Conditions Of The Leg, Ankle + Foot Flashcards
1
Q
What is compartment syndrome?
A
A condition resulting from increased pressure within a closed fascial compartment that compromises the neurovascular bundle
2
Q
Causes of compartment syndrome
A
- Trauma
- Long bone fracture
- Can lead to oedema + haemorrhage > increases pressures
3
Q
Treatment of compartment syndrome
A
Fasciotomy
4
Q
Signs and symptoms of compartment syndrome
A
6 Ps
Pain
Paraesthesia
Pulselessness
Perishingly cold
Pallor
Paralysis
5
Q
Operative complications of compartment syndrome
A
Poor surgical technique
Necrotic tissue
Nerve + vascular injury
6
Q
Post-operative complication of compartment syndrome
A
Infection
Inability to close
Treatment failure
7
Q
Short term consequences of inadequate treatment of compartment syndrome
A
- decreased blood supply > ischaemia
- ischaemic muscles release mediators >
^ capillary permeability > further ^ in pressure - nerves die within minutes of O2 loss
- acute kidney injury due to Rhabdomyolysis (ischaemia > muscle death > myoglobin)
8
Q
Long term consequences of inadequate treatment of compartment syndrome
A
- necrotic muscle undergoes fibrosis causing Volkman’s ischaemic contraction
- acute kidney failure > chronic
9
Q
Fracture defintion
A
Discontinuation in cortex of bone
10
Q
Open/compound fracture
A
Fracture with break in skin
11
Q
Bimalleolus fracture meaning
A
Both medial + later malleoli are fractured
12
Q
Trimalleolar fracture meaning
A
Medial, lateral + posterior malleolus fractured
13
Q
Cause of bi/trimalleolar fractures
A
High energy trauma
14
Q
What is a stable fracture?
A
Undisplaced fracture
15
Q
Treatment of stable fracture
A
Fibreglass cast
Aircast boot
16
Q
What is an unstable fracture?
A
Displaced + loss of bone
17
Q
Treatment of unstable fracture
A
Surgical stabilisation
Realignment
18
Q
Avulsion fracture meaning
A
Bone breaks due to excessive tension through the inserting tendon
19
Q
Common cause of 5th metatarsal fracture
A
Stepping on curb
Climbing steps
20
Q
What muscle inserts into the 5th metatarsal?
A
Peroneus brevis
21
Q
What do you need to look out for in children’s x rays from 5t metatarsal fracture?
A
The 5th metatarsal is unfused
Looks like a fracture
22
Q
What causes significant tension during forced inversion of the foot?
A
Peroneus brevis
Plantar aponeurosis
Both insert into 5th metatarsal
23
Q
Ankle sprain meaning
A
Partial or complete tear of one or more ligament in ankle
24
Q
What type of sprain is cause by forced eversion?
A
Medial ligament sprain
25
What type of sprain is cause by forced inversion?
Lateral ligament sprain
26
What ligament is most at risk of tearing in forced inversion?
Anterior talofibular ligament
27
Risks factors of sprains
- Weak muscles/tendons across ankle joint
- Weak or lax ligaments
- Uneven surfaces
- Inadequates heel support
- High heels
- Slow response to off balance
28
Treatment of sprains
90% heal with rest
Some requires surgery
29
Cause of sprains
Excessive strain on ligaments
- over inversion
- over eversion
- excessive external rotation
30
What is the most common mechanism of injury in ankle sprains?
Inversion injury
Effects plantarflexed + weight bearing foot
31
Hallux meaning
Great toe
32
Joint subluxation meaning
Partial dislocation
33
Describe hallux valgus
**M**edial deviation of 1st **M**etatarsal
Lateral deviation of proximal phalanx
34
Risk factors of hallux vagus
Female
>65 years old
Connective tissue disorders
Hyper mobility syndrome
35
Management of hallux valgus
Supportive footwear
Analgesia
Surgical correction - not for aesthetic reasons
36
What is analgesia?
Medication that acts to relieve pain
37
Tendiopathy meaning
Repetitive action causing micro tears in the tendon
38
Rupture meaning
Complete loss of attachment
39
Rupture site of achille’s tendon
Vascular watershed
Proximal to insertion of calcaneal tubercle
40
Why is the vascular watershed the rupture site in the Achilles tendon?
Area of decreased thickness and vascularity
41
Risk factors in Achilles rupture
Trauma
Poor footwear
Obesity
Drug induced
Sudden increase in exercise
42
Diagnosis of Achille’s tendon rupture or tendiopathy
Simmons test
Ultrasound
MRI scan
43
Describe the Simmond’s test
Squeeze calf
Foor plantarflexes - intact
No movement - ruptured
44
Treatment of Achilles tendon rupture
Analgesia
Physiotheraphy
Surgical fixation - difficult
Aircast boot
45
Why is surgical fixation of Achilles tendon rupture difficult?
Two ends fray so reconstruction is difficult
46
Mechanism of injury of Achilles tendon rupture
- Forceful push off with extended knee
- Fall with foot outstretched in front + ankle dorsiflexed > tendon forcibly overstretched
- Falling from height
- Abruptly stepping into hole/off curb
47
paraesthesia meaning
pins and needles
48
what causes Volkman’s ischaemic contraction?
inadequate treatment of compartment syndrome
49
Signs and symptoms of Achilles’ tendon rupture
Sudden serve pain at back of ankle
Loud pop or snap sound
Palpable gap/depression in tendon
Initial pain + swelling > bruising
Inability to stand on tip toes
Inability to push off when walking
50
Types of toe deformities
Claw toe
Mallet toe
Hammer toe
Curly toe
51
What toes are effected in claw toe?
