Ankle/Foot

Question 1

Ottawa ankle rules (ankle)

Answer 1

ankle- pain in the malleolar zone and either of the following:

pain to palpation at the medial and lateral malleoli

inability to beat weight both immed after injury and in the ER

Question 2

Hindfoot

Answer 2

calcaneous

talus

Question 3

High ankle sprain

Answer 3

syndesmosis-

ant and post tibiofibular ligaments

Question 4

Routine radiographs-anke/foot

Answer 4

ankle:
AP-tib, fib, and dome of talus
AP oblique (mortise)-leg rotated 15 deg internally allows entire ankle to be seen without superimposition of the tibia over the fibula
Lateral-ant and post aspects of the tibia, fibula, and tibiotalar and subtalar jt articulations

foot:
AP- phalanges, metatarsals, cuneiforms, cuboid, and navicuar
Oblique- phalanges, meatarsals, and midfoot tarsals from a perspective of 45 deg between the AP and lateral views
Lateral- subtalar, talonavicular, calcaneocuboid, and tarsometatarsal articulations. Boehler’s angle normally 20-40 deg.

Question 5

Lisfranc fractures

Answer 5

disruption of tarsals from metatarsals

Question 6

MRI indications

Answer 6

soft tissue
bone marrow

achilles tendon disorders

post tibial and peroneal tendon disorders

ant talofib, calcaneofibular, deltoid, spring, and syndesmotic lig tears

soft tissue or osseous impingement syndrome

osteochondral and articular cartilage abnormalities

loose bodies’ chondral, osteochondral, or osseous

plantar fascitis, fascial rupture, plantar fibromatosis

marrow abnormalities; contusions, osteonecrosis, stress fractures

neoplasms or infections

congenital or developmental conditions

Question 7

CT scan indications

Answer 7

significant trauma/fractures

complex fractures and dislocations of ankle and hindfoot

loose bodies in the joint

osteochondral lesions if MRI contraindicated

tarsal coalition

pre-operative planning

3D CT model good for surgical planning

Question 8

Ottawa ankle rules (foot)

Answer 8

foot- pain in the midfoot zone and any of the following:

pain to palpation at the base of the 5th metatarsal

pain to palpation at the navicular

inability to bear weight both immediately after injury and in the ER

Question 9

Bohler’s fracture

Answer 9

<20 deg could be calcaneus fracture

Question 10

MS US indications

Answer 10

detect soft tissue injury

visualize capsule, synovium, and bursa

define lig, muscle, or tendon tear

eval soft tissue masses (morton’s neuroma)

indentify loose bodies

differentiate effusion

guide needle aspiration of jt

eval congenital or development abnormalities

Question 11

Bimalleolar fracture

Answer 11

imagine-radiographs sufficient for tx decisions

Question 12

Fracture at the base of the 5th metatarsal

Answer 12

imaging-radiographs for tx decisions and MRI to confirm stress fractures

Question 13

Fracture of the talar neck

Answer 13

imaging-radiographs, CT or MRI, as other subluxations and fractures typically coexist with this injury

Question 14

Tarsal coalition

Answer 14

union between two or more tarsal bones

imaging-radiographs identify condition. MRI or CT determines whether it is a fibrous or bony coalition

Question 15

Ankle spain

Answer 15

imaging-radiographs to role out fracture, MRI or US to assess tears of ligaments or tendons