Foot and Ankle Disorders Flashcards
By which movement is ankle fracture most common?
Inversion of the ankle
What co-morbidities can affect ankle fracture healing?
- Diabetes mellitus
- neuropathy
- peripheral vascular disease
- smoking
What is talar shift?
When there is disruption of any two syndesmosis causing the ankle mortise to become unstable and widen- the talus can shift medially or laterally within the ankle joint
What is the standard treatment for a stable ankle fracture?
Aircast boot or fibroblast cast
What is an ankle sprain?
Partial or complete tear of one or more ligaments of the ankle joint
Name some of the factors that cause an increased risk of ankle sprain
- weak muscles/ tendons of the joint
- weak or lax ankle ligaments
- inadequate sense of joint position
- slow neuromuscular response to being in an off balance position
- running on uneven surfaces
- inadequate heel support from footwear
- wearing high heels
What is the most common mechanism of injury for an ankle sprain?
Inversion injury on a plantar-flexed, weigh bearing foot
Which ankle ligament is the most at risk of spraining?
Anterior talofibular ligament
What is an avulsion fracture?
When the tendon or ligament is under tension (rather than tears) and pulls the bone off at the site on insertion
Why does the 5th metatarsal undergo an avulsion fracture in an ankle sprain?
The peroneus (fibularis) bravis tendon is attached to a tubercle on the base of the 5th metatarsal.
Inversion injury can pull the bone off at its attachment site
In what group is achilles tendon rupture most common in?
Men aged 30-50 years
What is the most common site of rupture of the achilles tendon?
The ‘vascular watershed’ - 6 cm from the insertion onto the cancaneal tuberosity
An area of decreased vascularity and thickness
Describe the test used to test for an Achilles tendon rupture
The Thompson’s test - squeeze the calf (gastronemus and soleus complex) when the patient is lying prone - if the foot undergoes plantar flexion the achilles tendon is intact
What is Hallux Valgus?
When the distal part of the big toe is deviated laterally
It is the most common cause of a ‘bunion’
What group is Hallux Valgus most common in?
Middle aged females
What surgery is performed to correct Hallux Valgus?
Metatarsal osteomy - cutting through the metatarsal bone to realign the fragments
What is Hallux rigidus?
Osteoarthritis of the 1st Metarsophalangeal joint causing stiffness
Causes pain on walking and toe dorsiflexion
What is arthroplasty?
Joint replacement
What is arthrodesis?
Joint fusion
What is excision arthroplasty?
surgical removal of the joint with the tendon rolled up between the bone ends
What is osteotomy?
Cutting of bone to allow realignment
What is claw toe?
All 4 toes are hyperextended at the MTPJ and flexed at the DIP
How might claw toe develop?
As a result of muscle imbalance from neurological damage that causes ligaments and tendons to become unnaturally tight
Types of injury:
- cerebral palsy
- diabetes
- stroke
- alcohol dependence
What is hammer toe?
A deformity where the toe is flexed at the PIPJ
Can occur in any toe but mainly the 2nd toe
What is mallet toe?
A deformity where the toe is flexed at the DIPJ
Can occur in any toe but mainly the 2nd toe
What is the most common cause of hammer and mallet toes?
Ill- fitting shoes putting pressure on the 2nd to from the adjacent hallux valgus
What are curly toes?
Congenital curling of the toes, usually the 3rd and 5th digits bilaterally
Thought to develop as tendons of FDL or FDB are too tight
What is Achilles tendinopathy?
A degenerative condition of the Achilles’ tendon due to many years of over use
What are some of the signs and symptoms of Achilles tendinopathy?
- pain and stiffness along the tendon in the morning
- pain in tendon at the back of the heel that worsen with activity
- severe pain 24hrs after exercise
- tendon thickening
- swelling present and worsens with activity
- palpable bone spur
What is pes planovalgus?
Flat footedness
The medial arch of the foot has collapsed
What is the difference between flexible flat feet and rigid flat feet?
Flexible flat feet= no medial arch but one appears when standing on tip toes
Rigid flat foot= no arch appears when on tip- toes
What causes rigid flat foot?
Tarsal coalition = failure of tarsal bones to separate in development
What deformity in the ankle/foot can poorly controlled diabetes lead to?
Charcot arthropathy
Progressive destruction of bones, joints and soft tissues of the ankle or foot (but can also affect the knee)
In severe cases a rocker bottom foot may develop
