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MSK > Conditions Of The Leg, Ankle + Foot > Flashcards

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

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2
Q

Causes of compartment syndrome

A
  • Trauma
  • Long bone fracture
  • Can lead to oedema + haemorrhage > increases pressures
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3
Q

Treatment of compartment syndrome

A

Fasciotomy

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4
Q

Signs and symptoms of compartment syndrome

A

6 Ps
Pain
Paraesthesia
Pulselessness
Perishingly cold
Pallor
Paralysis

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5
Q

Operative complications of compartment syndrome

A

Poor surgical technique
Necrotic tissue
Nerve + vascular injury

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6
Q

Post-operative complication of compartment syndrome

A

Infection
Inability to close
Treatment failure

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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)
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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
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9
Q

Fracture defintion

A

Discontinuation in cortex of bone

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10
Q

Open/compound fracture

A

Fracture with break in skin

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11
Q

Bimalleolus fracture meaning

A

Both medial + later malleoli are fractured

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12
Q

Trimalleolar fracture meaning

A

Medial, lateral + posterior malleolus fractured

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13
Q

Cause of bi/trimalleolar fractures

A

High energy trauma

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14
Q

What is a stable fracture?

A

Undisplaced fracture

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15
Q

Treatment of stable fracture

A

Fibreglass cast
Aircast boot

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16
Q

What is an unstable fracture?

A

Displaced + loss of bone

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17
Q

Treatment of unstable fracture

A

Surgical stabilisation
Realignment

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18
Q

Avulsion fracture meaning

A

Bone breaks due to excessive tension through the inserting tendon

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19
Q

Common cause of 5th metatarsal fracture

A

Stepping on curb
Climbing steps

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20
Q

What muscle inserts into the 5th metatarsal?

A

Peroneus brevis

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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

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22
Q

What causes significant tension during forced inversion of the foot?

A

Peroneus brevis
Plantar aponeurosis
Both insert into 5th metatarsal

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23
Q

Ankle sprain meaning

A

Partial or complete tear of one or more ligament in ankle

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24
Q

What type of sprain is cause by forced eversion?

A

Medial ligament sprain

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25
Q

What type of sprain is cause by forced inversion?

A

Lateral ligament sprain

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26
Q

What ligament is most at risk of tearing in forced inversion?

A

Anterior talofibular ligament

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27
Q

Risks factors of sprains

A
  • Weak muscles/tendons across ankle joint
  • Weak or lax ligaments
  • Uneven surfaces
  • Inadequates heel support
  • High heels
  • Slow response to off balance
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28
Q

Treatment of sprains

A

90% heal with rest
Some requires surgery

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29
Q

Cause of sprains

A

Excessive strain on ligaments
- over inversion
- over eversion
- excessive external rotation

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30
Q

What is the most common mechanism of injury in ankle sprains?

A

Inversion injury
Effects plantarflexed + weight bearing foot

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31
Q

Hallux meaning

A

Great toe

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32
Q

Joint subluxation meaning

A

Partial dislocation

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33
Q

Describe hallux valgus

A

Medial deviation of 1st Metatarsal
Lateral deviation of proximal phalanx

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34
Q

Risk factors of hallux vagus

A

Female
>65 years old
Connective tissue disorders
Hyper mobility syndrome

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35
Q

Management of hallux valgus

A

Supportive footwear
Analgesia
Surgical correction - not for aesthetic reasons

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36
Q

What is analgesia?

A

Medication that acts to relieve pain

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37
Q

Tendiopathy meaning

A

Repetitive action causing micro tears in the tendon

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38
Q

Rupture meaning

A

Complete loss of attachment

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39
Q

Rupture site of achille’s tendon

A

Vascular watershed
Proximal to insertion of calcaneal tubercle

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40
Q

Why is the vascular watershed the rupture site in the Achilles tendon?

A

Area of decreased thickness and vascularity

41
Q

Risk factors in Achilles rupture

A

Trauma
Poor footwear
Obesity
Drug induced
Sudden increase in exercise

42
Q

Diagnosis of Achille’s tendon rupture or tendiopathy

A

Simmons test
Ultrasound
MRI scan

43
Q

Describe the Simmond’s test

A

Squeeze calf
Foor plantarflexes - intact
No movement - ruptured

44
Q

Treatment of Achilles tendon rupture

A

Analgesia
Physiotheraphy
Surgical fixation - difficult
Aircast boot

45
Q

Why is surgical fixation of Achilles tendon rupture difficult?

A

Two ends fray so reconstruction is difficult

46
Q

Mechanism of injury of Achilles tendon rupture

A
  • 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
Q

paraesthesia meaning

A

pins and needles

48
Q

what causes Volkman’s ischaemic contraction?

A

inadequate treatment of compartment syndrome

49
Q

Signs and symptoms of Achilles’ tendon rupture

A

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
Q

Types of toe deformities

A

Claw toe
Mallet toe
Hammer toe
Curly toe

51
Q

What toes are effected in claw toe?

A

Often all 4 small toes at once

52
Q

How are joints effected in claw toe?

A

Hyperextension at MTPJ
Flexed at PIP

53
Q

MTPJ meaning

A

Metatarsophalangeal joint

54
Q

PIP meaning

A

Proximal interphalangeal joint

55
Q

DIP meaning

A

Distal interphalangeal joint

56
Q

What does claw toe result from?

