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

Ankle and Foot Flashcards by Brian Bradway

At what joint does inversion and eversion occur?

Calcaneo-talar joint

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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

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MOI for calcaneal fx

Compression (ie. falling from a height)

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MOI for talar fx

Foot hyper-plantarflexion

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MOI for cuboid fx

Crush injury

Can be associated with navicular or cuneiform injuries

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What is a Jones Fx

Fx of the diaphysis of 5th metatarsal

NOT an avulsion fx

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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)

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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)

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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

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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

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Management of ankle sprain

Ice, elevation, immobilization, consider crutches; third degree may need surgery

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Clinical signs of ankle fx

Pain, swelling, bruising, inability to bear weight, significant deformity if dislocation is also present

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Management of ankle fx

reduce fx/dislocation
immobilize, elevate
surgery
cast

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Clinical signs and tx of calcaneal fx

swelling, pain, ecchymosis;

tx w/ surgery

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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

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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 ```