Foot and ankle Flashcards
Compartment syndrome
What is it?
What are the symptoms and signs?
What is the treatment?
What are the short term consequences?
What are the long term consequence?
- Trauma to fascial compartment which lead to haemorrhage, oedema and can cause rise in intracompartmental pressure
- severe pain, not releived by analgesia, exacerbated by passive stretch of muscle
- surgical decompression
- Rhambdomyolysis (inc. in intracompartmental pressure > dec. in perfusion of muscles ischaemia > necrosis), distal paraesthesia, loss of motos function
- acute kidney injury, volkmann’s ischaemia contracture
Ankle fracture
What causes it?
What co morebidities affect the wound healing?
What is an open ankle-fractrue?
What is the treatment for open ankle frcture?
- inversion or eversion injury
- DM, neuropathy, peripheral vascular disease
- skin is breached and there is direct exposure of fracture to external environment
- surgery, extensive irrigation and debirement
Ankle fracture
What are the ligaments associated in the ankle joint ring?
What causes talar shift ?
- Proximal part : syndesmotic ligament
- Medial side : deltoid ligament
- Inferior part : subtalar joint
- lateral side : ant. talofibular, talocalcaneal, post. talofibular
- disruption of any two ligaments unstabilise ankle mortise > talus shift medially or laterally
Sprained ankle
What is it?
What inc. risk of ankle sprains?
What is the common injury cause and which ligament will tear?
What is the common complication and why?
What can the 5th metatarsal fracture be mistaken for?
- partial or complete tear of one or more ankle joint ligaments
- weak fibular muscles, weak ankle ligaments, running on uneven surfaces, wearing high heeled shoes
- inversion injury - talofibular ligament
- Fifth metatarsal fracture - fibularis brevis tendon attach to tubercle on base of 5th metatarsal. Inversion injury- fibularis brevis under tension > pull of fragment of bone
- unfused 5th metatarsal apophysis in 10-16 y/o
Achilles tendon rupture
What causes it?
Where is the site of rupture at and describe it
What are the symptoms?
What is test for achilles tendon rupture and how does it work?
What is the treatment?
- forceful push-off with an extended knee, fall with foot outstretched in front
- vascular watershed area - area of decreased vascularity and thickness of tendon
- sudden and severe pain of back of ankle, palpable gap in tendon, inability to stand tiptoe
- Thompson’s test - force applied to calf muscle > contracts achilles tendon > foot plantar flex if normal, no action if rupture
- aircast boot
Hallux valgus
What is it?
What are the symptoms?
What causes it?
What is the treatment?
- Varus deviation of 1st metatarsal, Valgus deviation and lateral rotation of hallux,
- painful movement of 1st MTPJ, difficulty with footwear, bunion
- trauma, gout, RA
- metatarsal osteotomy and realignment of fragments
Hallux rigidus
What is it?
Why is 1st MTPJ prone to OA?
What are the symptoms?
What are the treatments?
- OA of 1st MTPJ
- exposed to constant stress during walking
- pain in MTPJ on walking and dorsiflexion of toe, walking on outside of foot
- activity modification, analgesia, orthotics, intra-articular steroid injections, arthrodesis of 1st MTPJ
Describe the following terms :
arthroplasty
arthrodesis
excision arthroplasty
osteotomy
- joint replacement
- joint fusion
- surgical removement of joint with interposition of soft tissue
- surgical cutting of bone fore realignment
Claw toe
What is it?
What causes it?
What causes neurological damage?
- all 4 small toes hyperextended at MTPJ and flexed at PIPJ
- neurological damage > muscle imbalance > ligaments and tendons to become unnaturally tight
- cerebral palsy, stroke, diabetes, alcohol dependance
Hammer toe & Mallet toes
What are they?
Which toe is commonly affected?
What causes them?
- Hammer toe : toe is flexed at PIPJ
Mallet toe : toe flexed at DIPJ
- second toe
- ill-fitting pointed shoes
Curly toes
Which toes are affected?
What are the causes?
What is the teratment?
- 3rd to 5th digits
- congenital, FH of curly toes, tendon of FDL too tight
- passive extension of toes and stretching of flexor tendon
Achilles tendinopathy
Is it degenerative or infalmmatory?
What are the areas where tendinopathy can develop?
What causes tendinopathy?
What are the risk factors?
What are the symptoms?
- degenerative
- point of inertion into calcaneum, vascular watershed area
- overuse ie- long distance runner
- obesity, diabetes
- pain and stiffness along achilles tendon in morning, pain after excercising, thickening of tendon
Pes planovalgus
Define it
What is it?
Why is this normal amongst young children?
What age will the medial longitudinal arch form?
What is flexible flat feet?
What is rigid flat feet?
What causes rigid flat feet?
- Pes : foot, Plano : flat, valgus : lateral angulation distally
- medial longitudinal arch collapse > medial border of foot touched ground. Valgus angulation of hindfoot
- arches not fully developed, lots of subcutaneous adipose tissue in sole of foot
- 5
- no medial arch while standing, have medial arch when standing tip toe and hindfoot returns to normal alignment
- when stand on tip toe, feet remains abnormal
- tarsal coalition
Adult acquired flatfoot
What causes it?
What is the symptom?
What are the risk factors?
Why does lateral deviation of hindfoot occur?
What are the teratments?
- dysfunction of tibialis posterior tendon
- pain behind medial malleolus
- obesity, hypertension, diabetes
- dec. support of medial arch by tibialis posterior > stretching of spring ligament > talar head displaced inferomedially
- orthotics, surgical recontruction, arthrodesis of hindfoot joints
