ankle & foot Flashcards by Anika Dossa

ANKLE FRACTURE classification?

broadly: isolated lat malleolus fracs, isolated med malleolus fracs, trimalleolar fracs (med+lat+posterior malleolar frac)
- also weber classifcation -> lat malleolus fracs:
weber A= ? the syndesmosis
weber B= ? the syndesmosis
weber C= ? the syndesmosis
** what one is most unstable A,B or C???

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ANKLE FRACTURE clinical features?

pain
deformity if associated dislocation
very deformed? neurovascular compromise & often tend to be open fracs (typically lat or med side?)

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ANKLE FRACTURE investigations?

plain radiograph - what views? x2
check joint space for uniformity ensuring no evidence of talar shift
complex? CT for sirgical planning

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ANKLE FRACTURE immediate management?

i immediate frac reduction - under sedation in ED to realign frac

once reduced - below knee back slab. REPEAT neurovasc exam
request x ray - if not adequate try to reduce again

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ANKLE FRACTURE surgical management?

ORIF

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ANKLE FRACTURE complications?

post traumatic arthritis
infection
DVT/PE
neurovascular injury
non-union

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ACHILLES TENDON PATHOLOGY includes?

achilles tendonitis -» achilles tendon rupture

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ACHILLES TENDON PATHOLOGY what makes up the achilles tendon, where does it insert and what action does it perform?

gastrocnemius, soleus & plantaris
inserts into calcaneus
plantarflexion

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ACHILLES TENDON PATHOLOGY pathophysiology?

of tendonitis? repetitive action -> micotears -> localised inflammation. overtime tendon becomes thickened, fibrotic & loses elasticity
of rupture? substantial sudeen force applied across the tendon in the context of tendonitis eg sudden jump, change of direction running

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ACHILLES TENDON PATHOLOGY risk factors?

classic case: unfit individual w a sudden inc in exercise freq

poor footwear choice
male
obesity
recent fluoroquinolone use (rupture)

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ACHILLES TENDON PATHOLOGY tendonitis clinical features?

gradual onset of pain & stiffness in what part of ankle? worsens w? improved w? x2

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ACHILLES TENDON PATHOLOGY tendonitis on examination?

tenderness over the tendon on palpation (worse ? cm above its insertion site

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ACHILLES TENDON PATHOLOGY rupture clinical features?

sudden onset severe pain in posterior calf w audible popping sound & a feeling that something ‘went’

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ACHILLES TENDON PATHOLOGY rupture on examination?

marked loss of power of ankle plantarflexion (what tendons minorly contribute to plantarflexion so preserve this movement slightly?)
- what 2 tests are indicators of a clinical tendon rupture?

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ACHILLES TENDON PATHOLOGY differential diagnoses?

tendonitis
- ankle sprain
- stress fracs (tibial or calcaneal)
- OA
rupture
- ankle frac
- ankle sprain

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ACHILLES TENDON PATHOLOGY investigations?

both are clinical diagnoses - unsure? USS. good to see if the tear is complete or partial

ACHILLES TENDON PATHOLOGY tendonitis management?

supportive measures. pts are told to: stop precipitating exercise, ice area, NSAIDs
- chronic tendonitis? rehab and PT

ACHILLES TENDON PATHOLOGY rupture management?

early presentation (<2 wks):

analgesia
immobilisation - ankle splinted in plaster in full equinus (whats this?)
2 wks of this w crutches and not allowed to weight bear
now ankle brought to semi equinus and held for 4 wks
now neutral position and held again for 4 wks

delayed presentation (>2wks)/ re rupture:
surgical fixation w end to end tendon repair

HALLUX VALGUS what is it?

bunion - deformity @ first MTPJ
characterised by medial deviation of the 1st metatarsal & lateral deviation. =/- rotation of the hall us w associated joint subluxation

HALLUX VALGUS pathophysiology?

normal: digits should remain parallel to floor in normal gait & so foot is kept stable by static stabilisers (bones&ligaments) & dynamic stabilisers (muscles & tendons) - as metatarsals are inherently unstable we rely on the others
….
once the metatarsal head escapes the intrinsic anatomical control the extrinsic tendons become a deforming forced so the 1st MT head drifts medially - causes bone to proliferate on the dorsomedial aspect

HALLUX VALGUS risk factors ?

F
Connective tissue disorder
hyper mobility syndromes
anatomical variants eg flat feet

HALLUX VALGUS clinical features?

painful medial prominence aggravated by walking, weight bearing, narrow toes shoes
sx for a long time. but have worsened in freq & intensity

HALLUX VALGUS OE?

- ensure foot is assessed in what 2 positions?
assess position & lateral deviation of hallux
check for inflammation or skin breakdown over prominence @ base of hallux
check for worsening of the prominence in ? position
assess ROM - active & passive
assess for creps
what may be visible in longstanding joint subluxation?
what may indicate abnormal weight distribution from gait?

HALLUX VALGUS differentials?

gout, septic arthritis, hallux rigidus, OA, RA

HALLUX VALGUS investigations?

- xray - to measure the degree of lateral deviation (how? what angles…) & signs of joint subluxation

HALLUX VALGUS non-surgical management ?

- analgesia - change footwear - PT

HALLUX VALGUS surgical management ?

if QOL rlly affected: - chevron procedure - scarf procedure - lapidus procedure - keller procedure what are these?

HALLUX VALGUS comps?

avascular necrosis, non union, displacement, RROM

all about lisfranc injuries

severe injuries to the tarsometatarsal (ie lisfranc ) joint between the medial cuneiform & base of the 2nd metatarsal . either solely ligamentous injuries or involving the bony structures. - commonly occur following severe transational forces through a plantarflexed foot ie in RTAs or athletes - present: severe pain mid foot & difficulty weight bearing - oe: swelling & tenderness of mid foot (what is the piano key sign?), plantar bruising ***keep an eye out for compartment syndrome - investigations : x ray (what views?), ct if comminuted, mri to confirm purely ligamentous - mgmt: significant displacement?closed reduction in ed then backslab. minor displacement? cast immobilisation & non weight bearing mobilisation for 6-12 wks . clear displacement? surgery….^^^soft tissue swelling? temp external fixation. definitive? screw fixation - comps post traumatic arthritis (common in?)