Foot and Ankle

Question 1

When to order x-rays in ankle injuries?

Answer 1

Ottawa ankle rules

Ankle series:
1) tenderness at posterior edge or tip of lateral malleolus
2) tenderness at posterior edge or tip of medial malleolus
3) inability to bear weight both immediately and in the ED
Foot series:
1) tenderness at 5th MT
2) tenderness at navicular
3) inability to bear weight both immediately and in the ED

Question 2

X-ray findings high ankle sprain

Answer 2

1) decreased tibiofibular overlap (<6mm on AP view and <1mortise view)
2) increased medial clear space > 4mm
3) increased tibiofibular clear space (>6mm on AP/mortise view)

Question 3

Injury mechanism Lisfranc injury

Answer 3

usually caused by indirect rotational forces and axial load through hyper-plantarflexed forefoot

Question 4

Lisfranc ligament

Answer 4

an interosseous ligament that goes from medial cuneiform to base of 2nd metatarsal on plantar surface

Question 5

Lisfranc injury

Answer 5

tarsometatarsal fracture-dislocation between the articulation of the medial cuneiform and the base of the second metatarsal

Question 6

Plantar ecchymosis should raise suspicion for

Answer 6

Lisfranc injury

Question 7

How to assess hindfoot flexibility?

Answer 7

Coleman block test

Correction of hindfoot varus implies that the deformity is driven by the forefoot.

Question 8

Jones fracture

Answer 8

metadiaphyseal fracture of the fifth metatarsal that involves the 4th-5th intermetatarsal joint

Question 9

most commonly reported pathologies that are associated with SCF include

Answer 9

lateral column overload, stress fractures, and injury to the peroneal tendons and/or the lateral ankle ligaments

Question 10

treatment of subtle cavovarus foot

Answer 10

full-length, semirigid orthosis with arch support and a lateral wedge

Question 11

First-line treatment for chronic, untreated ankle sprain

Answer 11

Proprioception and peroneal strengthening

Question 12

Function of posterior tibialis muscle

Answer 12

dynamic stabilizer of the medial longitudinal arch of the foot and the most powerful foot inverter

Question 13

Cavovarus positioning of the foot leaves the ankle susceptible to

Answer 13

inversion sprains and lateral ligament attenuation

Question 14

modified Brostrom technique

Answer 14

anatomic reconstruction of the lateral ankle ligaments (ATFL and/or CFL) and augmentation with the inferior extensor retinaculum.

Question 15

Chronic Lisfranc injury may lead to

Answer 15

Progressive pes planovalgus and midfoot arthritis

Question 16

Treatment for flexible flatfoot deformity that is refractory to bracing and therapy

Answer 16

Medializing calcaneal osteotomy with tendon transfers and lateral column lengthening

Question 17

Indication triple arthrodesis

Answer 17

Flatfoot deformity associated with a rigid hindfoot and extensive arthritic changes

Question 18

Triple arthrodesis

Answer 18

fusion of calcaneocuboid, talonavicular, and subtalar joints

Question 19

Which tendon insufficiency may manifest with weakness in heel raise?

Answer 19

Posterior tibialis tendon insufficiency

Weakness of tibialis tendon results in inability to lock the transverse tarsal joint. Locking the transverse tarsal joint creates a rigid lever arm during late stance phase of gait, increasing the mechanical advantage of the triceps surae. Failure of the posterior tibial tendon to achieve a locked transverse tarsal joint manifests with a flexible flatfoot and can cause pain and fatigue of the gastroc-soleus complex.

Question 20

Acquired pes planus deformity in adults is generally caused by posterior tibial tendon insufficiency, a vital hindfoot inverter.

As the dysfunction progresses, the ensuing deformities include the following:

Answer 20

Hindfoot valgus, midtarsal abduction and forefoot supination.
With valgus deformity of the hindfoot, the Achilles tendon insertion is located lateral to the rotation of the subtalar joint.
Loss of the longitudinal arch results in a fixed equinus deformity of the hindfoot and contracture of the Achilles tendon.
With equinus contracture, the foot is further mechanically disadvantaged and this can lead to worsening of the arch collapse which then can result in worsening equinus, causing a vicious cycle

Question 21

Which foot deformitiy may be treated with medial hindfoot posting?

Answer 21

Flexible pes planovalgus