Foot And Ankle Flashcards
How many bones, tendons, arteries, veins and nerves in the foot?
28 bones in the foot
12 tendons
2 major arteries and veins
5 nerves
Why does the foot arch?
Because Tallis sits on top of cuneiform so higher and not in contact with the ground.
Ankle joint
Tibular and fibula with Talus underneath it.
Held together with ring of ligaments.
Bones are held together by tendons
Functions of the foot?
Designed to move.
- Support body weight -shape of bones, tie inferior edges together, tie ends together, suspend arch from above.
- Propulsion (efficiently)
Adapt to different surfaces
The mortise?
Supported by lateral, medial and syndesmotic ligaments.
Fracture mechanism?
Inversion / Eversion
Medical co-morbidities of fractures?
- Diabetes (double healing time)
- Neuropathy
- Vascular disease
- Smoker
Treatment of stable ankle fractures?
Can weight bare safely
Need cast / boot only for comfort
Low rate of complications or arthritis
Treatment of unstable ankle fractures?
Need surgical stabilisation
Can be high risk surgery in complicated diabetic / poor blood supply (6% amputaion rate)
Ankle sprain?
Similar mechanism to ankle fractures by ligaments fail first
90% heal with rest and time
Those that do not cause ankle instability
What is an avulsion fracture?
Bone pulled off by tendon or ligament.
Achilles’ tendon rupture?
Largest tendon in the body
Vascular “watershed” 6cm from insertion into calcaneum
Rupture typically in 30-50yr olds “weekend warriors”
Often complain of being ‘Kicked in the back of the heal”
Thompsons test?
The patient lies face down with feet hanging off the edge of the bed. If the test is positive, there is no movement of the foot (normally plantarflexion) on squeezing the corresponding calf, signifying likely rupture of the Achilles tendon
Treatment of Achilles’ tendon rupture?
Most now treated conservatively
5-10% wound complications with surgery
12 months recovery
Re-repture rate 2-8%
90-95% function
Bunions - Halllux (toe) Valgus (deformity)
Mostly middle aged females.
Presentation:
- Don’t like look of feet
- Pain over the bump
- Difficulty with shoes.
Causes:
- Genetic factors
- Laxity
- Shoewear (but not shoewear alone)
First metatarsal has deviated medically and hallux deviated laterally.
VaLgus: deviation of the distal limb away (Leaving) from the midline.
Treatment of bunions?
Change shoes
Operation
- metatarsal osteotomy (surgical realignment of the big toe).
Recovery: Silmilar to if broken foot - Speical shoe for 6 weeks.
Hallux Rigidus?
Arthritis of the big toe
Osteoarthritis 1st MTPJ (metatarsophalangeal joint)
Presentation:
- Pain in MTPJ
- Lump over joint.
X-ray signs of arthritis?
- Loss of joint space
- Osteophytes (extra bone)
- Cysts
- Subchondral sclerosis (marble -appear whiter)
Conservative arthritis treatment?
If symptoms not bad enough or unfit for surgery
- Orthotics or aids (stick)
- Painkillers
- Activity modification
- Steroid injections
Surgical treatment for arthritis?
Replace = Arthroplasty
Fuse = Arthrodesis
Remove = Excision arthroplasty
Realign (to take weight off the joint) = osteotomy
Surgical treatment of Hallux Rigidus?
Rigid sole orthotic
1st MTP joint fusion - Gold standard
1st MTP joint replacement
Create a “fracture” instead of the joint
Stabilise the “fracture”
Allow normal bone repir to fuse the joint
Ankle arthritis?
Is usually secondary
Post traumatic 70-80%
Inflammatory 12%
Primary osteoarthritis 7%
Why less primary ankle arthritis?
Don’t really know - undergoing research.
What is the gold standard treatment for ankle arthritis?
Arthrodesis (fusion) - Because the results are very good.
Arthroplasty does give a better range of movement
BUT, bigger op and more previous complications.
