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Emergency learning modules > Foot > Flashcards

Foot Flashcards

1
Q

What group of patients are predisposed to foot fractures and why?

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2
Q

What medications may predispose patients to fractures and why

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3
Q

What medical conditions may predispose patients to present with foot injuries?

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4
Q

What is the importance of determining if there are any associated injuries?

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5
Q

What are the most common mechanisms of injury for acute foot fractures?

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6
Q

What is the relevance/importance of establishing of the mechanism of injury for acute foot injuries?

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7
Q

What is the significance of a foot injury sustained from a fall from a height > 1m?

A

Increased risk of sustaining fracture (eg calcaneal fracture)

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8
Q

What mechanisms would suggest clearing other regions of the body?

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9
Q

What is the relevance of establishing any sensations felt at the time of injury (pop, crack)?

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10
Q

What is the relevance of determining the type of activity which led to the foot injury?

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11
Q

What is the relevance of determining the patient’s ability to weight bear at the time of injury?

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12
Q

What is the relevance of determining the neurovascular status of the foot?

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13
Q

What key information is important to assess for red flags?

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14
Q

What key information is important to determine in the setting of chronic foot pain?

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15
Q

What key information is important to determine in the setting of atraumatic foot pain?

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16
Q

What key information of medical history is important for patient’s presenting with foot pain/history?

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17
Q

What key areas of social history are important for patients presenting with foot pain/injury?

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18
Q

What is the relevance of determining any intervention to date?

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19
Q

What is the relevance of determining the compensable status or health insurance status of the patient?

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20
Q

What is the relevance of determining the first aid/pre hospital treatment?

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21
Q

What is the relevance of determining the last intake of food or fluids?

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22
Q

Name the nerve supply of the foot

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23
Q

Name the vascular supply of the foot

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24
Q

How would you determine the neurovascular status of the foot

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25
Q

Describe the relevance of any local skin changes/open wounds to the foot

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26
Q

Describe what your assessment should include if the mechanism was a fall from a height >1m>

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27
Q

Describe what your assessment should include if you patient is a diabetic?

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28
Q

What findings on assessment would warrant escalation for an immediate medical review?

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29
Q

When would you need to take vital signs?

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30
Q

When would you consider ordering an x-ray for a patient with a foot injury?

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31
Q

What other anatomical areas may you need to x-ray an acute foot injury and why?

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32
Q

What are the Ottawa Foot/ankle rules and what is the relevance of these

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33
Q

When would a CT be indicated for a patient with a foot injury?

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34
Q

When would an ultrasound be indicated for a patient with a foot injury?

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35
Q

When would pathology test be required for a patient with a foot injury?

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36
Q

Describe Bohler’s angle and its significance to calcaneal fracture

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37
Q

What type of foot condition would require the involvement of the Orthopaedic team on the day of assessment?

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38
Q

What type of foot condition would require referral to the orthopaedic team for assessment at a latera date

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39
Q

Described the management of foot injury without fracture seen on x-ray where the patient is weightbearing

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40
Q

Describe the management of foot injury without fracture seen on x-ray where the patient is non weightbearing

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41
Q

Describe the signs, symptoms and management of

Acute Lisfranc injury

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Injuries to the Lisfranc (tarsometatarsal) joint involve a spectrum of injury from the stable sprain to the complex and unstable fracture-dislocation.
The Lisfranc joint is defined by the articulations of the midfoot and metatarsals. The base of the 1-3 MT aligns with the cuneiform and 4-5th MT articulate with the cuboid bone.
Ligaments are essential in the stability of the tarsometatarsal joint.

Lisfranc fracture-dislocations generally occur after a high-energy trauma such as fall or MVA. The MOI is either direct or indiret.

The ED management include analgesics, ice, elevation and immobilisation. Even a mild sprain with normal radiographs should be kept NWB until further evaluation due to the potential for disability. Fracture-dislocations almost always require operative repair.
The orthopaedic surgeon may consider nonoperative management for Lisfranc joint sprains with NWB and short-leg cast for 6 weeks.

42
Q

Describe the signs, symptoms and management of

Chronic Lisfranc injury

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43
Q

Describe the signs, symptoms and management of

Turf toe injury

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44
Q

Describe the signs, symptoms and management of

Acute Achilles tendon rupture

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45
Q

Describe the signs, symptoms and management of

Acute calf tear. What other medical conditions may mimic an acute calf tear?

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46
Q

Describe the signs, symptoms and management of

Acute navicular fracture

A

The most common midfoot fracture is the navicular fracture. Of navicular fractures, the dorsal avulsion factures is the most frequent followed by tuberosity fractures and navicular body fracture.

Dorsal avulsion fracture usually result from acute PF and inversion. The talonavicular joint capsule is stressed and avulses the proximal dorsal aspect of the navicular.
Tuberosity fractures are also avulsion fractures which occurs following forceful eversion which increases tension on the tibialis posterior tendon.

47
Q

Describe the signs, symptoms and management of

Navicular stress fracture

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48
Q

Describe the signs, symptoms and management of

Cuboid fracutre

A

Cuboid and cuneiform fractures usually occur in combination. Isolated injuries are uncommon and the clinician should consider the possibility of injury to the Lisfranc joint in any patient with these injuries.

cuboid and cuneiform fractures are the result of direct crush injuries to the foot. The patient will present with pain, swelling, tenderness over the involved area. Midfoot motion will exacerbate the pain. Dislocations presents with a palpable deformity and severe pain.

