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Orthopedics > Foot > Flashcards

Foot Flashcards

1
Q

Talar fracture mechanism

A

axial loading or hyperdorsiflexion (MVC, fall from height)

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2
Q

Most common fracture of the talus

A

Talar neck (50%)

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3
Q

Complication with talar fracture

A

tenuous blood supply runs distal to proximal along talar neck ■ high risk of AVN with displaced fractures

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4
Q

How to determine extent of AVN

A

MRI

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5
Q

Talar fracture treatment

A

• non-operative
■ indication: non-displaced
■ NWB, below-knee cast x 6 wk

• operative
■ indication: displaced
■ ORIF (high rate of nonunion, AVN)
■ neck fracture: ORIF

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6
Q

What are the components of the medial ankle ligament complex (deltoid)

A

Posterior tibiotala

Anterior tibiotalar

Tibiocalcaneal

Tibionavicular

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7
Q

What is the most common tarsal fracture

A

calcaneal

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8
Q

What needs to be r/o with calcaneal fracture

A

spine injury (fractures of thoracic or lumbar spine)

bilateral calcaneal fractures

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9
Q

Clinical features of calcaneal fracture

A
  • marked swelling, bruising on heel/sole
  • wider, shortened, flatter heel when viewed from behind
  • varus heel
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10
Q

calcaneal fracture investigations

A
  • X-rays: AP, lateral, oblique foot (mandatory views); can also assess with Broden view, Harris view, or AP ankle.
  • loss of Bohler’s angle
  • CT: gold standard, assess intra-articular extension
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11
Q

calcaneal fracture treatment

A
  • closed vs. open reduction is controversial
  • NWB cast x 3 mo with early ROM and strengthening
  • Avoid wound complications (10-25%)
  • Restore articular congruity
  • Restore normal calcaneal width and height
  • Maximum functional recovery may take longer than 12 mo
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12
Q

Achilles tendonitis mechanism

A

• chronic inflammation from activity or poor-fitting footwear • may also develop heel bumps (retrocalcaneobursitis or Haglund deformity

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13
Q

Achilles tendonitis clinical features

A
  • pain, stiffness, and crepitus with ROM

* thickened tendon, palpable bump

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14
Q

Achilles tendonitis investigations

A

• X-ray: lateral, evaluate bone spur and calcification;

U/S, MRI (to assess degenerative change)

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15
Q

Achilles tendonitis treatment

A

• non-operative
■ rest, NSAIDs, shoe wear modification (orthotics, open back shoes)
■ heel sleeves and pads are mainstay of non-operative treatment
■ gentle gastrocnemius-soleus stretching, eccentric training with physical therapy, deep tissue calf massage
■ shockwave therapy in chronic tendonitis
■ DO NOT inject steroids (risk of tendon rupture)

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16
Q

What is a Haglund Deformity

A

an enlargement of the posterior superior tuberosity of the calcaneus

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17
Q

What is the best test for MCL in the elbow

A

Moving valgus stress test

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18
Q

Achilles tendon rupture mechanism

A
  • loading activity, stop-and-go sports (e.g. squash, tennis, basketball)
  • secondary to chronic tendonitis, steroid injection
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19
Q

Achilles tendon rupture clinical features

A

audible pop, sudden pain with push-off movement

  • pain or inability to plantarflex
  • palpable gap
  • apprehensive toe off when walking
  • weak plantarflexion strength

• Thompson test: with patient prone, squeeze calf, normal response is plantar flexion
■ no passive plantarflexion s positive test = ruptured tendon

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20
Q

Achilles tendon rupture investigations

A

• X-ray (to rule out other pathology),

U/S or MRI (for partial vs. complete ruptures)

21
Q

Achilles tendon rupture treatment

A

• non-operative
■ indication: low athletic demand or elderly
■ cast foot in plantar flexion (to relax tendon) x 8-12 wk

• operative
■ indication: high athletic demand
■ surgical repair, then cast as above x 6-8 wk

22
Q

Most common site of Achilles tendon rupture

A

2-6 cm from insertion where blood supply is the poorest

23
Q

Complications of Achilles Tendon rupture

A
  • Infection
  • Sural nerve injury
  • Re-rupture: surgical repair decreases likelihood of re-rupture compared to nonoperative management
24
Q

Plantar fasciitis (heel spur syndrome) definition

A
  • inflammation of plantar aponeurosis at calcaneal origin
  • common in athletes (especially runners, dancers)
  • also associated with obesity, DM, seronegative and seropositive arthritis
25
Q

