Ankle and foot mishaps

Question 1

what does talor shift mean?

Answer 1

• ligament injury may cause shift in talus.

Question 2

how does treatment for ankle fractures vary on if it’s stable or unstable?

Answer 2

• stable fractures : weight bearing, need cast or boot for comfort and low rate of complications.
• unstable fractures require surgical stabilisation and high risk of complications in diabetes and poor blood supply.

Question 3

why is achiles tendon rupture so significnt?

Answer 3

• Achilles is the largest and most powerful tendon in the body.
• often at vascular watershed 6cm proximal to insertion of Achilles into calcaneal tuberosity which has decreased thickness so more susceptible for tear.

Question 4

what would the symptoms be is a ruptured Achilles tendon?

Answer 4

• sudden severe pain at back of ankle.
• palpable depression in tendon.
• inability to push off when walking.

Question 5

what investigations would be carried out at ruptured Achilles tendon? what would the treatment be?

Answer 5

• thompson’s test also called simmond’s test when calf squeezed no plantar flexion.
• MRI and USS to diagnose.
• treatment with air-cast boot holding foot in correct position or surgery if young.

Question 6

what is the halux valgus complication?

Answer 6

• Hallux (big toe) valgus (distal part deviated laterally).
• varus deviation of first metastarsal.
• valgus deviation or lateral rotation of hallux.
• prominence of first metatarsal head with or without callus.
• caused by genetics or shoe-wear.

Question 7

what is the treatment for hallux valgus?

Answer 7

• change shoes and attitudes.

- operation.

Question 8

what is hallux rigidus?

what would the treatment be?

Answer 8

• osteoarthritis of 1st metastarsophalengeal joint.
• Xray may show loss of joint space, extra bone structures, cysts.
• painkillers, steroids.
• surgery realign, remove extra bony structures, fuse, replace in arthroplasty.
• fusion or joint replacement where fracture created and stabilised and allowed normal fusion.

Question 9

how would you treat ankle arthritis?

Answer 9

• arthrodesis (fusion).

- arthroplasty (ankle replacement) .

Question 10

what is planovagus and how is it treated?

Answer 10

• change in shape due to tibialis posterior disfunction leading to pain behind medial malleolus.
• treatment include insoles for medial arch support, physiotherapy, reconstruction if flexible foot, arthrodesis if stiff foot.

Question 11

why is diabetes a risk factor for foot complications?

Answer 11

• because diabetes causes loss of protective sensation in foot so injuries may lead to severe infections as undetected.
• debridement required.

Question 12

what is charcot arthropathy?

Answer 12

• a complication of diabetes leading to massive deformity and bone loss, loss of soft bone due to inflammation and lack of pain.
• patients obese, immunocompromised with poor diabetic control to complicate matters.
• cast to protect foot.