Foot and ankle Flashcards
Ottawa ankle rules
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
Ottawa foot rules
Pain in midfoot zone
AND
-bone pain in base of 5th MT or navicular
AND/OR
-can’t bear weight immediately and in clinic
standard and stress views of the ankle
AP
AP oblique (mortise view)
Lateral
Oblique
inversion stress
eversion stress
standard and stress views of the foot
AP
oblique
lateral
AP view of the ankle is good for:
- distal tib and fib
- medial and lateral malleoli
Notice:
- lateral tibia superimposed over fibula
- parallel talar dome and distal tib
AP ankle view outline
- distal tibia
- distal fibula
- talar dome
AP oblique (mortise view) is good for:
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
mortise view outline
- distal tibia
- distal fibula
- talar dome
- mortise width and constancy of width
lateral view of the ankle good for:
pt position: ankle should be close to neutral (medial side up)
- anterior and posterior tibia
- positions of hindfoot and mid foot
lateral ankle view outline
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
oblique view of the ankle is good for:
pt position: IR ~45 deg
- distal fibula
- lateral malleolus
- distal tibiofibular joint
- talofibular joint
oblique view of ankle outline
- fibula and tibia
- lateral malleolus
- talar dome
- distal tibiofibular joint
AP view of the foot good for:
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)
AP foot view outline
phalanges metatarsals midfoot 1-2 intermetatarsal angle hallux valgus angle chopart joint lisfranc joint
hallux valgus
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
oblique view of the foot
- non WBing
- lateral foot lifted ~45 deg
- notice less superimposition of tarsals and metatarsals
- first and second cuneiform are superimposed
oblique foot view outline
1-5 metatarsals
- head, shaft, base of 1st
- tuberosity of 5th
1-5 prox phalanges
sesamoid bones
cuboid and 3rd cuneiform
navicular, talus, calcaneus
lateral view of the foot
- weightbearing (for longitudinal arch measures)
- non WBing (trauma)
- usually neutral position
lateral foot view outline
distal tibia and fibula
talus, calcaneus, navicular, cuboid
subtalar, midtarsal (chopart) and tarsometatarsal (lisfranc) joints
lateral view of the foot- lines and angles
***important to know if the foot is loaded or not Boehler angle (calcaneal fx)
talometatarsal angle
calcaneal inclination
Boehler angle (calcaneal fx)
line joining anterior and posterior calcaneal facets
line posterior facet and superior posterior process
normal= 25-40 deg
Talometatarsal angle
line bisecting the 1st MT
line bisecting the talus
normal= 0-10 deg
calcaneal inclination
line joining inferior limit of distal calcaneal facet and inferior distal tuberosity
plane of support
normal= 20-30
inversion or eversion stress view
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
sesamoid view
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
malleolar fractures
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)
calcaneal fractures
Boehler Angle
usually fall from height
most fractured bone in the foot!
Boehler angle
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
talar fractures
second most fractured bone in the foot
neck fractures most common
high incidence of: AVN, subtalar and ankle DJD
adult acquired flatfoot
most common:
- women, 45-65 y/o
- diabetes, Seroneg arthropathies, overweigh, smoking?
many theories, but most common involves PTT
posterior tibialis dysfunction/rupture
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
stage I adult acquired flatfoot
painful synovitis of PTT, tender to palpation
tendon length and function maintained, strength can be 5/5
stage II adult acquired flatfoot
progressive tendon dysfunction
weakness and tendon lengthening
flexible flatfoot develops
stage III adult acquired flatfoot
deformity becomes rigid
stiff/arthrosis
rigid flatfoot= loss of arch even when NWBing, not a laxity
stage IV adult acquired flatfoot
tibiotalar valgus
arthritic changes progress
rigid flatfoot
loss of medial arch even if they are NWBing, not a laxity
flexible flatfoot
loss of medial arch only when WBing
adult acquired flatfoot conservative treatment
stages I and II
- orthosis
- inflammation reduction
- stretching
- high rep PF training
adult acquired flatfoot surgical treatment
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
arthrodesis
often done:
- to correct hyperpronation/painful flexible flatfoot
- severe subtalar DJD
- trauma
talonavicular
calcaneal cuboid
subtalar
