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Clinical Medicine PT-517 > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

1
Q

Common impairments at the ankle

A 
Swelling/effusion
Decreased ROM
Postural Abnormalities
Muscle Weakness
Joint Instability
Decreased Joint Compression Load Tolerance
Pain
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2
Q

Common Functional Limitations at the ankle

A 
Need for assistive devices to ambulate
Unable to don shoes
Abnormal gait
Limited standing/walking tolerance
Limited surface ambulation
Limited stair negotiation
Limited squatting, running, jumping
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3
Q

Rearfoot Bones

A

Talus and Calcaneus

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4
Q

Midfoot Bones

A

Cuneiforms
Cuboid
Navicular

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5
Q

Forefoot Bones

A

Metatarsals

Phalanges

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6
Q

Talipes Equinoverus

A

Clubfoot
Usually Rigid
Inversion of rearfoot
PF, Inversion, and adduction of forefoot

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7
Q

Talipes Equinoverus Causes

A 
Genetics
Fetal Position
Neuromuscular Dysfunction
2 per 1000 live births
Bilateral in 50%
Boys 2x as much
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8
Q

Talipes Equinoverus Treatment

A

Reduction of varus and later equinus component performed by gentle stretching
Splinting
77% good and fair results
Surgery required in recalcitrant cases

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9
Q

Convex Pes Valgus

A

Congentical vertical talus w/ dislocation of the navicular
Can occur in isolation or with CNS abnormalities
Valgus and Plantarflexed rearfoot
DF force causes convexity along the foot’s plantar aspect
Surgery correction

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10
Q

Tarsal Coalitions

A

Hereditary and Congenital
Incidence 6% general population
Complete or incomplete fusion of the mid and rearfoot
Most common is calcaneonavicular fusion, then talocalcaneal
Subtalar motion limited
Rigid pronated foot can develop, symptomatic between 8-12 years

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11
Q

Tarsal Coalition treatment

A 
Relative Rest, Short leg cast
Oral anti-inflammatories
Orthotics to control compensation
Surgical treatment
Subtalar fusion sometimes indicated
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12
Q

Talipes Calcaneovalgus

A

1/1000 births
Caused by malposition in uterus
Foot in dorsiflexion and eversion
Talus platarflexed and calcaneus everted

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13
Q

Metatarsus Adductus

A 
Most common causes of intoeing in children
1/1000-2000 live births
Greater in females
90% corrected by 3 yrs
4% severe deformity @7 years
10% moderate deformity
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14
Q

Metatarsus Adductus Causes

A

Intrauterine molding or overactive abductor hallucis in CP

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15
Q

Metatarsus Adductus Grade I

A

Reversibility beyond neutral, flexible

Treatment by stretching at each diaper

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16
Q

Metatarsus Adductus Grade II

A

Reversibility to neutral

Treatment by serial casting and possible hallucis release 6-18 months

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17
Q

Metatarsus Adductus Grade III

A

Not reversible to neutral, rigid

Treatment by serial casting then corrective surgery at 2-4 years

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18
Q

Metatarsus Adductus Bar protocol

A

Excellent results in early ages

More cost effective and less inconvenient than serial casting

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19
Q

Common Ankle Fractures

A

Injuries involving one or more of the 3 malleoli about the ankle joint
Bimalleolar
Trimalleolar

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20
Q

Classification systems of ankle fractures

A

Danis-Weber

Lauge Hansen

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21
Q

Weber A Fx

A

Fibular fracture distal to the plafond

Bimalleolar

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22
Q

Weber B Fx

A

Fibular fractures originate at the level of the plafond and often spiral proximally

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23
Q

Weber C Fx

A

Fibular fractures originate at a level proximal to the plafond and are associated with injury to the syndesmosis

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24
Q

Lauge-Hansen Classification of ankle fractures

A

Divides ankle fx into 4 categories based on the mechanism of injury
First part is the position of foot at time of injury
Second part refers to the direction of the force that caused the Fx
-Adducted, Abducted, Externally Rotated

