Foot and ankle Flashcards
What is a good view of talar dome?
AP view of ankle
Which view is good for mortise joint? What position is the leg in?
AP oblique view of ankle
- lower leg is in IR
What is calcaneal inclination? What is normal?
line from bottom of calcaneus to bottom of metatarsals
- normal is 20-30 deg
Pes cavus and pes planus angles
pes cavus - > 50 deg calcaneal inclination
pes planus - < 20 deg calcaneal inclination
What is tarsal coalition? What view can this be seen in?
unions of bones in foot that are not normal
- seen in lateral view of the ankle
Ottawa Ankle and Foot Rules
Ankle
- bone tenderness at posterior edge or tip of lateral malleolus OR
- bone tenderness at posterior edge or tip of medial malleolus OR
- inability to bear weight both immediately and in ED for 4 steps
Foot
- bone tenderness at base of 5th metatarsal OR
- bone tenderness at navicular OR
- inability to bear weight both immediately and in ED for 4 steps
1st imaging study for suspected stress (fatigue) including sacrum, excluding vertebrae
x-ray
Next imaging study for suspected stress (fatigue) fx, excluding hip and vertebrae, negative radiographs
- repeat x-ray in 10-14 days
- MRI
What is a fatigue fx?
abnormal stress to normal bone
Next imaging study for suspected stress (fatigue) fx, hip (non-lower leg), negative radiographs
MRI
Next imaging study for suspected stress (fatigue) fx, excluding vertebrae, negative radiographs, immediate “need-to-know” diagnosis
MRI
Follow-up imaging study for return to play eval for confirmed stress (fatigue) fracture, excluding vertebrae
MRI
What is an insufficiency fx?
normal stress to abnormal bone
Initial imaging for suspected stress (insufficiency) fx of lower extremity, excluding pelvis and hip
x-ray lower extremity area of interest
Next imaging study for suspected stress (insufficiency) fx of lower extremity, excluding pelvis and hip, negative radiographs
- MRI
- x-ray repeat in 10-14 days
Initial imaging of suspected stress (insufficiency) fx, pelvis or hip (non-lower leg)
x-ray
Next imaging study of suspected stress (insufficiency) fx, pelvis or hip (non-lower leg), negative radiographs
- MRI
- CT
Acute trauma to ankle - initial imaging for adult or child >/= 5 y/o w/ acute trauma to ankle w/ persistent pain for more than 1 week but less than 3 weeks, meet Ottawa Ankle rules (no exclusionary criteria)
radiography
Acute trauma to ankle - initial imaging for adult or child >/= 5 y/o w/ acute trauma to ankle, negative Ottawa Ankle Rules (no exclusionary criteria present)
no imaging recommended
Acute trauma to ankle - initial imaging for adult or child >/= 5 y/o w/ acute trauma to ankle, Ottawa Ankle Rules negative, not neurological intact
radiography
acute trauma to the foot - initial imaging for adult or child >/= 5 y/o w/ acute trauma to foot, negative Ottawa Rules, no suspected abnormalities in regions not evaluated by Ottawa Rules
no imaging recommended
acute trauma to the foot - initial imaging for adult or child >/= 5 y/o w/ acute trauma to foot, positive Ottawa Rules
- radiography foot
- radiography foot w/ weightbearing
acute trauma to the foot - initial imaging for adult or child >/= 5 y/o w/ acute trauma to foot, negative Ottawa Ankle Rules, suspected pathology to area not addressed by Ottawa Rules (not involving the midfoot; metatarsal-phalangeal joint, metatarsal, toe, tendon, etc)
- radiography foot
- radiography foot w/ weightbearing
chronic ankle pain - initial imaging
x-ray ankle
chronic ankle pain - next study, chronic ankle pain, ankle radiographs normal, suspected osteochondral lesion
MRI
What injury is there concern for talar dome osteochondral lesion that is not traumatic?
inversion ankle sprain
chronic ankle pain - next study, chronic ankle pain, ankle radiographs normal or nonspecific, suspected tendon abnormality
- MRI
- US
chronic ankle pain - next study, chronic ankle pain, ankle radiographs normal, pain of uncertain etiology
MRI
chronic foot pain - initial imaging, unknown etiology
radiography foot
chronic foot pain - next imaging study, chronic plantar heel pain, radiographs negative or equivocal, clinical concern includes plantar fasciitis or plantar fascia tear
- US foot
- MRI foot