Clinical Disorders Of The Foot And Ankle Flashcards
What is an open fracture?
Any fracture that is associated with a break in the skin
Why are open fractures much more dangerous than closed fractures?
Infection risk from commensile bacteria and foreign pathogens
Increased neurovascular injury risk
What is the proper ankle joint (talorcrural joint)?
Articulation between tibia, fibula and talus
What movements can happen across the proper ankle joint?
Plantarflexion
Dorsiflexion
What is the subtalar joint?
Articulation between talus and calcaneus
What movement does the subtalar joint allow?
Inversion
Eversion
What is meant by a fracture?
Discontinuation in the cortex of a bone
What is a syndesmosis?
A fibrous joint by where 2 adjacent bones are joined by a strong membrane or ligaments
What helps ensure the tibia and fibula remain stably attached to each other?
Interosseous membrane
Superior tibiofibular ligaments (Posterior and anterior)
Inferior tibiofibular ligaments (Posterior and anterior)
What are the medial ligaments of the ankle that are important for stability?
Deltoid ligaments:
-Anterior tibiotalar ligament
-Posterior tibiotalar ligament
-Tibionavicular ligament
-Tibiocalcaneal ligament (Big triangle/deltoid)
What are the lateral ligaments of the ankle?
Anterior tibiofibular ligament
Posterior tibiofibular ligament
Calcaneofibular ligament
Anterior talofibular ligament
Posterior talofibular ligament
How many ligaments lead to the talus on the medial side and the lateral side of the ankle?
2 on both sides
Each have an anterior and posterior ligament on both medial and lateral sides
On the medial side of the ankle, where do the ligaments come from?
Tibia (medial malleolus)
On the lateral side of the ankle, where do the ligaments that cross to the tarsal bones all come from?
Fibula (lateral malleolus)
What is a bimalleolar fracture?
When both the medial and lateral malleoli are fractured
What excessive movements usually lead to an ankle fracture?
Inversion injury
Or
Eversion injury
With an open fracture surgery needs to happen immediately, what is a patient at increased risk of?
Osteomyelitis (infection of bone)
What is a Talar shift?
When theres a disruption of any 2 of the syndesmosis, medial or lateral ligaments of the ankle (ankle unstable)
Talus can move either medially or laterally in the ankle joint
How are stable ankle fractures usually treated?
Non-operatively
Aircast boot
Fibreglass cast
How are unstable ankle fractures treated?
Surgical stabilisation
Reduce
Stabilise
Rehabilitate
Patients with what conditions are at high risk in fixing an unstable ankle fracture?
Diabetes
Peripheral vascular diseases
What type of fracture is a 5th metatarsal fracture?
Avulsion fracture
What is an avulsion fracture?
When the bone breaks due to excessive tension through the inserting tendon
What muscles tendon is responsible for causing the tension in an avulsion fracture of the 5th metatarsal?
Fibularis brevis
What needs to happen to the foot for a 5th metatarsal fracture to occur (avulsion fracture)??
Forced inversion while plantarflexed
The significant force from fibrularis brevis pulls of bone where it inserts
Stepping on a curb or climbing steps is typical cause
What is a sprained ankle?
The partial or complete tear of one or more ligaments of the ankle joint
When do ankle sprains usually happen?
Excessive:
External rotation
Inversion
Eversion
Strains ligaments pst yield point
What is the most common mechanisms of injury for an ankle sprain?
Inversion injury of weight bearing plantarflexed foot
What ligaments are going to be damaged in an Eversion injury of the ankle?
Deltoid ligaments
What ligaments are going to be damaged in an inversion injury?
Lateral ligaments
What is the layman’s term for Hallucis Valgus?
Bunions
Which digit is affected in Hallucis Valgus?
Digit 1/The Great toe
What occurs in Hallux Vagus?
Metatarsal 1 medially deviates
Proximal and distal phalange laterally deviate
What are the risk factors making developing Hallux Valgus more likely?
Female
65yrs +
Connective tissue disorders
Hyper mobility syndromes
How is Hallux valgus treated/managed?
Analgesia
Supportive footwear
Surgical correction (if necessary)
How can I remember how the toe is orientated in Hallux ValGus?
Like ValGus strain on the knees where knees come together
The big toes of the 2 feet come together
Which are the 2 most common joints of the foot most commonly affected by osteoarthritis?
1st metatarsophalangeal joint
Midfoot (Tarso-metatarsal joints)
What is Hallux rigidus?
Osteoarthritis of the 1st metatarsophalangeal joint
What presents in Hallux rigidis (OA of 1st MTPJ)?
Stiffness of joint
Pain on walking here
Reduced dorsiflexion of toe
What is Arthroplasty?
Joint replacement
What is Arthrodesis?
Joint fusion
What is excision arthoplasty?
Surgical removal of joint with interposition of soft tissue
What is an osteotomy?