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25
Treatment of Ankle Fx
Non-operative treatment can occur if Fx is in stable, anatomic configuration Displaced Fx require reduction with acceptable limits of displacement from 0-5 mm
26
Non-operative Ankle Fx
Long leg cast with knee flexed at 30 degrees, non-weight bearing Radiographs weekly Short leg walking cast at 4 weeks After 8 weeks, cast removed and unprotected WB begins
27
Surgical vs Non-surgical Ankle Fx
Theoretical advantage to ORIF are shorter acute recovery time, better maintenence of reduction decreasing chance of OA Surgery indicated for unstable fx and open fx
28
Fx dislocation of the tarsometatarsal joint
Lisfranc - Lisfranc ligament usually causes avulsion fx on base of 2nd met, permitting lateral dislocation of lateral mets - Dislocation almost always dorsal - Dorsalis Pedis artery at risk for injury
29
Type A Lisfranc
Total incongruity
30
Type B Lisfranc
Partial inconcgruity Lateral dislocation Medial dislocation if 1st met
31
Type C Lisfranc
Divergent Partial displacement Total displacement
32
MOI responsible for Tarsometatarsal fracture dislocation
- Direct force- dropping heavy weight on foot - Force up through toes of PF foot - Pronation/Supination of RF on fixed forefoot - Violent abduction or plantarflexion of the forefoot
33
Signs and symptoms of Tarsometatarsal injury
``` Severe pain in forefoot Inability to WB Swelling and deformity Tenderness, pain w/ passive motion Diagnosed through radiographs ```
34
Treatment of Tarsometatarsal Injury
- Manual closed reduction of subluxation attempted - Percutaneous pin used if reduction is not stable - Immobilization, NWB up to 3 months - ORIF may be necessary. NWB 8 weeks WBAT 4 weeks - Post-traumatic arthritis and ankylosis common
35
Stress Fractures Incidence
- Most occur in running population or high impact activity - Can occur in any bone. - Mostly in 1st, 2nd, 3rd met or lateral malleolus
36
Stress Fracture Cause
Increased load after fatigue of supporting structures Muscle forces acting across and on the bone Hypovascularity of certain bony areas
37
Signs and symptoms of stress Fx
Swelling, tenderness Possible gait change Causation of pain by inciting activity
38
Diagnosing Stress Fx
US and tuning fork X-ray- not positive for several weeks Bone scan positive at one week Differential diagnosis includes malignancy, osteomyelitis, osteoid osteoma
39
Treatment of "at risk" stress fx
Aggressive operative and non-operative treatment - navicular - proximal second metatarsal - any intra-articular fx - medial and lateral great toe sesamoid bones
40
Treatment of less critical stress fx
Pain free activity May require immobilization May require PWB Healing times based on chronicity of overload
41
Major mechanisms of ankle ligamentous injuries
Inversion/Supination | Eversion/Pronation
42
Inversion/Supination
``` Ankle in PF -ATFL first -CFL next CFL tears with greater varus moment in neutral or DF Subtalar tears can be present Anterior Deltoid ligament often torn ```
43
Instability
10% of acute lateral ankle injuries Half Mechanical instability Half Functional instability
44
Mechanically unstable lateral ankle injuries
Positive anterior draw | Positive Talar Tilt
45
Functionally unstable lateral ankle injuries
Peroneal weakness | Proprioceptive loss
46
Pronation/Eversion Injuries
Deltoid ligament injured in 10% of inversion injuries | MOI is abduction, eversion or external rotation
47
Syndesmosis Injuries
Isolated injuries occur with and ER or hyperDF MOI May often go unrecognized Longer recovery times May cause greater disabling symptoms than lateral ankle injuries
48
Signs and symptoms of ankle sprains
``` Localized tenderness Swelling, increased temp, ecchymosis Pain with tension Acute painful WB Stress radiograph reliability questionable ```
49
Treatment of ankle sprains
75-100% have good to excellent outcomes most can be treated non-operatively Short period of protection, early ROM and WB Grade III ruptures casting or removable boot Return to play 2-8 weeks If functionally unstable, surgery indicated
50
Osteochondral Lesions of the Talus and Medial Malleolus
Associated with trauma Condition resulting from loss of blood supply to a bone Can be congenital
51
Treatment of osteochondral injuries
If early, immobilization Osteochondral drilling Chrondrocyte Implementation Mosaicplasty
52
OATS Procedure
Osteoarticular Transfer System Damage only 6-20 mm in size Young Patients
53
Post Op OATS
CPM 8 hours to 6 Weeks Non-WB 6-8 weeks with WBAT up to 12 weeks Return to running 8-18 months
54
Treatment Options for severe ankle/foot OA
Ankle fusion Subtalar fusion Midfoot fusion
55
Post Op foot fusion
8-12 weeks NWB | Shoe modification
56
Non Insertional Achilles tendonitis
2-6 cm proximal to insertion | Avascular zone
57
Insertional Achilles tendonities
Involves tendon bone interface
58
Haglund Deformity
Highly prominent posterosuperior calcaneal tuberosity Retrocalcaneal bursitis Bony impingement produces chemical attrition and mechanical abrasion of the Achilles
59
Peritendinitis
Inflammation limited to the peritendon
60
Peritendinitis with tendinosis
Tendon is involved | Thickening of tendon may be palpated
61
Tendinosis
Diagnosis made at time of rupture | Microscopic degenerative changes without symptoms
62
Signs and symptoms of plantar fascitis
Localized tenderness Pain with contraction or passive stretch Pain and stiffness in the morning or after prolonged sitting Worsens with activity duration or intensity
63
Treatment of tendinitis/plantar fascitis
``` Relative rest/assistive devices Foot orthotics Immbilization NSAIDS Cortisone Injection Rarely Rehab ```
64
Operative Treatment for insertional achilles tendinitis
Haglund deformity, retrocalcaneal bursa resected Inflamed tissue resected Post op mobilization starting at 1 month
65
Treatment of achilles tendon rupture
Operative or Non-Operative
66
Hammer Toe
DIP extended PIP flexed MTP extended
67
Claw Toe
DIP neutral PIP flexed MTP extended
68
Mallet Toe
DIP flexed PIP neutral MTP extended
69
Treatment of Hallux deformities
Orthotics | Surgical realignment
70
Commonly Effected nerves for entrapment
Fibular Sural Long Saphenous Posterior Tibial
71
Tarsal Tunnel Syndrome
Posterior TIbial Nerve Medial Heel/Foot pain Paraesthesias
72
Anterior Tarsal Tunnel Syndrome
Deep Fibular Nerve | Dorsal Foot pain/1st Web space
73
Anterolateral Compartment Syndrome
Superficial Fibular Nerve | Pain on outer border of distal calf, dorsum of foot and ankle
74
Sural Nerve entrapment
Pain on outer border of distal calf and lateral heel/foot
75
Interdigital Neuroma
Pain affected web space and toes | Toe painful extension
76
Differential Diagnosis of nerve entrapments
``` Clear lumbar spine Pain with palpation Tinel's sign Tension nerve Quality of pain ```
77
Diabetic Foot
Concurrent neurologic and circulatory involvement Sensory loss Motor weakness Fat pads migrate and no longer protect the met heads
78
Reiter's syndrome
Arthritis, urethritis, conjuctivitis, dysentary of bowel
79
Ankylosing Spondylosis
Ossification of periarticular structures

Clinical Medicine PT-517 (10 decks)

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