Plantar fasciitis (heel spur syndrome) mechanism

A

• repetitive strain injury causing microtears and inflammation of plantar fascia

26
Q

Plantar fasciitis (heel spur syndrome) clinical features

A
  • insidious onset of heel pain, pain when getting out of bed, and stiffness
  • intense pain when walking from rest that subsides as patient continues to walk, worse at end of day with prolonged standing
  • swelling, tenderness over sole
  • greatest at medial calcaneal tubercle and 1-2 cm distal along plantar fascia pain with toe dorsiflexion (stretches fascia)
27
Q

Plantar fasciitis (heel spur syndrome) investigations

A
  • plain radiographs to rule out fractures
  • often see bony exostoses (heel spurs) at insertion of fascia into medial calcaneal tubercle
  • spur is secondary to inflammation, not the cause of pain
28
Q

Plantar fasciitis (heel spur syndrome) treatment

A

• non-operative
■ pain control and stretching programs are first-line
■ rest, ice, NSAIDs, steroid injection
■ physiotherapy: Achilles tendon and plantar fascia stretching, extracorporeal shockwave therapy
■ orthotics with heel cup – to counteract pronation and disperse heel strike forces

• operative
■ indication: failed non-operative treatment
■ endoscopic surgical release of fascia
■ spur removal is not required

29
Q

Bunions (hallux valgus) definition

A

• bony deformity characterized by medial displacement of first metatarsal and lateral deviation of hallux

30
Q

Bunions (hallux valgus) mechanism

A
  • valgus alignment on 1st MTP (hallux valgus) causes eccentric pull of extensor and intrinsic muscles
  • many associated deformities in foot from altered mechanics
  • reactive exostosis forms with thickening of the skin, creating a bunion
  • most often associated with poor-fitting footwear (high heel and narrow toe box)
  • can be hereditary (70% have family history)
  • 10x more frequent in women
31
Q

Bunions (hallux valgus) clinical features

A
  • painful bursa over medial eminence of 1st MT head
  • pronation (rotation inward) of great toe
  • numbness over medial aspect of great toe
32
Q

Bunions (hallux valgus) investigations

A

• X-ray: standing AP/lateral/sesamoid view, NWB oblique

33
Q

Bunions (hallux valgus) treatment

A

• indications: painful corn or bunion, overriding 2nd toe

• non-operative (first-line)
■ properly fitted shoes (low heel) and toe spacer

• operative: goal is to restore normal anatomy, not cosmetic reasons alone
■ osteotomy with realignment of 1st MTP joint (Chevron Procedure)
■ arthrodesis

34
Q

Mobility of the metatarsals

A

• as with the hand, 1st, 4th, 5th MT are relatively mobile while the 2nd and 3rd are fixed

35
Q

Avulsion of base of 5th metatarsal mechanism

A

Sudden inversion followed by contraction of peroneus brevis

36
Q

Avulsion of base of 5th metatarsal clinical presentation

A

Tender base of 5th MT

37
Q

Avulsion of base of 5th metatarsal treatment

A

req ORIF if displaced

38
Q

Midshaft 5th metatarsal (Jones fracture) mechanism

A

stress injury

39
Q

Midshaft 5th metatarsal (Jones fracture) clinical

A

painful shaft of 5th MT

40
Q

Midshaft 5th metatarsal (Jones fracture) treatment

A

NWB BK cast x 6 weeks

ORIF if athlete

41
Q

Shaft 2nd, 3rd MT (March Fracture) mechanism

A

stress injury

42
Q

Shaft 2nd, 3rd MT (March Fracture) clinical

A

painful shaft of 2nd or 3rd MT

43
Q

Shaft 2nd, 3rd MT (March Fracture) treatment

A

symptomatic

44
Q

1st MT # mechanism

A

trauma

45
Q

1st MT # clinical

A

painful 1st metatarsal

46
Q

1st MT # treatment

A

ORIF if displaced otherwise NWB BK cast x 3 weeks then walking cast x 2 weeks

47
Q

Tarso-MT fracture-dislocation (Lisfranc fracture) mechanism

A

Fall onto plantar flexed foot or direct crush injury

48
Q

Tarso-MT fracture-dislocation (Lisfranc fracture) clinical

A

Shortened forefoot prominent base

49
Q

Tarso-MT fracture-dislocation (Lisfranc fracture) treatment

A

ORIF

Orthopedics (19 decks)

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