Ankle and Foot Conditions (Week 5--Module) Flashcards
Lateral malleolar fracture
Fracture of distal fibula, “ankle fracture”
Due to direct trauma or twisting injury of ankle
Usually accompanied by ligament injury on medial side (evident by widening of joint)
Bone tenderness at posterior edge and tip of lateral malleolus, and inability to bear weight
Medial malleolar fracture
Fracture of distal tibia, “ankle fracture”
Landing from jump, rolling ankle puts stress on tibia and medial malleolus
Often occurs in combo with other injuries (deltoid ligament can be torn)
Sudden onset sharp intense inner ankle pain and walk with limp
5th metatarsal fracture (Jones’ fracture)
Avulsion fracture of base of 5th metatarsal bone
Results from forceful inversion of foot concurrent with contraction of peroneus brevis muscle
Fracture line extends transversely or obliquely through base of 5th metatarsal
Pain, tenderness at base of 5th metatarsal; local bruising, swelling
Nondisplaced fractures treated conservatively but orthopedic referral if fracture is comminuted or displaced, or if nonunion
Calcaneus fracture
High enery injury (fall from height, auto accident or sports injury)
Swelling and pain over calcaneus and severe heel pain
No inversion/eversion of foot, because of damage to subtalar joint (between calcaneus and talus)
Subtalar joint more vulnerable to OA
Dorsiflexion/plantar flexion is fine
Treat with surgery
Gout
Pathophysiology: most common inflammatory monoarthritis; MSUM crystals deposit in joint and periarticular tissues when physiological threshold of 6.8 mg/dl exceeded; because human uricase gene is nonfunctional pseudogene; men over 40 but increasing in younger individuals, especially with increased alcohol consumption
Clinical presentation: can have asymptomatic hyperuricemia; acute gouty arthritis when MSUM crystals are present and cause inflammatory response; pain with passive range of motion; pain intensity increases over 8-12 hours; usually involves 1st MTP joint (called podagra) but can be anywhere; birefringent MSUM crystals are yellow parallel; erosion w/sclerotic margin and overhanging edges on x-ray only after 6-12 years
Management/prognosis: control inflammation (colchicine, NSAIDs, systemic steroids, steroid injection); eliminate MSUM deposits by lowering serum uric acid level (reduce red meat, shellfish; increase low fat dairy!)
Ankle sprain
Pathophysiology: most common is lateral sprain due to inversion of foot, anterior talofibular ligament (ATFL) most commonly involved
Clinical presentation: diffuse pain then localized to ATFL or deltoid ligament; swelling; passive and active ROM pain; should NOT have bony tenderness; normal radiology
Management/prognosis: NSAIDs, PRICE; surgery if severe; may take 4-8 weeks to recover if severe medial (deltoid) “high” sprain
Plantar fasciitis
AKA jogger’s heel, tennis heel, policeman’s heel
Pathophysiology: maximal plantar flexion of ankle and simultaneous dorsiflexion of MTP joints cause overuse of plantar fascia at attachment to calcaneus bone
Clinical presentation: gradual onset inferior heel pain after change in amt/intensity of running, footwear, surface; morning is worst pain or long periods of non-weight bearing; pain with stretching, walking barefoot or up stairs; ROM dorsiflexion limited if tight achilles tendon; pain on palpation at medial process of calcaneal tuberosity; calcaneal spurs on x-ray
Management/prognosis: NSAIDs, PRICE, PT, orthotics for heel support and medial arch support, steroid injection, surgery for fascial release/debridement; prognosis good bc 80% of cases resolve in a year
Achilles rupture
Pathophysiology: common in 30-50 yo, occurs 4-5cm proximal to calcaneus bone (poor blood flow)
Clinical presentation: due to sudden strain/blow while tendon contracted, pain increases with weight bearing and palpation, and decreases with rest, swelling, ROM no plantar flexion, palpable defect in tendon, Thompson test
Management/prognosis: NSAIDs, PRICE, surgical repair for athletes; good prognosis but some ROM usually lost
Tarsal tunnel syndrome
Tibial nerve compressed posterior to medial malleolus where it travels under flexor retinaculum through tarsal tunnel
Most common entrapment neuropathy in foot/ankle area
Paresthesis of plantar foot, posterior leg numbness, plantarflexion weakness, clawing of toes
Interdigital neuritis (Morton’s Neuroma)
Entrapment of plantar interdigital nerve as it passes under transverse metatarsal ligament
As weight transferred to ball of foot when toes dorsiflexed during push off of gait, interdigital nerve compressed between plantar foot and distal edge of plantar metatarsal ligament
Do squeeze test (metatarsal head compression)
Ankle and Foot conditions
Bones: lateral melleolar fracture, medial malleolar fracture, 5th metatarsal fracture, calcaneus fracture
Joints: gout
Muscles/tendons: ankle sprain, plantar fasciitis, achilles rupture
Nerves/vessels: tarsal tunnel syndrome, interdigital neuritis
