Foot and ankle disorders

Question 1

What nerve supplies sensation to the sole of the foot?

Answer 1

tibial nerve

Question 2

List two non fracture related common problems of the foot

Answer 2

plantar fasciitis
fat pad atrophy
morton’s neuroma
bunions
gout

Question 3

Where is pain felt in plantar fasciitis?

Answer 3

plantar fascia attaching to calcaneus at the heel, plantar aspect of the heel

Question 4

Differential for plantar fasciitis?

Answer 4

fat pad atrophy

Question 5

Where is the fat pad in the foot located?

Answer 5

under the calcaneus

Question 6

What is morton’s neuroma?

Answer 6

dysfunction of nerve in intermetatarsal space, usually between the third and fourth metatarsal

Question 7

What are the symptoms of morton’s neuroma?

Answer 7

pain at front of the foot, sensation of lump in shoe, burning numbness felt in distal toes

Question 8

How to test for morton’s neuroma?

Answer 8

deep pressure, metatarsal squeeze

Question 9

Management of morton’s neuroma?

Answer 9

avoid high heels
insoles
weight loss
steroid injections
surgery

Question 10

What is another name for bunions?

Answer 10

hallux valgus= big toe angulation laterally

Question 11

Which fractures does Weber classification describe?

Answer 11

lateral malleolus

Question 12

Why are lateral malleolus fractures significant?

Answer 12

This tibiofibular syndesmosis is very important for the stability and function of the ankle joint. If the fracture disrupts the syndesmosis, surgery is more likely to be required in order to regain good stability and function of the joint.

Question 13

What is Type A Weber’s?

Answer 13

Type A – below the ankle joint – will leave the syndesmosis intact

Question 14

Type B?

Answer 14

at the level of the ankle joint/syndesmosis – the syndesmosis will be intact or partially torn

Question 15

Type C?

Answer 15

above the ankle joint – the syndesmosis will be disrupted

Question 16

Name the malleoli of the ankle?

Answer 16

medial, lateral, and posterior

Question 17

What are trimalleolar fractures?

Answer 17

lateral, medial, and posterior malleoli are affected

Question 18

Are distal and proximal ankle fractures more unstable?

Answer 18

the proximal, the higher the likelihood of ankle instability, therefore type X almost always need surgical fixation

Question 19

What are the Ottawa rules?

Answer 19

If any of the three following features are present then xray must be undertaken:
1. bony tenderness at tip of lateral malleolus OR
2. bony tenderness at tip of medial malleolus OR
3. Inability to bear weight

Question 20

Patient presents with displaced weber’s fracture. You realign the fracture with sedation in the ER. What must you do before and after reduction?

Answer 20

test neurovascular integrity!!