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Clin Med > Ankle and foot module 1 > Flashcards

Ankle and foot module 1 Flashcards

1
Q

what are some potential foot and ankle pathologies?

A

fractures, achilles tendon rupture, DVT, muscle and tendon injuries, plantar fasciitis, ligament injuries, ankle stability and movement coordination impairments, congenital foot conditions/deformities, osteochondral injuries, OA, capsular restrictions, peripheral nerve injuries, and diabetic foot

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2
Q

in what population are most stress fractures seen?

A

running population approx 10%

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3
Q

what activities do stress fractures occur from?

A

high impact activities like gymnastics and marching

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4
Q

where can stress fractures occur?

A

in any bone, with greatest percentage of fractures in the metatarsals and fibula (lateral malleolus)

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5
Q

what are some key signs of stress fractures?

A

swelling, tenderness, gait change, reproduction of cc by performing activity

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6
Q

what is a cause of stress fractures?

A

increased load on the bone after fatigue of supporting structures (ligaments/tendons)

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7
Q

what is the pathology of stress fractures?

A

hypovascularity of certain areas of bone will create non-healing

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8
Q

T/F: xrays will immediately show a stress fracture?

A

false they may not be positive for several weeks

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9
Q

What is the gold standard test for a stress fracture?

A

a bone scan. it will be positive at one week

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10
Q

what are some differential diagnosis for stress fractures?

A

malignancy, osteomyelitis, osteoid osteoma

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11
Q

what is a common site for foot fractures?

A

5th metatarsal (jones fracture)
stress fractures of metatarsals (march fracture)
calcaneus

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12
Q

which fracture is the one to be most worried about with fractures and why?

A

Jones fractures because there is longer prolonged healing times due to lack of blood supply

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13
Q

should reproduction of pain be felt when healing stress fractures?

A

no pain reproduction or chief complaint should be avoided during healing

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14
Q

what are some treatments of stress fractures?

A

may require immobilization with walking boot, may require partial weight bearing

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15
Q

how are healing times determined for stress fractures?

A

usually based on chronicity of overload and symptoms as well as its location.

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16
Q

what is the average healing time for stress fractures?

A

6-8 weeks

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17
Q

what may traumatic fractures result in at the tarsometatarsal joint (lisfranc) ?

A

in complicated fracture dislocations in the foot

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18
Q

what are some mechanisms of injury for tarsometatarsal injuries?

A

direct force dropping heavy weight on foot
jumping down onto a plantarflexed foot
force up through the toes of a PF positioned foot
pronation of the RF on a fixed positioned foot
supination of the RF on a fixed forefoot
violent abduction or plantarflexion of the forefoot

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19
Q

what are some signs and symptoms of a tarsometatarsal injury?

A

severe pain in the forefoot
possibly paresthesias
inability to bear weight on the foot
swelling and deformity
tenderness, pain with passive motion of the forefoot
diagnosed through radiographs

20
Q

what are common mechanism of injuries for calcaneal injuries?

A

usually when a person lands on their feet following a fall from a height
motor vehicle collision

21
Q

what are some red flags foot and ankle pathologies?

A

fractures
achilles tendon rupture
DVT

22
Q

what are some sign and symptoms of calcaneal injuries?

A

severe pain in the rearfoot, possibly paaresthias
inability to bear weight on the foot; severe limp
deformity of the heel
bruising in heel and arch
diagnosed through radiographs

23
Q

what are some common ankle fractures?

A

bimalleolar fractures
trimalleolar fractures

24
Q

what is the 2 classification systems for ankle fractures?

A

danis-weber (fibular location)
lauge-hansen (foot position and force application)

25
Q

what is the danis weber classification?

A

a classification to describe the level of fibular fracture relative to the syndesmosis
level a: below syndesmosis
level b: level of syndesmosis
level c: above level of syndesmosis

26
Q

which weber classification level is the worst?

A

B because it is not only bone but also joint and ligamentous damage

27
Q

what is the surgical treatment for ankle fractures?

A

indicated for unstable fractures, open fractures and multiple injuries
acceptable limits of displacement ranging from 0-5mm
theoretical advantages to ORIF are shorter acute recovery time, and better maintenance of reduction decreasing chance of osteoarthritis

28
Q

what is the conservative treatment for ankle fractures?

A

long leg cast with knee flexed at 30º NWB
radiographs can be taken on a weekly basis to confirm maintenance of reduction
at 4 weeks change to short leg walking cast
after 4 additional weeks, radiographs are then taken- if bony union has been achieved, cast is removed and unprotected weight-bearing begun

29
Q

what is the purpose of the ottawa foot and ankle rules?

A

to determine which patients who have experienced trauma may need radiographs

30
Q

what are the benefits of the ottawa foot and ankle rules?

A

this may help to decrease unnecessary exposure to radiation and reduce costs

31
Q

what are some limits of the ottawa foot and ankle rules?

A

can only be used in skeletally mature patients and only if within 10 days of traumatic event

32
Q

are the ottawa foot and ankle rules sensitive or specific?

A

nearly perfect sensitivity and higher specificity

33
Q

when is an x-ray required for the ankle according to the ottawa foot and ankle rules?

A

pain in malleolar region: anterior aspect of medial or lateral malleoli and anterior talar dome area
bone tenderness: distal 6cm of posterior medial malleolus or posterior lateral malleolus
inability to bear weight on limb

34
Q

when is an x-ray required for the foot according to the ottawa foot and ankle rules?

A

pain in metatarsal region: dorsal medial and lateral aspect of the mid-foot
bone tenderness: base of the 5th metatarsal or navicular
inability to bear weight on limb

35
Q

what is the mechanism of injury for an achilles tendon rupture?

A

trauma, often when jumping or landing, prolonged steroid or history of certain antibiotic use

36
Q

what are the symptoms of an achilles tendon rupture?

A

“hit” in back of ankle, report hearing a loud “pop”

37
Q

what is the typical age and sex for an achilles tendon rupture?

A

males >40 years old

38
Q

what activity is common for an achilles tenon rupture?

A

“weekend warriors”, explosive activities

39
Q

how can we determine if there is an achilles tendon rupture?

A

palpable defect, severe loss of function

40
Q

what medications put some one at higher risk for an achilles tendon rupture?

A

fluoroquinolones (antibiotics), systemic corticosteroids

41
Q

what is the percent risk of re rupture with non surgical repair for an achilles tendon rupture?

A

8-10%

42
Q

what is the percent risk of re rupture with surgical repair for an achilles tendon rupture?

A

approx 2%

43
Q

what is the protocol for a non surgical repair of an achilles tendon rupture?

A

immobilized in 20º PF for at least 4 weeks and progressive WB as tolerated

44
Q

what is the protocol for a surgical repair of an achilles tendon rupture?

A

initial NWBing status and casted 4-6 weeks
slowly increase WBing status, in controlled ankle motion (CAM) boot so that AROM can be started early
accelerated program may progress DF ROM to neutral 2 weeks earlier, and allow earlier WBing progression

45
Q

what is DVT of the distal lower extremity?

A

thrombus (blood clot) in the deep veins causing leg pain or swelling but also can occur with no symptoms

46
Q

what is an embolism?

A

when the blood clot breaks loose and travels through your bloodstream…. can travel to your lungs and cause a PE (pulmonary embolism

Clin Med (17 decks)

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