Ankle and Foot Disorders Flashcards
How many bones and joints are of the foot and ankle?
26 bones and 33 joints.
Which radiographic test is the best for evaluating bone?
CT Scan
Provides information regarding tendon injuries or more subtle pathology, such as stress fractures and tumors?
MRI
What is the most common MSK injury in the US?
Ankle Sprains (low ankle sprains) - 90% are lateral ankle injuries.
What is the MOI of ankle sprains?
Inversion/Plantar Flexion MOI
MC ligaments involved in ankle sprains?
#1: ATF - anterior talofibular. #2: CF - calcaneofibular. #3: PTF - posterior talofibular - the strongest of the ligs.
High-ankle sprains?
Dorsiflexion/Eversion (exterior rotation).
-accounts for 1-10% of all ankle injuries.
What other injury is associated with a dorsiflexion/eversion injury or high-ankle sprain?
Injury to the MCL due to valgus stretch of the knee.
Classification of acute ankle sprains:
Grade I, II, III.
Grade __: stretch but within tensile limits, no failure, w/o significant tear.
Grade I
Grade __: exceeds limits, stretch w/disruption of fibers.
Grade II
Grade __: audible snap, followed by pain and swelling, complete tear of fibers.
Grade III
Initial treatment for ankle injuries?
R.I.C.E
Peroneal Tendon Injuries…
- Can be injured during forceful inversion.
- posterolateral ankle pain and swelling along the course of the tendon.
- pt may complain of “snapping tendon.”
Avulsion fracture of the base of the 5th metatarsal?
Ballerina Fracture
5th metatarsal fracture at the metaphyseal/diaphyseal junction - ORIF needed.
Jones Fracture
Complications of Tendinopathies?
Chronic pain, swelling, rupture of tendon.
What is the Thompson Test and what is it used for?
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.
Progressive bony enlargement of calcaneus at Achilles insertion site?
Haglund Deformity that leads to retrocalcaneal bursitis and Achilles tendinopathy.
What is Plantar Fasciitis?
Heel pain that is centered along plantar surface of the medial calcaneal tubercle at the insertion of the plantar fascia.
Heel Spur?
Possibly associated w/plantar fasciitis but has no bearing or correlations to the injury.
Loss of the medial longitudinal arch? Types?
Flat Feet - flexible vs Rigid.
MCC of Flat Feet in Adults?
Posterior Tibialis Tendon Dysfunction/Tear.
Flat Foot - Flexible PE finding?
“too many toes sign,” TTP over posterior Tibialis tendon and unable to single leg calf raise if PTT torn/severe dysfunction.
Compression of Tibial nerve by the flexor retinaculum?
Tarsal Tunnel Syndrome.
Define the pain associated with Tarsal Tunnel Syndrome?
Vague medial hind foot pain, sometimes heel pain and may be accompanied by shooting pain down the foot, numbness and tingling.
MRI, nerve conduction, lumbar disc pathology used in Diagnosis of Tarsal Tunnel Syndrome?
MRI may demonstrate mass effect w/nerve compression (lipoma, ganglion, neoplasm).
Nerve conduction often normal, but show altered nerve conduction.
consider lumbar disc pathology.
Treatment of Tarsal Tunnel Syndrome?
Pain treated w/conservative care - NSAIDs, rest , orthotics.
Chronic Progressive destructive disease of foot and ankle due to sensory neuropathy?
Charcot Foot.
Etiology of Charcot Foot?
Diabetic Neuropathy - 7.5% of Diabetics w/neuropathy develop Charcot.
Presentation of Charcot Foot?
painless; warm, swollen foot, erythema; Rocker Bottom Deformity.
What other disease is Charcot Foot often confused with? Diagnostics?
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.
Sprain of the plantar plate of the 1st MTP joint? Etiology?
Turf Toe - seen in athletes due to forces at the ball of the foot.
What are bunions?
nonspecific term for any swelling of the great toe MTP joint.
MC foot deformity of the 1st MTP that causes pain and stiffness of the joint?
Hallux Valgus.
Presentation and Treatment of Hallux Valgus?
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.
Etiology of Hallux Rigidis?
Degenerative OA of the great toe.
Common foot deformity noted at birth (wound packing) that causes the forefoot to turn inward?
Metatarsus Varus (Adductus).
Common overuse injury that causes pain and inflammation at the ball of the foot?
Metatarsalgia.
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?
Morton’s Neuroma.
