Foot Flashcards
the excessive eversion or inversion of the ankle exceeding the strength of the ligament that stabilizes it
ankle sprain
maneuvers that help the diagnosis of ankle srain
anterior drawer test, talar tilt test
ankle sprain grading
I overstretching of the fibers of supporting ligament
II partial tear of the ligament
III complete tear of the ligament
t/f all ankle sprains need radiographic exams
false!! check ottawa rules
ottawa rules for ankle xray
pain at the malleolar zone and:
- bone tenderness at posterior edge or tip of lateral malleolus,
- bone tenderness at post edge or tip of medial malleolus,
- inability to bear weight immediately/er
ottawa rules for foot xray
- pain in the midfoot zone and:
- bone tenderness at base of 5th metatarsal
- bone tenderness at navicular
- inability to bear weight immediately/er
conservative treatment for ankle sprains
- immobilization with brace or case
- aggressive rehabilitation: for mobility and proprioception around joints
other treatment options for ankle sprains
- best for displaced fractures: reduction and fixation using plates and screws
what is a hallux valgus (bunion)
- excessive valgus angulation of first metatarsophalangeal joint
- cc: cosmetically unappealing appearance (no pain)
- more severe valgus angulation = severe pain and dysfunction
management of hallux valgus
- shoes with wide toe box
- toe separators to align
- distal osteotomy
- proximal osteotomy
what is plantar fasciitis
- inflammation of plantar fascia
- pain around heel area
etiology of plantar fasciitis
- joint bursae around achilles tendon
- origin of plantar fascia
- heel fat pad
- bone spurs at heel = direct trauma
treatment for plantar fasciitis
- short term: pain medication and anti-inflammatory drugs
- long term: stretching of achilles tendon and plantar fascia
- orthotic devices (heel cups)
changes in flatfeet
- heel: valgus, ext rot, plantar flexion
- talus: abducted, plantaflexed
- forefoot: supinated
- navicular: subluxation
net effect: decrease in height of plantar arch = less efficient
most common cause for flatfeet
- generalized ligamentous laxity !!
- cerebral palsy
- marfan’s syndrome
- other neuro/endo disorders
distribution of weight in normal vs flatfoot
- normal: heel 61% ball of foot 35% midfoot 4%
- flatfoot: no weight bearing or contact at heel, midfoot 17-30%
management of flatfoot
- arch support: shifts weightbearing area but does not correct
- surgery not indicated in growing child
- surgery for symptomatic adolescents near maturity and failure of conservative management
natural history of flatfeet
- growth = ligaments become stronger and tighten
- ligaments pull on bones and restore arch as child matures
management for flexible flatfeet with tight ta
- nonpainful: family and patient education
- painful: ta stretching/serial casting
epidemiology of clubfeet
- male > female
- 80% idiopathic but watch out for neural tube defects, hip dislocation, other joint problems
presentation of clubfeet
- heel in equinus
- navicular and tarsals in varus
- forefoot is adducted
management of clubfeet in children
- toc: ponseti method (serial casts)
- heel cord tenetomy
- denis-browne shoes/splints (wear for 23 hours/day until ambulation, maintenance until 3 yo)
t/f clubfeet will never look normal even after treatment
true
management of clubfeet in adults
- no treatment: child will walk with deformity
- weight bearing on dorsal or lateral side of foot
- tx: bone reshaping
