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MSK 2 test 2 > Ankle and foot pathologies > Flashcards

Ankle and foot pathologies Flashcards

1
Q

anatomical classification potts fracture- anatomical

A

Isolated medial malleolus
isolated lateral malleolus (most common)
Bimalleolar fx
trimalleolar fx

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2
Q

Danis and Weber classification A

A

distal fibula below syndesmosis

Stable conservative treatment

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3
Q

DW class B

A

distal fibula at level of syndesmosis

Treated conservatively if stable, if not do fixation

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4
Q

DW class C

A

fibula fracture above level of syndesmosis

usually unstable requires surgical fixation

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5
Q

Lauge Hansen classification- supination adduction

A
  1. distal fibula transverse fracture
  2. Medial malleolus vertical fracture
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6
Q

LH class- supination external rotation

A

60%
1. ant tib fib ligament
2. distal fib oblique spiral fx
3. post tib fib lig or posterior mallelous alvusion
4. medial malleolus fx or deltoid lig

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7
Q

LH class- pronation external rotation

A
  1. medial malleolus fx or deltoid lig
  2. ant tib fib lig
  3. fibula proximal to plafond - oblique spiral fx
  4. post tib fib lig or posterior malleolus avulsion
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8
Q

LH class- pronation abduction

A
  1. medial malleolus fx
  2. ant tib fib lig
  3. fibula proximal to plafond- transverse or comminuted
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9
Q

etiology of plafond fx

A

talus drilling upward into the tibial plafond
High energy - MVA , fall from height
Low energy -ski injury most common (impact with rotation of tibia)

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10
Q

management of plafond fx

A

Advanced life support and stabilization

Not displaced well aligned -cast immobilization and nonweightbearing

displaced -surgical 4 stage approach

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11
Q

displaced surgical approach for plafond fracture

A

Restore fibula length and reestablish lateral column

Restore articular surface of distal tibia

Autologous bone graph to fill metaphyseal bone defects

Buttress plate placed on distal aspect of tibia

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12
Q

maisonneuve fx

A

unstable fracture caused by pronation, external rotation ankle injury

Proximal fibula fracture and deltoid ligament injury
May include medium malleolus fx and syndesmotic injury

Require surgical fixation of the fibula

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13
Q

bosworth fx dislocation

A

fibula is dislocated posteriorly at the ankle

Posterior tibial border block fibular reduction

Surgery to reduce, reposition the fibula and incisura fibularis

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14
Q

frank (clear) calcaneal fx

A

mechanism- fall or jump from height, MVA

managed with immobilization or surgical fixation if displaced

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15
Q

calcaneal stress fx

A

recent new activity or a change in that activity

Repetitive load and stress like runners or military recruits

May not show on plain film x-ray requires a bone scan or MRI

manage- produce pain, manage load, gradual progression to full weight-bearing and activity

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16
Q

Chopart fx dislocation

A

dislocation of the mid tarsal joints with associated fractures of the calcaneus, cuboid and navicular bones

Less common

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17
Q

Chopart fx management

A

ORIF or displaced malaligned fracture or dislocation
Closed reduction, rigid cast 6 to 8 weeks with PWB
Focus on maintenance of arch

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18
Q

chopart fx symptoms

A

abnormal position of forefoot mediately directed
Swelling in dorsum of foot
midfoot pain

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19
Q

lisfranc fx

A

fracture in mid foot, TMT joint region

Severity ranges from mild to severe
Ligaments are often torn, in lieu of fractures, or in combination
Fracture dislocations occur
Cartilage damage can occur can lead to osteo arthritis

Often a low energy twist and fall injury or someone landing on foot

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20
Q

lisfranc fx symptoms

A

dorsal foot swelling, and bruising
Bruising on the bottom of the foot is highly suggestive of this fracture
Pain in mid foot with standing walking and pushoff
Weight-bearing may not be possible due to pain

21
Q

lisfranc fx management

A

depends on severity

Non-fractured non-dislocated - nonweightbearing boot for six weeks progress to weight-bearing in boot

fractured dislocated - surgical fixation and realignment via ORIF or mid foot fusion

Postop nonweightbearing for 6 to 8 weeks
Manage weight-bearing progression and work on impairments

22
Q

metatarsal fx

A

61% of all foot fractures in children
41% of those in the fifth metatarsal

Direct trauma or held in place while body falls over the area
Stress fractures due to repetitive loading or activity -March fracture

23
Q

fifth metatarsal fracture; Lawrence and botte

A

proximal fractures

Zone 1- tuberosity
zone 2- metaphysis/diaphysis junction
Zone 3- diaphyseal within 1.5 cm of tuberosity

24
Q

Avulsion fracture of fifth metatarsal

A

zone 1- pseudo Jones fracture

Mechanism is typically inversion plantar flexion

25
Q

Jones fractured fifth metatarsal

A

Zone 2- proximal fifth metatarsal fracture

Mechanism- plantar flexion with forceful adduction of forefoot

Poor healing ; nonunion rates 15 to 30%

26
Q

stress fracture of fifth metatarsal

A

Zone 3
Chronic repetitive micro trauma
Pain with activities over months
Increased risk of nonunion

