Ankle and Foot Fractures

Question 1

What rules help decide whether to x-ray an ankle?

Answer 1

Ottawa ankle rules, tenderness over:

1. Lateral malleolus
2. Medial malleolus
3. Base of 5th metatarsal
4. Navicular

Question 2

Which fracture is most common in young males and middle-aged overweight females?

Answer 2

Ankle fracture

Question 3

What indicates more instability in a fibular fracture?

Answer 3

The higher up the fibula, the more instability.

Question 4

How is an ankle fracture investigated and managed?

Answer 4

1. X-ray

2. Cast if stable injury, surgical open reduction internal fixation if unstable or open.

Question 5

What is this a presentation of?

Repetitive stress/overuse (running), gradual onset pain in foot, made worse by weight bearing, tenderness on touch.

Answer 5

Metatarsal stress fracture (2nd commonly)

Question 6

What is the management for a metatarsal stress fracture?

Answer 6

Rest, walking boot/cast

Question 7

What is this a presentation of?

RTA/fall from height/sports, medial plantar bruising, inability to weight bear, swelling over midfoot.

Answer 7

Lisfranc injury (tarso-metatarsal fracture-dislocation, 2nd metatarsal commonly)

Question 8

How is a Lisfranc injury investigated?

Answer 8

X-ray shows widened gap between medial cuneiform and base of 2nd metatarsal.

Question 9

What is the management of a Lisfranc injury?

Answer 9

Conservative or open reduction internal fixation

Question 10

What is this a presentation of?
Male, steroid use, sudden audible snap in back of heel during activity with immediate pain. Unable to walk or stand on tip toes. Positive Simmonds/Thompson test.

Answer 10

Achilles tendon rupture (commonly 5cm from calcaneus)

Question 11

How is an Achilles tendon rupture investigated?

Answer 11

X-ray and USS to confirm size of gap.

Question 12

What is the treatment for an Achilles tendon rupture?

Answer 12

Cast if gap <5cm and elderly and comorbid. Surgical tendon repair if gap >5cm or younger patient.

Question 13

What is this a presentation of?

Stiffness, tenderness over lateral ankle ligament, pain on inversion.

Answer 13

Ankle ligament sprain

Question 14

What causes an ankle ligament sprain and which ligaments are damaged in each case?

Answer 14

1. 85% due to inversion injury injuring anterior talofibular ligament.
2. 5% are eversion sprains damaging medial deltoid ligament.

Question 15

What is the treatment for an ankle ligament sprain?

Answer 15

RICE, protect from further injury, optimal loading, compression, elevation, simple analgesia.