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MDCN 360: Course 2 > Common Foot and Ankle Conditions > Flashcards

Common Foot and Ankle Conditions Flashcards

1
Q

what is the normal standing hindfoot alignment

A

slightly valgus

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2
Q

What is not an indication for bunion surgery

• Pain

• Metatarsalgia in the lesser toes in the presence of a
bunion

• Cosmesis

• rapidly progressing bunion
What is not an indication for bunion surgery

A

cosmesis

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3
Q

normal or pathological heel valgus?

A

normal

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4
Q
A

normal physiological heel valgus

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5
Q 
What joint(s) is/are primarily responsible for
dorsiflexion/plantarflexion of the foot/ankle?
A

The ankle joint (or talocrural joint) is a synovial joint located in the lower limb. It is formed by the bones of the leg (tibia and fibula) and the foot (talus). Functionally, it is a hinge type joint, permitting dorsiflexion and plantarflexion of the foot.

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6
Q 
What joint(s) is/are responsible for
inversion/eversion of the foot/ankle?
A

The ankle joint is a hinge type joint, with movement permitted in one plane. Thus, plantarflexion and dorsiflexion are the main movements that occur at the ankle joint. Eversion and inversion are produced at the other joints of the foot, such as the subtalar joint.

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7
Q

implications of missing an achilles tendon rupture

A

If diagnosed late, nonoperative treatment doesn’t
work well and the surgical reconstruction is a big
deal with potentially disastrous complications

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8
Q

T/F if you suspect an achilles tendon injury you should inject it with steroids to reduce inflammation

A

false. NEVER

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9
Q

Achilles tendon is made of
the confluence of the
____ and ____
tendons.

A

Achilles tendon is made of
the confluence of the
gastrocnemius and soleus
tendons.

Watershed region of
vascularity 5 cm proximal to
the calcaneal tuberosity.

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10
Q

How can I most effectively diagnose an Achilles
tendon rupture?
A. Physical Examination

B. Imaging

C. Call an Orthopaedic Surgeon

A

Physical exam– you sohld be able to do enough maneuvers to diagnose achilles tendon rupture

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11
Q

which test to see achilles tendon rupture

A

Thompson test;

go prone– no plantarflexion of the ankle with squeezing the calf implies no connection between the Achilles and the Foot.

  • may also feel a gap at achilles tendon site.
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12
Q

T/F you can assess a persons ability to plantarflex ankle and show an achilles tendon rupture

A

false. NEVER use this as an indicator for a torn achilles. lots of other things can plantarflex the ankle such as all of the posteromedial tenons (TDL, Tib Post, FHL), plantaris, peroneus longus.

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13
Q

what should you do when you see an achilles tendon rupture and positive thompson test?

A

1 . put the patient in a full plantarflexion splint (non-weightbearing) and refer to an orthopaedic surgeon within 1-2 weeks.

  1. educate the patient that regardless of the treatment, they are at a high risk of a DVT. some studies suggest upwards of 30%!
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14
Q

T/F you should always surgically repair achilles tendons to prevent a re rereupture rate.

A

false. Nonoperative if caught early works fine. There’s no difference to re-rupture rates, but th ecomplications are more common with surgery and these can be catastrophic

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15
Q

overall: for ruptured achilles tendons:

A
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16
Q

ottawa ankle rules help edtermine if physicians should order radiographs in the owrkup of an ankle injury. when should you order one?

A
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17
Q

should you get an MRI for an ankle sprain to get visualization of the soft tissue?

A

NO! Look for bruising and swelling.

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18
Q

You shouldn’t order an MRI for a suspected ankle sprain. When should you?

A

if you suspect a talar osteochondral injury, or if you suspect peroneal tendon damage.

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19
Q

what is the post-injury recovery time period of an ankle sprain?

A

SO LONG. months and months and months and months. become suspicious when there’s no improvement at all and persistent pain beyond reasonable doubt after 2-3 months of rehap

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20
Q
A
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21
Q

how should you treat a sprained ankle?

