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Diagnostic Imaging 2 > Foot and ankle > Flashcards

Foot and ankle Flashcards

1
Q

Ottawa ankle rules

A

Pain in malleolar zone
AND

-bone pain in posterior edge or tip of med or lat malleolus
AND/OR
-can’t bear weight immediately and in clinic

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2
Q

Ottawa foot rules

A

Pain in midfoot zone
AND

-bone pain in base of 5th MT or navicular
AND/OR
-can’t bear weight immediately and in clinic

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3
Q

standard and stress views of the ankle

A

AP
AP oblique (mortise view)
Lateral
Oblique

inversion stress
eversion stress

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4
Q

standard and stress views of the foot

A

AP
oblique
lateral

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5
Q

AP view of the ankle is good for:

A
  • distal tib and fib
  • medial and lateral malleoli

Notice:

  • lateral tibia superimposed over fibula
  • parallel talar dome and distal tib
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6
Q

AP ankle view outline

A
  • distal tibia
  • distal fibula
  • talar dome
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7
Q

AP oblique (mortise view) is good for:

A

pt position: shank is IR ~15-20 deg

  • mortise
  • mortise width is normally 3-4 mm
  • angulations or translations of talus in mortise
  • minimal superimposition of lateral tibia and fibula
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8
Q

mortise view outline

A
  • distal tibia
  • distal fibula
  • talar dome
  • mortise width and constancy of width
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9
Q

lateral view of the ankle good for:

A

pt position: ankle should be close to neutral (medial side up)

  • anterior and posterior tibia
  • positions of hindfoot and mid foot
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10
Q

lateral ankle view outline

A

distal tibia

  • anterior tubercle
  • posterior malleolus

distal fibula

calcaneus
talus
navicular
3 cuneiforms
cuboid

tasral sinus

tuberosity of the 5th MT
sesamoid bones of the 1st ray

subtalar and midtarsal joints

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11
Q

oblique view of the ankle is good for:

A

pt position: IR ~45 deg

  • distal fibula
  • lateral malleolus
  • distal tibiofibular joint
  • talofibular joint
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12
Q

oblique view of ankle outline

A
  • fibula and tibia
  • lateral malleolus
  • talar dome
  • distal tibiofibular joint
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13
Q

AP view of the foot good for:

A

DORSOPLANAR view

Can be weight bearing or non

  • phalanges
  • metatarsals
  • midfoot
  • 1st MT angle
  • hallux valgus angle
  • Chopart joint (calcaneocuboid & talonavicular)
  • Lisfranc joint (tarsal and metatarsal)
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14
Q

AP foot view outline

A 
phalanges
metatarsals
midfoot
1-2 intermetatarsal angle
hallux valgus angle
chopart joint
lisfranc joint
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15
Q

hallux valgus

A

weight bearing AP view of foot

1-2 intermetatarsal angle
-bisection of 1st and 2nd MT

hallux valgus angle
-bisection of 1st MT and prox phalanx

mild:
1-2 IMA = 15 deg
HVA= >40 deg

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16
Q

oblique view of the foot

A
  • non WBing
  • lateral foot lifted ~45 deg
  • notice less superimposition of tarsals and metatarsals
  • first and second cuneiform are superimposed
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17
Q

oblique foot view outline

A

1-5 metatarsals

  • head, shaft, base of 1st
  • tuberosity of 5th

1-5 prox phalanges

sesamoid bones

cuboid and 3rd cuneiform

navicular, talus, calcaneus

18
Q

lateral view of the foot

A
  • weightbearing (for longitudinal arch measures)
  • non WBing (trauma)
  • usually neutral position
19
Q

lateral foot view outline

A

distal tibia and fibula
talus, calcaneus, navicular, cuboid
subtalar, midtarsal (chopart) and tarsometatarsal (lisfranc) joints