A

Muscle imbalance
Causes ligament + tendon tightness
Due to neurological damage

57
Q

What conditions can claw toe be secondary to?

A

Cerebral palsy
Stroke
Diabetes
Alcohol dependence
Rheumatoid arthritis
Trauma
Inflammation

58
Q

What toe does hammer toe often effect?

A

2nd toe

59
Q

What toe does mallet toe often effect?

A

2nd toe

60
Q

What toe does curly toe often effect?

A

3rd + 5th digits

61
Q

How are joints effected in hammer toe?

A

Flexed at PIP

62
Q

How are joints effected in mallet toe?

A

Flexed at DIP

63
Q

Causes of hammer and mallet toe

A
  • Pressure from hallux valgus
  • Ill fitting shoes > tight = constant flexed position > muscle contract + shorten > inability to extend
64
Q

Cause of curly toe

A

Congenital
Flexor digitorum longus tendon is too tight

65
Q

Treatment of curly toe

A

Stretching of flexor tendons
Passive toe extension

66
Q

Is surgery needed in curly toe?

A

Only if pain on activity
For 6+ years

67
Q

What age group are avulsion fractures more common in?

A

Teenagers

68
Q

Explain how a long term consequence of compartment syndrome is Volkmann’s ischaemic contracture

A
  • compartment pressure increase&raquo_space; 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
Q

What joints are most commonly effected in osteoarthritis of the foot?

A

1st MTPJ
Mid foot -TMTJ - tarsometatarsal joints

70
Q

Complications of osteoarthritis in MTPJ

A

Hallux rigidis
Hallux valgus
Ligament weakness
Corns + calluses

71
Q

Complications of osteoarthritis in midfoot

A

Arch collapse

72
Q

What joints are affected in osteoarthritis of the ankle?

A

Talocrural joint
Subtalar joint

73
Q

Management of osteoarthritis in the foot + ankle

A

NSAIDs
Support brace
Surgery

74
Q

Types of tendiopathy and their sites

A

Insertional tendiopathy - at point of insertion into calcaneum
Non-insertional tendiopathy - at vascular watershed area

75
Q

Risk factors Achilles tendiopathy

A

Many years of overuse
Inactivity
Diabetes
Obesity

76
Q

Signs + symptoms of Achilles tendiopathy

A

Pain + stiffness in morning
Pain that worsen with activity > severe 24hrs after
Thick tendon
Swelling
Palpable bone spur

77
Q

What happens in flat foot?

A

Collapsed medial arch
Valgus angulation of hind foot { }

78
Q

Who is flat foot normal in and why?

A

Young children
Arches haven’t developed yet
Medial arch forms ~ 5 years

79
Q

When is flat foot abnormal?

A

Persists into adolescence
Occurs during or after adolescence

80
Q

Describe flexible flat foot

A
  • no medial arch when standing normally
  • medial arch appears when standing on tiptoes + valgus hind foot disappears
81
Q

Describe rigid flat foot

A

No medial arch
Valgus hind foot
Regardless of how patient is standing
Due to tarsal coalition

82
Q

What is tarsal coalition?

A

Failure of tarsal bones to separate

83
Q

Describe adults acquired flat foot

A

Dysfunction of Tibialis posterior tendon
Causes stretching of spring ligament and plantar aponeurosis&raquo_space; flat medial arch

84
Q

Risk factors for adult acquired flat foot

A

Obesity
Hypertension
Diabetes
Pregnancy - temporarily due to lax ligaments

85
Q

How can diabetes effect feet?

A

Foot ulcers
Severe infection
Charot arthropathy

86
Q

How does diabetes cause feet issues?

A
  • 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&raquo_space; patients continue to weight bear on soft tissue abnormalities

87
Q

What is used to decrease the risk of feet issues causes by diabetes?

A

Diabetic foot clinics for screening
- sensation + perfusion assessed
- correct shoes
- education - glycaemic control
- callouses + corns
- cracks + dry skin

88
Q

What is charot foot?

A

Progressive destruction of bones + soft tissue of foot

89
Q

How does charot foot happen?

A

Severe diabetic foot

90
Q

Characterisations of charot foot

A

Multiple:
- joint dislocations
- fractures
- deformities

91
Q

Presentation of charot foot

A

Pain?
Swelling
Loss of sensation
Loss of joint function
Instability

92
Q

Treatment of charot foot

A

Treat underlying condition - diabetes > correct glycaemic control
Support deformity

93
Q

What is hallux rigidus?

A

Osteoarthritis in 1st MTPJ&raquo_space; stiffness of joint

94
Q

Signs and symptoms of hallux rigidus

A

Pain in 1st MTPJ on walking and dorsiflexion of toe
Walking on outside of foot
Restricted dorsiflexion
Dorsal bunion

95
Q

Surgical management of osteoarthritis

A

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
Q

What is arthroplasty?

A

Joint replacement

97
Q

What is arthrodesis?

A

Joint fusion

98
Q

What is excision arthroplasty?

A

Removal of a joint with interposition of soft tissue
*e.g. rolled up tendon**

99
Q

What is osteotomy?

A

Surgical cutting of a bone to allow realignment

MSK (25 decks)

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