, heel and arch support; steroid injection
Post. tibial tendinitis MOI and tx
Overuse injury
Tx: rest, NSAIDs, possibly immobilize
Peroneal tendinitis MOI and tx
Overuse injury
Tx: rest, NSAIDs, possibly immobilize
Tarsal tunnel syndrome definition, clinical, tx
Entrapment of post. tibial nerve by flexor retinaculum usually caused by inflamm.
Clinical: numbness, pain of sole of foot
Tx: rest, NSAIDs, immobilize, possibly surgery
Subluxing peroneal tendons MOI and tx
Occurs after injury that disrupts peroneal retinaculum; acute or chronic
Tendons sublux or actually dislocate over later malleolus
Tx; surgery
Achilles tendonitis MOI, clinical, tx
MOI: overuse of calf muscles
Clinical: tenderness, increased pain w/ dorsiflexion
Tx: acute: rest, ice, NSAIDs, immobilize
chronic: may need surgery
Achilles tendon rupture MOI
Usually d/t forced dorsiflexion of ankle (initiating sprint, slipping on stair)
Also may see with direct trauma (blow to taut tendon, laceration)
maybe partial or complete
occur often in middle age men
Achilles tendon rupture clinical signs and tests
Signs: sudden pain, pt. may hear snap, difficulty stepping off, swelling in distal calf, palpable tendon defect, weak plantarflexion, MAY still be able to flex (d/t other muscles assisting)
Tests: + Thompson test
What is Thompson test?
Sensitive for Achilles tendon rupture
Pt. lies prone with knee flexed to 90 degrees
Examiner squeezes the calf and the foot should plantarflex
If foot doesn’t plantarflex, + for Achilles tendon rupture
Tx of Achilles tendon rupture
Initially splint Non weight bearing refer to ortho Conservative: casting for 8 weeks and PT Surgery recommended for younger, athletic pts
Hindfoot bursitis definition, MOI, tx
inflammation of 2 bursae: -btw calcaneus and achilles tendon -btw achilles tendon and skin overuse injury usually d/t poor fitting shoes Tx: rest, NSAIDs, proper fitting shoes
