Ankle and foot module 1 Flashcards
what are some potential foot and ankle pathologies?
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
in what population are most stress fractures seen?
running population approx 10%
what activities do stress fractures occur from?
high impact activities like gymnastics and marching
where can stress fractures occur?
in any bone, with greatest percentage of fractures in the metatarsals and fibula (lateral malleolus)
what are some key signs of stress fractures?
swelling, tenderness, gait change, reproduction of cc by performing activity
what is a cause of stress fractures?
increased load on the bone after fatigue of supporting structures (ligaments/tendons)
what is the pathology of stress fractures?
hypovascularity of certain areas of bone will create non-healing
T/F: xrays will immediately show a stress fracture?
false they may not be positive for several weeks
What is the gold standard test for a stress fracture?
a bone scan. it will be positive at one week
what are some differential diagnosis for stress fractures?
malignancy, osteomyelitis, osteoid osteoma
what is a common site for foot fractures?
5th metatarsal (jones fracture)
stress fractures of metatarsals (march fracture)
calcaneus
which fracture is the one to be most worried about with fractures and why?
Jones fractures because there is longer prolonged healing times due to lack of blood supply
should reproduction of pain be felt when healing stress fractures?
no pain reproduction or chief complaint should be avoided during healing
what are some treatments of stress fractures?
may require immobilization with walking boot, may require partial weight bearing
how are healing times determined for stress fractures?
usually based on chronicity of overload and symptoms as well as its location.
what is the average healing time for stress fractures?
6-8 weeks
what may traumatic fractures result in at the tarsometatarsal joint (lisfranc) ?
in complicated fracture dislocations in the foot
what are some mechanisms of injury for tarsometatarsal injuries?
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
what are some signs and symptoms of a tarsometatarsal injury?
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
what are common mechanism of injuries for calcaneal injuries?
usually when a person lands on their feet following a fall from a height
motor vehicle collision
what are some red flags foot and ankle pathologies?
fractures
achilles tendon rupture
DVT
what are some sign and symptoms of calcaneal injuries?
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
what are some common ankle fractures?
bimalleolar fractures
trimalleolar fractures
what is the 2 classification systems for ankle fractures?
danis-weber (fibular location)
lauge-hansen (foot position and force application)
what is the danis weber classification?
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
which weber classification level is the worst?
B because it is not only bone but also joint and ligamentous damage
what is the surgical treatment for ankle fractures?
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
what is the conservative treatment for ankle fractures?
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
what is the purpose of the ottawa foot and ankle rules?
to determine which patients who have experienced trauma may need radiographs
what are the benefits of the ottawa foot and ankle rules?
this may help to decrease unnecessary exposure to radiation and reduce costs
what are some limits of the ottawa foot and ankle rules?
can only be used in skeletally mature patients and only if within 10 days of traumatic event
are the ottawa foot and ankle rules sensitive or specific?
nearly perfect sensitivity and higher specificity
when is an x-ray required for the ankle according to the ottawa foot and ankle rules?
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
when is an x-ray required for the foot according to the ottawa foot and ankle rules?
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
what is the mechanism of injury for an achilles tendon rupture?
trauma, often when jumping or landing, prolonged steroid or history of certain antibiotic use
what are the symptoms of an achilles tendon rupture?
“hit” in back of ankle, report hearing a loud “pop”
what is the typical age and sex for an achilles tendon rupture?
males >40 years old
what activity is common for an achilles tenon rupture?
“weekend warriors”, explosive activities
how can we determine if there is an achilles tendon rupture?
palpable defect, severe loss of function
what medications put some one at higher risk for an achilles tendon rupture?
fluoroquinolones (antibiotics), systemic corticosteroids
what is the percent risk of re rupture with non surgical repair for an achilles tendon rupture?
8-10%
what is the percent risk of re rupture with surgical repair for an achilles tendon rupture?
approx 2%
what is the protocol for a non surgical repair of an achilles tendon rupture?
immobilized in 20º PF for at least 4 weeks and progressive WB as tolerated
what is the protocol for a surgical repair of an achilles tendon rupture?
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
what is DVT of the distal lower extremity?
thrombus (blood clot) in the deep veins causing leg pain or swelling but also can occur with no symptoms
what is an embolism?
when the blood clot breaks loose and travels through your bloodstream…. can travel to your lungs and cause a PE (pulmonary embolism
