Ankle pathology

Question 1

Ankle fracture

Answer 1

Most common lower limb fractures

Management
Pre and post reduction Xray

Conservative - cast if stable injury

Surgical - if unstable (weber B) or open fracture
may need external fixation prior to ORIF if tissues are poor or lots of swelling

Question 2

Weber classification

Answer 2

A - below syndesmosis
B - level of syndesmosis
C - above level of syndesmosis

Question 3

Lisfranc injury

Answer 3

Tarso metatarsal fracture dislocation

Mechanism: RTA, fall from height, sports

Crucial for integrity of mid food arch
‘Medial plantar bruising’
Unable to weight bear

Lateral movement of tarsal bones on X ray

Management
Conservative - Cast
Surgical - ORIF

Question 4

Achilles tendon rupture

Answer 4

Males, can be due to steroids or quinolone antibiotics

Presents with sudden audible snap in back of heel during activity with immediate pain. Unable to walk or stand on tip toes

Simmonds test positive - kneel on bed and squeeze calf

Investigations - X ray, USS

Managment
Conservative - gravity equines cast 3-4 weeks, progressively decreasing plantar flexion
Surgical - tendon repair

Question 5

Halux Valgus (bunion)

Answer 5

Lateral deviation of the great toe at the MTPJ with medial deviation of the 1st metatarsal

Narrow shoes RA, OA, FHx

Management
Non operative - wider shoes, night splint
Operative - osteotomy (Chevron/Scarf)

Question 6

Plantar Fasciitis

Answer 6

Heel pain
30-50 years old
Tip toeing/standing a lot (drs)
Gradual onset, worse in the morning/after rest

Management
Non operative - plantar fascia stretching with tennis balls night splint, NSAID, steroid injection
Operative - plantar fascia release

Question 7

Achilles tendonitis

Answer 7

Gradual onset posterior ankle pain and stiffness
Worse at start of exercise
Swelling, thickening and tenderness of tendon

Ix - Clinical ddx but can do USS or Xray

Mx
Conservative - physio, rest, NSAID, orthotics
Surgical - release +/- excision of paratenon

Question 8

Morton’s neuroma

Answer 8

Benign fibrotic thickening of nerve tissue => causes compression of common digital nerve between metatarsal heads

Dull ache, sharp burning pain in ball of foot, 3rd webspace

Mx
Conservative - steroids
Surgical - excision