20
Q

lateral view of the foot- lines and angles

A 
***important to know if the foot is loaded or not
Boehler angle (calcaneal fx)

talometatarsal angle

calcaneal inclination

21
Q

Boehler angle (calcaneal fx)

A

line joining anterior and posterior calcaneal facets

line posterior facet and superior posterior process

normal= 25-40 deg

22
Q

Talometatarsal angle

A

line bisecting the 1st MT
line bisecting the talus

normal= 0-10 deg

23
Q

calcaneal inclination

A

line joining inferior limit of distal calcaneal facet and inferior distal tuberosity
plane of support

normal= 20-30

24
Q

inversion or eversion stress view

A

AP views
stress manually applied
-looking for excessive tilting of talus in mortise

abnormal= >10 deg
pt will get bone bruising, swelling on contralateral side

25
Q

sesamoid view

A

plantar dorsal view
position of sesamoids in groove

normal: ride of bone (leaving two grooves for sesamoids)

hallus valgus= medial migration of sesamoids. the worse the hallux valgus, the more stress on the EHL, EDL, FHL stress everything medially, dislocated sesamoids medially

26
Q

malleolar fractures

A

UNI-MALLEOLAR FX: either med or lat

BI-MALLEOLAR FX: both med and lat

TRI-MALLEOLAR FX: med, lat and posterior tibial rim (only seen in a lateral view-posterior edge of tibial rim)

27
Q

calcaneal fractures

A

Boehler Angle

usually fall from height

most fractured bone in the foot!

28
Q

Boehler angle

A

used to evaluate the angular relationship of the talus and calcaneus in the presence of trauma

normal= 25-40 degrees
less=calcaneal fractures

1 line from the posterior aspect of the subtalar joint to the anterior process of the calcaneus
2nd line drawn across the posterior superior margin of the calcaneus

29
Q

talar fractures

A

second most fractured bone in the foot

neck fractures most common

high incidence of: AVN, subtalar and ankle DJD

30
Q

adult acquired flatfoot

A

most common:

  • women, 45-65 y/o
  • diabetes, Seroneg arthropathies, overweigh, smoking?

many theories, but most common involves PTT

31
Q

posterior tibialis dysfunction/rupture

A

lacking supination at Tst, PSw

loss of dynamic control of medial longitudinal arch

prolonged excessive, uncontrolled pronation eventually stretches static stabilizers

PTT: goes through some dysfunction and could actually rupture

tenosynovitis: only when it develops a tendon sheath bc it goes around a bony protuberance

32
Q

stage I adult acquired flatfoot

A

painful synovitis of PTT, tender to palpation

tendon length and function maintained, strength can be 5/5

33
Q

stage II adult acquired flatfoot

A

progressive tendon dysfunction

weakness and tendon lengthening

flexible flatfoot develops

34
Q

stage III adult acquired flatfoot

A

deformity becomes rigid

stiff/arthrosis

rigid flatfoot= loss of arch even when NWBing, not a laxity

35
Q

stage IV adult acquired flatfoot

A

tibiotalar valgus

arthritic changes progress

36
Q

rigid flatfoot

A

loss of medial arch even if they are NWBing, not a laxity

37
Q

flexible flatfoot

A

loss of medial arch only when WBing

38
Q

adult acquired flatfoot conservative treatment

A

stages I and II

  • orthosis
  • inflammation reduction
  • stretching
  • high rep PF training
39
Q

adult acquired flatfoot surgical treatment

A

transfer of FDL to navicula ( think about balance of toe flex/ext)

implant plug to limit subtalar eversion (subtalar arthroeisis)

calcaneal osteotomy
-make PF invert during late stance
osteotomy= rotational- long bone- cut through, rotate it and then fix it

arthrodesis

40
Q

arthrodesis

A

often done:

  • to correct hyperpronation/painful flexible flatfoot
  • severe subtalar DJD
  • trauma

talonavicular
calcaneal cuboid
subtalar

Diagnostic Imaging 2 (6 decks)

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