A. I’m not prescribing a treatment until I know the
damaged structures

B. Non-weight bearing in a boot for 6 wk followed by
progressive mobilization and ankle proprioceptive
training

C. RICE then Early functional rehabilitation (peroneal
tendon strengthening and proprioceptive training)

D. Benign neglect; i.e. mobilize as tolerated

A

C

22
Q

continued instability of the ankle often is due to a ____injury

A

ligament injury

23
Q

note:

A
24
Q

• “Ankle Fractures” are from
____ injuries, ____ fractures
are from axial load injuries

A

• “Ankle Fractures” are from
rotational injuries, Pilon fractures
are from axial load injuries

25
Q

treatments of fracturing lateral/medialposterior malleoli fractures.

A
26
Q
A

bimalleolar fracture. needs OR internal fixation.

27
Q

note:

A
28
Q

a person comes into the hospital after a sports injury where the ankle is crooked and displaced. what is the first thing to do?

A

NEUROVASCUALR EXAM AND REDUCTION. don’t take an xray of an unreduced crooked foot– reduce it and then check with X ray

29
Q

bunion is called __ ___

A

hallux valgus.

  • *medial** deviation of the first metatarsal and
  • *lateral** deviation and pronation of the hallux
30
Q
A
31
Q

a bunion involves a ___ deviation of the first metatarsal and ____ deviation and pronation of the hallux

A

medial deviation of the first metatarsal and
lateral deviation and pronation of the hallux

32
Q

most common cause of bunions

A

genetics.

33
Q

nonoperative management of bunions

A

Nonoperative management: Analgesia, activity
modification, accommodative footwear (i.e. deep
and wide toe box)

34
Q

note

A
35
Q

what is hallux rigidus

A

Arthritis in the big toe joint. Completely ankylosis. Usually idiopathic— no specific trauma. Pain and stiffness in big toe developing more and more.

Bunion and HR are unrelated— having a bunion doesn’t give you arthritis. But they can happen at the same time

36
Q

T/f bunions cause arthritis

A

FALSE. Bunion and HR are unrelated— having a bunion doesn’t give you arthritis. But they can happen at the same time

37
Q

is this a bunion?

A

no. this is hallux rigidus. Instead of having a lateral swelling like bunions, it’s medial dorsal eminence swelling. Osteophytes develop on phaylynx.

38
Q

first line modifications of halluz rigiditus.

What type of footwear modifications?

A
39
Q

surgery options of hallux rigiditus

A
40
Q
A

PES PLANOVALGUS

flat feet. Just because someone has flatfeet, that doesn’t
mean they have problems or need corrective
orthotics to help them

41
Q

Just because someone has flatfeet, that doesn’t
mean they have problems or need corrective
orthotics to help them. When do you need to intervene?

A
  1. pain in pediatric patients. pediatric stiff flat feet.
  2. adults who had normal feet and now they are flat (fallen arches.
42
Q

what are the stabilizers of the plantaris?

A

tibilis posterior tendon

  • triple joint complexx (subtalar, TN, and CC joints)
  • spring ligament, deltoid ligament, and the plantar fascia.
43
Q

T/F the tibialis posterior tendon dysfunction can cause a falling arch.

A

false. it is the result of a falling arch/adult flat feet but not the cause. the static stabilizers FAIL before dynamic stabilizers.

44
Q
A
45
Q

why is it important to get physio for AAFD

A

because it’s progressive. Generally a progressive condition which goes from a
mild medial pain and swelling (often incorrectly
called a “medial ankle sprain” by the ill-informed), to
a flexible flatting of the foot, to a stiff flattening of the
foot

46
Q

treatment for AAFD

A
47
Q

What is the most commonly torn ligament with an “ankle sprain”

A

ATFL and CFL

48
Q

how do you damage your ATFL

A

ankle eversion

49
Q

What is not a stabilizer of the medial arch?

  • Tibialis Posterior Tendon
  • Spring Ligament
  • Plantar Fascia
  • Tibialis Anterior Tendon
A

tibialis anterior tendon

50
Q

TRUE or FALSE: a bunion is defined as a bone growth off of the medial metatarsal head

  • TRUE
  • FALSE

• Regardless, I don’t care because I can’t fit into my
favourite pair of Manolo heels

A

False. it’s a primary medial deviation of the metatarsal

51
Q
A

MDCN 360: Course 2 (70 decks)

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