Definitive treatment on nondisplaced cuboid or cuneiform fractures consists of a short leg cast (NWB) for 6-8 weeks. After cast removal, a longitudinal arch supports is used for 5-6 months. Displaced fractures require operative fixation.

49
Q

Describe the signs, symptoms and management of

Undisplaced metatarsal fractures

A

MT fractures are classified on the basis of anatomy

  1. First MT
  2. Central (2-4th) MT
  3. 5th MT

The majority of MT fractures are the result of a direct crush injury. An indirect twisting mechanism can also cause these fractures.

The 1st MT # usually present w pain, swelling, tenderness localised over the dorsal and medial part of the foot. Axial compression along the 1st MT will exacerbate the pain. 1st MT # require ice, elevation, analgesics and immobilisation w the MTPJ kept in neutral position. Nondisplaced # remain in cast for 4-6 weeks while displaced neck # require ORIF.

The ED management of central MT # includes elevation, ice and analgesics. Isolated MT # are usually nondisplaced because of the stabilising effect of the adjacent MTs. nondisplaced # generally heal well and treated with hard-sole shoe. Displaced (>3mm) or angulated (>10degrees) MT # require closed reduction.
Open reduction is more common when multiple MTs are fractured because the stabilising effect of the adjacent MTs is lost.

50
Q

Describe the signs, symptoms and management of

Base of 5th metatarsal fractures

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Proximal 5th MT # consist of

  1. tuberosity avulsion #
  2. Jones #
  3. Diaphyseal stress #

Tuberosity avulsion # account for 90% of fractures at the base of the 5th MT.
An acute # at the junction of diaphysis and metaphysis is termed the Jones #. These fractures involve the articular facet between the 4th and 5th MT. Jones # are unique and important to distinguish from the tuberosity # because they may disrupt the tenuous blood supply to the distal portion of the proximal fragment.

Tuberosity avulsion # (nondisplaced) require protection and WBAT. healing occurs within 4-6 weeks.
Jones # require immobilisation and NWB for 6-8 weeks.
Diaphyseal stress # require immobilisation and NWB for 6-10 weeks but upto 20 weeks of immobilisation is required in some cases.

51
Q

Describe the signs, symptoms and management of

Type 2,3,4 talar neck fracture

A

Major talus fractures are those that involve the head, neck or the central portions of the body.
Hawkins classification:
Type 1 - nondisplaced
Type 2 - displacement w subluxation or displacement of the subtalar joint
Type 3 - displacement w dislocation of the talus from subtalar and ankle joint
Type 4 - displaced from the subtalar joint with the talar head dislocated

The patient presents with pain, swelling, ecchymosis and tenderness. Patients with neck fractures with dislocation will present with the foot locked into a hyperextended position.
The ED management of a major talus fracture includes ice, elevation and immobilisation and early referral.

52
Q

Describe the signs, symptoms and management of

lateral process of the talus fracture

A

The lateral process of the talus is fractured with axial loading, DF, eversion and ER.
A posterior process fracture is often the result of extreme PF with impingement of the posterior process against the posterior tibia and calcaneous.

Patient with lateral process talus fracture will have pain and swelling over the lateral malleolus and localised tenderness just anterior and inferior to the tip of the lateral malleolus.

Lateral process fractures are treated with ice, elevation and immobilisation in a short-leg splint.

53
Q

Describe the signs, symptoms and management of

Calcaneal fracture including types of fractures, other body areas requiring consideration/clearing

A

Extra-articular calcaneous fractures are those fractures that do not involve the posterior articular surface. These fractures occur from falls, twisting injuries or avulsions from strong muscular contractions.

Anterior process fracture is an avulsion fracture secondary to abduction with the foot in PF. This position stresses the bifurcate ligament, which inserts on the calcaneous and both cuboid and navicular. Patient will complain of pain, swelling and tenderness just distal to the lateral malleolus. Management consists of ice, elevation and WBAT in CAM boot for 4-6 weeks.

Sustentaculum Tali fracture usually occur from axial compression on the heel with marked inversion of the foot The patient presents with pain, tenderness, swelling just distal to the medial malleolus and over the medial heel. The pain will be exacerbated by inversion of foot or hyperextension of big toe as this will pull on the FHL which passes beneath the sustentaculum tali. Nondisplaced fractures should be casted and NWB for 8 weeks but early ortho referral is required.

Lateral calcaneal process and peroneal tubercle fractures can result from PF + inversion. Treatment is symptomatic with WBAT with a soft ankle support for 4-6 weeks

Medial calcaneal fracture is usually caused by direct blow and pain and swelling is localised to the medial heel. Treatment includes compressive soft tissue dressing and a posterior splint (WBAT). Early ortho consultation is recommended

Calcaneal tuberosity fracture is most commonly from avulsion by the insertion of the Achilles tendon as occurs during a fall or a landing on the DF foot with knee extended. The patient will present with pain, swelling and tenderness, inability to walk and weak PF. Nondisplaced fractures are treated in NWB cast with foot in slight PF for 6-8 weeks.

54
Q

Describe the signs, symptoms and management of

Describe the types of base of 5th MT fractures and their respective management regimes

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55
Q

Describe the signs, symptoms and management of

Phalangeal fracture or dislocation

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56
Q

Describe the signs, symptoms and management of

Gout in the foot/toe

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Emergency learning modules (14 decks)

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