27
Q

dancers fracture fifth metatarsal

A

Mid shaft fracture

Mechanism - rolling foot and Demi point position or while landing a jump

28
Q

phalangeal Fracture

A

common

Symptoms include swollen, discolored, painful, sometimes deformed

management
Pain control, protected weight-bearing initially
Buddy taping; wide toed shoes for comfort
walking normally within two weeks
Fully healed within 6 to 8 weeks

29
Q

initial immobilization phase for patients with fractures

A

Assistive device training
Patient education
Monitor for vascular soft tissue other complications
Exercise uninvolved areas
infrequent visits

30
Q

post immobilization phase for patients with fractures

A

Protect healing tissues
Pain control
Manual therapy exercise HEP
Progress towards return to activity

31
Q

medial tibial stress syndrome

A

Accounts for inflammation traction event on the tibial aspect of the leg common in runners

Most accurately named medial tibial traction periostitis, or medial tibial periostitis

Tightness tenderness, throbbing along, tibial crest that comes with activity and settles with rest

32
Q

Causes of medial tibial stress syndrome

A

inappropriate footwear
Muscle weakness
Poor running mechanics
Improper training
Tight gastrocsoleus
Hyper mobile pronated feet
Excessive supination

33
Q

tibialis anterior tendinopathy

A

will look very similar to MTSS
MMT testing should provoke
palpation key
be sure to screen the lumbar
Gate and running analysis key

34
Q

Tibialis posterior tendinopathy

A

pf, inv, and anti pronator muscle
Pain with AROM and or MMT
repetitive stress
pes planus, hyper mobile feet
Irritation at insertion on navicular, or the medial malleoli
Look at resting and dynamic foot posture

35
Q

peroneal tendonopathy

A

occurs in sulcus behind lateral malleoli or at cuboid

Overuse or friction
Often after inversion sprain
Can rupture at retinaculum leading to peroneal subluxation

36
Q

tarsal tunnel syndrome

A

Posterior tibial neuritis

Lesion to posterior tibial nerve in flexor retinaculum
Entrapment or traction
behind medial malleoli

Running on hard surfaces or poor fitting shoes
Overpronation

37
Q

tarsal tunnel syndrome examination

A

swelling
Medial ankle and heel pain
Positive sensory loss to medial knee
Positive tinels sign
Possible adverse neural tension

38
Q

Chronic exertional compartment syndrome

A

typically anterior
two year history prior to diagnosis
runners and soccer players

Muscle herniation can be palpated in 40 to 60% of patients
Neurologic weakness and numbness in respective compartment

39
Q

Chronic exertional compartment syndrome examination

A

pain comes at predictable periods
Tested with wick catheter before and after treadmill test

burning, numb, tingling, pain, pressure, pallor, pulse

Consider transition to forefoot running

40
Q

keys to treating shin pain

A

Rice
Flexibility program for GS complex
Retrain inhibited musculature
Restore CKC dorsiflexion
Strengthen inhibited musculature
Improve intrinsic foot strength
Short term use of low dye taping
Running evaluation and retraining
Address associated triggerpoints
footwear changes if necessary

41
Q

achilles Tendinitis

A

inflammation of achilles tendon
Overuse overloaded state
Gradual onset
Decreased flexibility exacerbates

42
Q

achilles tendonosis

A

chronic
Hypovascular zone 2 to 6 cm from insertion
May present with crepitus
Often lack of CKC DF
thickening of Achilles tendon
Tight painful gastrocsoleus with TPs
painful resisted plantar flexion

Anti-inflammatories don’t work

43
Q

achilles tendonosis treatment

A

IASTM
Stretching
No NSAIDs

Eccentric training
3 sets of 15 eccentric heel drops
2 times daily for 12 weeks

44
Q

achilles tendon rupture

A

Chronic degeneration due to inflammation
Forceful, sudden contraction
Audible pop

Cortizone injection is a risk factor
30 to 40-year-old male

45
Q

achille tendon rupture symptoms and examination

A

palpable or visible defect in tendon
Gate changes unable to push off
swelling and ecchymosis
Positive thompson test
most Treated surgically

46
Q

halux abductovalgus

A

medial deviation of first metatarsal head in relation to center of the body

Adolescent - may require surgical intervention often associate with hyper pronation of the rear foot

Degenerative - degeneration of the first metatarsal head and base of proximal phalanx

47
Q

hallux abductovalgus interventions

A

strengthen intrinsic muscles
Manual therapy of foot and ankle
Modify footwear
Custom orthotics
Splinting

48
Q

mortons neuroma

A

Pain and paresthesia in interdigital space with fibrous entrapment of interdigital nerve

Conservative manage- decompression, change foot wear modification, metatarsal pads, mobilization

Surgical if symptoms do not improve

MSK 2 test 2 (10 decks)

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