Ankle and foot conditions Flashcards
What is achilles tendinitis?
Inflammation of the achilles tendon
What causes achilles tendinitis?
Small tears in collagen fibres in tendon
What factors contribute to achilles tendinitis?
Sudden increase in activity e.g. running
Poor footwear
What are the symptoms of achilles tendinitis?
Pain when walking
What causes achilles tendon rupture?
Forceful plantarflexion
What factors predispose to achilles tendon rupture?
Achilles tendinitis
What is felt immediately after achilles tendon rupture?
Calf pain
Sudden dorsiflexion, passive
Why does a lump appear in the calf with achilles tendon rupture?
Due to shortening of the
medial and lateral heads of gastrocnemius
soleus
How do you test for achilles tendon rupture?
Gap in achilles tendon is visible and palpable in posterior distal leg
Individuals cannot plantarflex against resistance
Thompson’s test
What is the Thompson’s test?
Patient kneeling on chair - knee is flexed 90degrees
Squeeze calf
Foot should plantar flex
How are the results of Thompson’s test interpreted?
If foot doesn’t plantarflex
means achilles tendon is ruptured
How is achilles tendon rupture treated?
Non-surgical repairs for most people
Surgical repairs for very active people e.g. athletes
Clawed toes tend to involve which toes of the foot?
Lateral four toes
What are the joints like with clawed toes?
Hyperextension at MTP joints
Flexion of DIP joints
What is the dorsal surface of the toes like with clawed toes? Why?
Callosities on dorsal surface
due to pressure from shoes
What is the plantar surface of the toes like with clawed toes? Why?
Callosities on metatarsal heads
and tip toes
because are having to bear more weight
What are the joints like with hammered toes?
Hyperextension at MTP
Flexion at PIP joints
Hyperextension at DIP joints
What causes the formation of hammer toes?
Weakness of lumbricals and interosseus muscles
which normally flex MTP joints
and extend IP joints
(don’t panic it’s the same as the hand)
What is the dorsal surface like with hammered toes?
Callosities on dorsal surface
due to pressure from shoes
What are the types of flatfoot?
Flexible
Rigid
What is flexible flatfoot?
Lack of medial arch of foot
but only when weight bearing
When is flexible flatfoot normal?
In children
Why is flexible flatfoot normal in children?
Thick subcutaneous fat in sole of foot
Ligaments of foot are not completely developed yet
What causes flexible flatfoot in adults?
Weakened ligaments of foot
What is rigid flatfoot?
Lack of medial arch of foot all the time
What causes rigid flatfoot?
Bone deformity
Dysfunction of tibialis posterior muscle - supports arch usually
What are the symptoms and signs of rigid flatfoot?
Pain behind medial malleolus, due to damage to tibialis posterior muscle
Heel protrudes laterally when walking
Is flatfoot more common in males or females?
Females
What causes ankle sprain?
Partial or complete tear in ligaments of ankle joint
What is the mechanism of an ankle sprain?
Foot is plantarflexed
Weight bearing
Then is excessively inverted
Which ligaments of the ankle joint are most commonly damaged?
Lateral ligament
- anterior talofibular
- posterior talofibular
- calcaneofibular
Why are the lateral ligaments most commonly damaged?
Resist excessive inversion, so become damaged by it
Weaker than medial ligaments
Which lateral ligament is at most risk of irreversible damage in an ankle sprain?
Anterior talofibular ligament
What is the mechanism of a 5th metatarsal fracture?
Sudden excessive inversion of foot
fibularis brevis muscle avulses base of metatarsal 5
5th metatarsal fractures often occurs alongside with…?
Why?
Ankle sprains
Because they both involve excessive inversion
What is a Pott’s fracture-dislocation of the ankle joint?
Fracture of medial malleolus
lateral malloelus
and in some cases distal tibia too
What is the mechanism of a Pott’s fracture dislocation? - 3 stages to it
Forced eversion of foot
pulls of medial ligament
avulses medial malleolus
Talus moves laterally
breaks off lateral malleolus
Tibia forced anteriorly
breaks of distal tibia
What is the medical term for a bunion?
Hallux valgus
What does valgus mean?
Deviation away from midline
lateral deviation
What causes hallux valgus?
Pressure from footwear
Degenerative joint disease
What is the appearance of hallux valgus?
Lump at first MTP joint
Why does the lump form?
Pressure and friction against head of metatarsal 1
causes subcutaneous bursa to form
become inflamed
How do the bones displace in hallux valgus?
First metatarsal shifts medially
Phalanges of big toe shift laterally
Hallux valgus is more common in males or females?
Females
What is a complication of diabetes mellitus?
Diabetic neuropathy - damage to nerves
gives loss of peripheral nerve functiond
Why are people with diabetes mellitus at increased risk of foot injuries?
Lose sensation of pain
Injuries in foot go unnoticed
Which injuries in particular are people with diabetes mellitus at increased risk of?
Ulcers
Infections of wounds
Damage to joints
Where is the common fibular nerve at most risk of injury? Why?
When it winds around the neck of the fibula
because it’s most superficial at this point
How is the common fibular nerve often injured?
Fracture of neck of fibula
Injury of knee joint
causing stretching of nerve
What are the consequences of common fibular nerve injury?
Motor function loss
- anterior leg muscles - supplied by deep fibular nerve
- lateral leg muscles - supplied by superficial fibular nerve
Sensory loss
- anterior and lateral leg, dorsum of foot - supplied by superficial and deep fibular nerves
- upper lateral leg - supplied by lateral sural nerve
What is a characteristic sign of common fibular nerve injury? Why?
Foot drop
loss of dorsiflexion by anterior leg muscles
loss of eversion by lateral leg muscles
gives unopposed plantarflexion