Surgical cutting of a bone to allow realignment
What are sometimes i need to know for surgical management of osteoarthritis?
Arthroplasty
Arthodesis
excision Arthroplasty
Osteotomy
What joints are affected in osteoarthritis of the ankle?
Talocrural joint
Subtalar joint
How are patients with osteoarthritis usually treated?
Non operative:
-NSAIDs
-Support brace
-Analgesia
-Activity modification
-Intra articular steroid injections
Operative (Arthrodesis)
Most cases of ankle arthritis occur in a joint that has previously suffered trauma, what is the arthritis that develops called?
Post-traumatic arthritis
How is arthritic ankle normally treated in surgery?
Arthrodesis normally
Or
Arthroplasty
What is the Pneumonic for what happens in osteoarthritis (visible on xray)?
LOSS
What does LOSS stand for?
Loss/narrowing of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
What is an Achilles tendon rupture?
Complete loss of attachment of Achilles tendon
What is Achilles tendinopathy?
Repetitive action causing microtears within the tendon
What are the risk factors for Achilles tenonopathy and rupture?
Trauma
Poor footwear
Obesity
Iatrogenic (drug induced) like Quinolones (nucleic acid synthesis inhibitors)
Sudden increase in exercise frequency
What tests/examinations can be used to check for Achilles rupture or tendinopathy?
Simmonds test (Calf squeeze)
Ultrasound
MRI
What is the Simmonds test (calf squeeze)?
Patient kneels on chair/lies face down on bed with foot hanging over edge
Squeeze their calf
Floor should plantarflex if Achilles is still attached
(Achilles attaches the posterior superficial leg muscles to calcaneus, these muscles are plantar flexors)
How is Achilles tendinopathy or rupture treated?
Analgesia
Physiotherapy
Surgical fixation
What usually happens leading to an Achilles tendon rupture?
Excessive repetitive action THEN A POP SOUND
What is claw toe?
Dorsiflexion of the metatarsal phalangeal joint, Plantarflexion of proximal interphalangeal joint and plantar Flexion of distal interphalangeal joint
What is hammer toe?
Dorsiflexion of metatarsophalangeal joint, plantar Flexion of proximal interphalangeal joint
Different to claw toe since Distal interphalangeal joint not plantarflexed
What are the risk factors for claw+hammer toe?
Diabetes
Neurological conditions
Trauma
Ill fitting shoes
High arches
What are the complications of claw+hammer toe?
Corns and calluses
Gait instability
Discomfort
Why does claw toe or hammer toe usually happen, what muscle is affecting them?
Flexor Hallucis longus or flexor Digitorium brevis too tight
What causes flat foot in adults?
Loss of medial longitudinal arch
What usually causes the loss of the medial arch in adult acquired flat foot?
Lack of support from Tibialis posterior
What are the risk factors for adult acquired flat foot?
Genetics (Marfan’s and Down’s syndrome)
Tight Achilles
Ligament laxity
Obesity
Diabetes
How is flat foot managed?
Physiotherapy (strengthen muscles)
Analgesia
How can diabetes Mellitus affect the foot?
Peripheral vascular disease (reduced blood supply)
Peripheral neuropathy (cant feel pain in foot)
Poor glycemic control supressed immune system (More prone to infection)
patient likely to get ulcers on feet, not feel the pain, keep putting weight on it, exacerbating problem and being prone to infection
How is diabetic foot prevented?
Annual diabetic foot check
Self care advice (good fitting shoes)
What is Charcot foot?
What condition is this often associated with?
Progressive destruction of the bone and soft tissue of foot
Characterised by multiple joint dislocations fractures and deformities
Peripheral neuropathy caused by uncontrolled Diabetes Mellitus (Chronic Hyperglycaemia)
What are the 2 theories for how chariot foot happens?
Neurotraumatic (can’t feel pain in the foot)
Neurovascular
How does Charcot foot present?
Pain
Swelling
Loss of sensation
Instability of joint and loss of function
What is compartment syndrome?
Increase in pressure within a CLOSED fascial compartment that compromises the NEUROVASCULAR BUNDLE
What are the 6P’s indicating compartment syndrome?
Pain (out of proportion)
Parasthesia (numbness)
Pulselessness (artery compress by swelling/fluid)
Perishingly cold
Paralysis (Nerve compressed)
Pallor (pale lack of blood supply)
What usually causes compartment syndrome?
Long bone fractures leading to haemorrhaging or swelling in the fascial compartment
What is the treatment for compartment syndrome?
Fasciotomy
What is a fasciotomy?
Cutting open fascia relieving pressure in the compartment
How is a patient with uncontrolled diabetes able to develop osteomyelitis?
Loss of sensation in foot (peripheral neuropathy) means patient doesnt feel ulcer as it develops
Eventually begins wearing down the bone making them prone to an infection of the bone
