Foot and Ankle Flashcards
Ottawa Ankle Rules
- Pain in malleolar zone AND
- bone pain in post edge 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 wt immediately/in clinic
Ankle standard views (4)
- AP
- AP Oblique (Mortise)
- Lateral
- Oblique
Foot Standard views (3)
- AP
- Oblique
- Lateral
AP Ankle View
- Good for: distal tib/fib, malleoli
- Notice: lateral tib superimposed over fib, parallel talar dome and distal tib
AP Mortise View
- shank internally rotated ~15-20
- Mortise width 3-4mm
- can see angulations or translations of talus in mortise (lig injury)
- minimal superimposition of lateral tib and fib
Lateral View Ankle
- done in neutral
- Good far: anterior/posterior tibia, position of midfoot and hindfoot
Oblique Ankle View
- Shank IR ~45
- Good for: distal fib, lateral malleolus, distal tib/fib jt, talofibular jt
AP Foot
- Can be WB or NWB
- Good for: phalages, MTs, midfoot, 1st MT angle, Hallux valgus angle, Chopart (calcaneocuboid and talonavicular) joint, Lisfranc (tarsometatarsal)
Hallux Valgus
- use WB AP view
- Mild: IMA 15, HVA >40
Oblique Foot
- NWB
- Lateral foot lifted ~45
- Less superimposation of tarsals/metatarsals
- First and second cuneiform are superimposed
- look for plantar curving of MT heads
Lateral Foot
- WB for long. arch measures
- NWB for trauma
- usu in neutral
Boehler angle (calcaneal fx)
- line joining midbump to front bump
- line joining midbump to back bump
- Normal 25-40
- lesser angle = fx
Calcaneal Inclination
- line along plantar foot
- line tangential to inferior surface of calcaneus
- normal 20-30
- higher values = pes cavus
Tarsometatarsal angle
- line bisecting talus
- line bisecting 1st MT
- normal 0-10
- increased angle = flat foot (talus plantarflexes)
Inversion/Eversion Stress view
Look for excessive tilting of talus in mortise
>10 = unstable
Unimalleolar fx
Either lateral or medial
Bimalleolar fx
-both med and lat
Trimalleolar fx
Medial, Lateral, and posterior tibial rim
Talar fx
- second most fx bone (1st = calcaneus)
- neck fx most common
- high incidence of AVN, subtalar/ankle DJD
Adult aquired flatfoor
- most common women 45-65, diabetes, sero-neg arthropathies, overweight/smoking?
- most commonly involves PTT dysfunction/rupture
- lack supination at TSt, PSw
- loss of dynamic control of medial long. arch
- prolonged excessive uncontrolled pronation eventually stresses static stabilizers
- too many toes
Arthrodesis
- Joint fusion
- Done for: correcting hyperpronation/painful flexible flatfoot, severe subtalar DJD, trauma
- can be talonavicular, calcaneocuboid, subtalar
Stress Fx
look for hotspot on bone scan
Stages of Adult Aquired Flatfoot
- Stage I: painful synovitis of PTT, tendon length/function maintained
- Stage II: weakens/tendon lengthens, flexible flatfoot
- Stage III: rigid foot
- Stage IV: tibiotalar valgus, arthritic changes
