Ankle & Foot Flashcards
What is the importance of the mortise?
Articulation between tibia, fibula, and the talus.
Distance should be equal all the way around, otherwise indicates talar shift
What is Zadek’s procedure?
Toenail ablation (for ingrowing toenail)
Describe metatarsalgia.
Pain across metatarsal heads due to collapse of transverse arch/congenital long 2nd and 3rd metatarsals —> load goes through 2nd and 3rd toes (should go through 1st and 5th only) —> pain
Mx:
- orthortics
- physio
- break, shorten, and fix metatarsals
- lengthen gastrocnemius
What is the Mx of midfoot arthritis?
Steroid + local anaesthetic (X-ray guided)
Fusion: remove remaining cartilage and nail across joint (prevents movement, therefore prevents pain)
MRI to confirm
What is plantar fascitis?
Inflamed plantar fascia.
Usually self-resolves in 2-3yrs
Can use lithotripsy (shockwave) treatment
What is hallux valgus?
Bunion = lateral deviation of great toe causing valgus deformity of 1st MTP joint
- great toe overlaps second toe
- lat. subluxation of 1st MTP joint —> prominence of metatarsal head (bunion) —> fluid-filled bursa develops (painful)
Mx: exostectomy/K wires if painful
Contrast the different type of toe deformities.
Claw toe = abnormal position of all three joints in toe
- extension contracture with dorsal subluxation of MTP and flexion deformities of PIP and DIP joints
Hammer toe = extension of MTP and DIP joints and hyperflexion of the PIP joint
Mallet toe = flexion of DIP joint
What is cavovarus?
High arched foot
Elevated longitudinal arch caused by fixed plantarflexion e.g. weak tibialis ant.
What is the Coleman block test?
Eliminate contribution of the first ray and evaluate flexibility of hindfoot
Contrast the different abnormal gaits caused by foot pathology.
Heel-walking = asses ant. compartment power and innervation (dorsiflexion)
Tip-toeing = assess plantarflexors power and innervation
Intoeing
Outoeing
How should the Achilles tendon move when standing on tiptoe?
Should move inwards
Otherwise:
- subtalar arthritis (fixed hindfoot)
- tibialis pos. problem —> weak or dysfunctional
What is the Silfverskiold test?
Passively dorsiflex ankle with knee flexed and extended
Improved ankle dorsiflexion when knee flexed indicates gastrocnemius tightness (can feel metatarsals plantarflexing when knee is extended)
Equivalent ankle dorsiflexion when knee flexed or extended indicates Achilles tendon tightness
