Foot and Ankle Fractures, Tendinopathies, DM implications Flashcards
How many bones in the foot
26 + tibia
What is the first question when presented with a foot or ankle fracture
Does the fx need sx?
- how displaced
- how mis-aligned
- is a joint surface involved?
How to heal fx that do no require sx?
- some fx heal better with slight movement some better with rigid immobilization
Low energy fractures
- usually dt what?
- classification name?
- rotational forces about the ankle
- Lauge-Hansen classification: based on position of foot at time of injury and force applied during injury
Fracture of foot/ankle
- clinical eval
- swelling
- bruising
- deformity
Fracture of foot/ankle
- radiographic eval
- alignment
- displacement
- comminution
- Articular involvement
Fracture of foot/ankle
- conservative tx
- limited weightbearing
- limitation in motion of fx
Fracture of foot/ankle
- sx tx
- reduction of fx
- maintenance of reduction (hardware)
- compression
Arthritis of foot and ankle
- define
- inflammation in a joint arising from loss or degeneration of hyaline cartilage
- 33 potential articulations in foot/ankle
Arthritis of foot and ankle
- types
- primary
- inflammatory (RA for ex)
- post-traumatic
- septic
what causes the pain in arthritis?
- bone and inflammation
- NOT the cartilage (no nerve)
Arthritis of foot and ankle
- clinical presentation
- swelling
- limited/irregular ROM
- pain
Arthritis of foot and ankle
- radiographic eval
- joint space narrowing
- osteophyte formation
- subchondral sclerosis and irregularity (bright right under joint space on xray)
Arthritis of foot and ankle
- conservative tx
- immobilization
- anti-inflammatory meds
- injections (caution in DM dt hyperglycemic effects)
Arthritis of foot and ankle
- sx tx
- debridement (remove bone spurs, buys time)
- arthrodesis (hallmark of arthritis tx in foot/ankle)
- arthroplasty
What is the gold standard sx tx for most ankle/foot arthritis
fusion (arthrodesis)
Plantar fasciitis
- cause
- secondary to contracture of the plantar fascia ligament
- results in repetitive micro trauma to the ligament (heals with scar tissue which causes more contracture = vicious cycle)
Plantar fasciitis
- clinical presentation
- am pain
- pain after rest
- tenderness over plantar hind foot
- limitation in ankle ROM
Plantar fasciitis
- radiographic eval
- usually not helpful
- possible plantar osteophyte (indication previous inflammation of plantar fascia)
Plantar fasciitis
- what causes pain
- the ligament not the bone!
Plantar fasciitis
- tx
- stretching protocols**
- massage
- NSAIDs
- night splinting
- injections (very common)
- conservative tx for 4-6 months before more aggressive
- conservative tx successful 99% of the time
Achilles tendinopathy
- describe
- inflammation of tendon OR
- degenerative change of the tendon
- insertional or non-insertional
Achilles tendinopathy
- clinical presentation
- swelling
- pain
- limited ROM
Achilles tendinopathy
- radiographic eval
- increased diameter of tendon
- osteophyte formation or calcification of the tendon
Cause of insertional Achilles tendinopathy
- usually overuse
- 80-90% of achilles tendinopathy
cause of non-insertional Achilles tendinopathy
- degeneration usually
- seen in younger people
- seen in middle of tendon
Achilles tendinopathy
- conservative tx
- stretching/PT
- immobilization
- NSAIDs (topical is great)
Achilles tendinopathy
- sx tx
only after fail conservative for a few months
Posterior tibial tendinopathy
- desribe
- inflammation
- imbalance across hind foot
- degenerative (MC) or traumatic
- can lead to arthritic changes to the hind foot
Posterior tibial tendinopathy
- clinical exam findings
- swelling
- WB pain
- hindfoot deformity
Posterior tibial tendinopathy
- radiographic exam findings
- collapse of longitudinal arch
- abduction of the forefoot
Posterior tibial tendinopathy
- conservative treatment
- bracing/orthotics
- PT
- NSAIDs
Posterior tibial tendinopathy
- sx treatment
- reconstruction
- fusion
Diabetic implications of the foot and ankle
- dt what
- poor glycemic control =
- impaired sensory fn
- impaired vascular fn
- micro and macro vascular disease
What are two common diabetic foot problems
- ulcers
- charcot arthropathy
Diabetic foot ulcers
- often dt neuropathy
- impaired vasculature delays wound healing
Charcot arthropathy
- describe
- hallmarks: bony destruction and collapse of foot bones
- large scale deformity
- unique to neuropathy, not just DM
Charcot arthropathy often confused with what?
infection bc warm, swollen foot
Charcot arthropathy
- conservative treatment
- bracing
- orthotics
- *tx like aggressive fx treatment
- limit weight bearing - bone is crumbly like butter (gross). Crutches or wheelchair if necessary
Charcot arthropathy
- sx tx
- fusion
- amputation