Often all 4 small toes at once
52
How are joints effected in claw toe?
Hyperextension at MTPJ
Flexed at PIP
53
MTPJ meaning
Metatarsophalangeal joint
54
PIP meaning
Proximal interphalangeal joint
55
DIP meaning
Distal interphalangeal joint
56
What does claw toe result from?
Muscle imbalance
Causes ligament + tendon tightness
Due to neurological damage
57
What conditions can claw toe be secondary to?
Cerebral palsy
Stroke
Diabetes
Alcohol dependence
Rheumatoid arthritis
Trauma
Inflammation
58
What toe does hammer toe often effect?
2nd toe
59
What toe does mallet toe often effect?
2nd toe
60
What toe does curly toe often effect?
3rd + 5th digits
61
How are joints effected in hammer toe?
Flexed at PIP
62
How are joints effected in mallet toe?
Flexed at DIP
63
Causes of hammer and mallet toe
- Pressure from hallux valgus
- Ill fitting shoes > tight = constant flexed position > muscle contract + shorten > inability to extend
64
Cause of curly toe
Congenital
Flexor digitorum longus tendon is too tight
65
Treatment of curly toe
Stretching of flexor tendons
Passive toe extension
66
Is surgery needed in curly toe?
Only if pain on activity
For 6+ years
67
What age group are avulsion fractures more common in?
Teenagers
68
Explain how a long term consequence of compartment syndrome is Volkmann’s ischaemic contracture
- compartment pressure increase >> compartment syndrome
- due to lack of O2, muscles undergo infarction
- in repair, muscle tissues are replaced by scar tissue through fibrosis
- myofibroblasts in fibrosis contract
- flexion contracture
69
What joints are most commonly effected in osteoarthritis of the foot?
1st MTPJ
Mid foot -TMTJ - tarsometatarsal joints
70
Complications of osteoarthritis in MTPJ
Hallux rigidis
Hallux valgus
Ligament weakness
Corns + calluses
71
Complications of osteoarthritis in midfoot
Arch collapse
72
What joints are affected in osteoarthritis of the ankle?
Talocrural joint
Subtalar joint
73
Management of osteoarthritis in the foot + ankle
NSAIDs
Support brace
Surgery
74
Types of tendiopathy and their sites
**Insertional tendiopathy** - at point of insertion into calcaneum
**Non-insertional tendiopathy** - at vascular watershed area
75
Risk factors Achilles tendiopathy
Many years of overuse
Inactivity
Diabetes
Obesity
76
Signs + symptoms of Achilles tendiopathy
Pain + stiffness in morning
Pain that worsen with activity > severe 24hrs after
Thick tendon
Swelling
Palpable bone spur
77
What happens in flat foot?
Collapsed medial arch
Valgus angulation of hind foot { }
78
Who is flat foot normal in and why?
Young children
Arches haven’t developed yet
Medial arch forms ~ 5 years
79
When is flat foot abnormal?
Persists into adolescence
Occurs during or after adolescence
80
Describe flexible flat foot
- no medial arch when standing normally
- medial arch appears when standing on tiptoes + valgus hind foot disappears
81
Describe rigid flat foot
No medial arch
Valgus hind foot
Regardless of how patient is standing
Due to tarsal coalition
82
What is tarsal coalition?
Failure of tarsal bones to separate
83
Describe adults acquired flat foot
Dysfunction of Tibialis posterior tendon
Causes stretching of spring ligament and plantar aponeurosis >> flat medial arch
84
Risk factors for adult acquired flat foot
Obesity
Hypertension
Diabetes
Pregnancy - temporarily due to lax ligaments
85
How can diabetes effect feet?
Foot ulcers
Severe infection
Charot arthropathy
86
How does diabetes cause feet issues?
- **loss of sensation** due to **peripheral neuropathy**
- **ischaemia** due to **peripheral arterial + micro vascular disease**
- **immunosuppression** due to **poor glycaemic control**
Loss of protective sensation >> patients continue to weight bear on soft tissue abnormalities
87
What is used to decrease the risk of feet issues causes by diabetes?
**Diabetic foot clinics** for screening
- sensation + perfusion assessed
- correct shoes
- education - glycaemic control
- callouses + corns
- cracks + dry skin
88
What is charot foot?
Progressive destruction of bones + soft tissue of foot
89
How does charot foot happen?
Severe diabetic foot
90
Characterisations of charot foot
Multiple:
- joint dislocations
- fractures
- deformities
91
Presentation of charot foot
Pain?
Swelling
Loss of sensation
Loss of joint function
Instability
92
Treatment of charot foot
**Treat underlying condition** - diabetes > correct glycaemic control
**Support deformity**
93
What is hallux rigidus?
Osteoarthritis in 1st MTPJ >> stiffness of joint
94
Signs and symptoms of hallux rigidus
Pain in 1st MTPJ on walking and dorsiflexion of toe
Walking on outside of foot
Restricted dorsiflexion
Dorsal bunion
95
Surgical management of osteoarthritis
**Arthrodesis** - joint fusion
**Athroplasty** - joint replacement
**Excision athroplasty** - surgical removal of joint with interposition of soft tissue *e.g. rolled up tendon*
**Osteotomy** - surgical cutting of bone to allow realignment
96
What is arthroplasty?
Joint replacement
97
What is arthrodesis?
Joint fusion
98
What is excision arthroplasty?
Removal of a joint with interposition of soft tissue
*e.g. rolled up tendon**
99
What is osteotomy?
Surgical cutting of a bone to allow realignment
100
Classification of ankle (fibula) fracture
_**weber’s classification**_
- **type A**: below the syndesmosis
- **type B**: at the level of the syndesmosis
- **type C**: above the syndesmosis
101
