Ankle and Foot Disorders

Question 1

How many bones and joints are of the foot and ankle?

Answer 1

26 bones and 33 joints.

Question 2

Which radiographic test is the best for evaluating bone?

Answer 2

CT Scan

Question 3

Provides information regarding tendon injuries or more subtle pathology, such as stress fractures and tumors?

Answer 3

MRI

Question 4

What is the most common MSK injury in the US?

Answer 4

Ankle Sprains (low ankle sprains) - 90% are lateral ankle injuries.

Question 5

What is the MOI of ankle sprains?

Answer 5

Inversion/Plantar Flexion MOI

Question 6

MC ligaments involved in ankle sprains?

Answer 6

#1: ATF - anterior talofibular.
#2: CF - calcaneofibular.
#3: PTF - posterior talofibular - the strongest of the ligs.

Question 7

High-ankle sprains?

Answer 7

Dorsiflexion/Eversion (exterior rotation).

-accounts for 1-10% of all ankle injuries.

Question 8

What other injury is associated with a dorsiflexion/eversion injury or high-ankle sprain?

Answer 8

Injury to the MCL due to valgus stretch of the knee.

Question 9

Classification of acute ankle sprains:

Answer 9

Grade I, II, III.

Question 10

Grade __: stretch but within tensile limits, no failure, w/o significant tear.

Answer 10

Grade I

Question 11

Grade __: exceeds limits, stretch w/disruption of fibers.

Answer 11

Grade II

Question 12

Grade __: audible snap, followed by pain and swelling, complete tear of fibers.

Answer 12

Grade III

Question 13

Initial treatment for ankle injuries?

Answer 13

R.I.C.E

Question 14

Peroneal Tendon Injuries…

Answer 14

• Can be injured during forceful inversion.
• posterolateral ankle pain and swelling along the course of the tendon.
• pt may complain of “snapping tendon.”

Question 15

Avulsion fracture of the base of the 5th metatarsal?

Answer 15

Ballerina Fracture

Question 16

5th metatarsal fracture at the metaphyseal/diaphyseal junction - ORIF needed.

Answer 16

Jones Fracture

Question 17

Complications of Tendinopathies?

Answer 17

Chronic pain, swelling, rupture of tendon.

Question 18

What is the Thompson Test and what is it used for?

Answer 18

Used to detect an Achilles Tendon Rupture; squeezing the calf in a normal/intact Achilles will initiate the Gastrocnemius and Soleus to contract causing plantar flexion.

Question 19

Progressive bony enlargement of calcaneus at Achilles insertion site?

Answer 19

Haglund Deformity that leads to retrocalcaneal bursitis and Achilles tendinopathy.

Question 20

What is Plantar Fasciitis?

Answer 20

Heel pain that is centered along plantar surface of the medial calcaneal tubercle at the insertion of the plantar fascia.

Question 21

Heel Spur?

Answer 21

Possibly associated w/plantar fasciitis but has no bearing or correlations to the injury.

Question 22

Loss of the medial longitudinal arch? Types?

Answer 22

Flat Feet - flexible vs Rigid.

Question 23

MCC of Flat Feet in Adults?

Answer 23

Posterior Tibialis Tendon Dysfunction/Tear.

Question 24

Flat Foot - Flexible PE finding?

Answer 24

“too many toes sign,” TTP over posterior Tibialis tendon and unable to single leg calf raise if PTT torn/severe dysfunction.

Question 25

Compression of Tibial nerve by the flexor retinaculum?

Answer 25

Tarsal Tunnel Syndrome.

Question 26

Define the pain associated with Tarsal Tunnel Syndrome?

Answer 26

Vague medial hind foot pain, sometimes heel pain and may be accompanied by shooting pain down the foot, numbness and tingling.

Question 27

MRI, nerve conduction, lumbar disc pathology used in Diagnosis of Tarsal Tunnel Syndrome?

Answer 27

MRI may demonstrate mass effect w/nerve compression (lipoma, ganglion, neoplasm).
Nerve conduction often normal, but show altered nerve conduction.
consider lumbar disc pathology.

Question 28

Treatment of Tarsal Tunnel Syndrome?

Answer 28

Pain treated w/conservative care - NSAIDs, rest , orthotics.

Question 29

Chronic Progressive destructive disease of foot and ankle due to sensory neuropathy?

Answer 29

Charcot Foot.

Question 30

Etiology of Charcot Foot?

Answer 30

Diabetic Neuropathy - 7.5% of Diabetics w/neuropathy develop Charcot.

Question 31

Presentation of Charcot Foot?

Answer 31

painless; warm, swollen foot, erythema; Rocker Bottom Deformity.

Question 32

What other disease is Charcot Foot often confused with? Diagnostics?

Answer 32

Osteomyelitis.

Labs - ESR, WBC w/elevation in both.
Xray - joint erosions, subluxations, dislocations.
MRI - sinus tracts and abscesses w/Osteo.
Bone Scan - (-) or cold in Charcot; (+) or hot in Osteo.
Biopsy - guide Abx if Osteo.

Question 33

Sprain of the plantar plate of the 1st MTP joint? Etiology?

Answer 33

Turf Toe - seen in athletes due to forces at the ball of the foot.

Question 34

What are bunions?

Answer 34

nonspecific term for any swelling of the great toe MTP joint.

Question 35

MC foot deformity of the 1st MTP that causes pain and stiffness of the joint?

Answer 35

Hallux Valgus.

Question 36

Presentation and Treatment of Hallux Valgus?

Answer 36

Presentation - complaints of a bunion, pain along medial forefoot w/difficulty wearing shoes.

Treatment - shoe modifications and padding; surgery if pain continued, cosmetic not indication for surgery.

Question 37

Etiology of Hallux Rigidis?

Answer 37

Degenerative OA of the great toe.

Question 38

Common foot deformity noted at birth (wound packing) that causes the forefoot to turn inward?

Answer 38

Metatarsus Varus (Adductus).

Question 39

Common overuse injury that causes pain and inflammation at the ball of the foot?

Answer 39

Metatarsalgia.

Question 40

A thickening of the tissue that surrounds the digital nerve that leads from the ball of the foot b/t the 3rd and 4th toes?

Answer 40

Morton’s Neuroma.