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MSK IMPROVED CX CONDITIONS > Foot and ankle problems > Flashcards

Foot and ankle problems Flashcards

1
Q

Usual mechanism of injury for ankle fractures

A

Eversion/inversion

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2
Q

What is commonly seen after ankle fractures?

A

fracture blisters - wait to heal until surgery

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3
Q

What is an open ankle fracture?

A

Skin breached direct communication of fracture with external environment
URGENT to reduce the risk of osteomyelitis (infection of bone)

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4
Q

Ankle joint ring

A

Proximal - articulation surfaces of tibia and fibula (inferior tibiofibular joint)
Medial - medial ligament (deltoid)
Lateral - Lateral ligaments (anterior talofibular, posterior talofibular, calcaneofibular)
Inferior - subtalar joint (talus and calcaneus)

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5
Q

What can often happen with fracture of ankle joint?

A

Ligament damage

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6
Q

Eversion causes damage to which ligament…

A

Medial (deltoid) ligaments

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7
Q

Inversion causes damage to which ligaments…

A

Lateral ligaments

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8
Q

What happens after mallelolus fracture or if medial or lateral ligaments are dusturbed?

A

Ankle mortise becomes unstable
Widens
Talus can shift medially/laterally =
(TALAR SHIFT)

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9
Q

How are stable ankle factures treated?

A

Non operatively - boot/fibreglass cast

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10
Q

How are unstable fractures treated?

A

Surgical stabilisation - high risk for diabetes/vascular disease

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11
Q

Factors that increase risk of ankle sprain

A

Weak muscles/tendons (peroneal muscles esp)
Laxity in ligaments
Inadequate shoe support
Running on uneven surfaces
High heeled shoes - ankle is week when plantarflexed

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12
Q

How do ankle sprains usually occur?

A

Excessive strain on ligaments

Over external rotation, inversion, eversion of foot

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13
Q

Most common mechanism of injury ankle sprain

A

Inversion affecting plantarflexed, weight bearing foot

ANTERIOR TALOFIBULAR LIGAMENT most at risk

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14
Q

What can occur during inversion ankle spraining?

A

Avulsion of 5th Metatarsal

Fibularis Brevis inserts here and when under tension can pull off fragment of bone

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15
Q

Caution with avulsion of 5th metatarsal

A

Children (10-16) unfused metatarsal apophysis can be confused for fracture

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16
Q

Achilles tendon rupture most common in…

A 
Men 30-50 years
Weekend warriors (sports) bursts of jumping
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17
Q

Mechanisms of achilles tendon rupture

A 
Trauma 
Poor footwear
Obesity
Iatrogenic (quinalones affect tendons)
Sudden increase in exercise
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18
Q

Site of achilles tendon rupture

A

Decreased vascular area

6cm above site of insertion (calcaneal tuberosity)

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19
Q

Symptoms and signs achilles tendon tear

A 
sudden and severe pain
loud pop/snap
palpable/visible depression in tendon
pain, swelling then bruising
Inability to stand up or push off when walking
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20
Q

Test for achilles tendon function

A

Thompsons test (knee on chair, squeeze calf, check for plantarflexion)

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21
Q

Diagnoses achilles tendon tear

A

MRI
Ultrasound
SOFT TISSUE!!!!

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22
Q

Treatment achiles tendon tear

A

Aircast boot to hold foot in position

Surgery = high complication rate

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23
Q

Bimalleolar fracture

A

Fracture both medial and lateral malleoli

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24
Q

Trimalleolar fracture

A

Fracture lateral, medial and posterior malleoli (posterior aspect of tibia)

25
Q

Hallux Valgus

A

Angle between 1st metatarsal and proximal phalnx
Lateral deviation of distal phalanx (toe outwards)
Medial deviation of metatarsal

26
Q

What happens to joint in Hallux Valgus?

A

Joint subluxation (moves out of alignment)

27
Q

Hallux valgus lay mans

A

Bunion

Bony deformity at 1st Metatarsophalangeal joint

28
Q

Causes of Hallux valgus

A

Trauma
Arthiritis
Connective tissue disorders
Metabolic conditions (gout, RA)

29
Q

Common Hallux Valgus presentation

A

Female >65 years old

30
Q

Treatment Hallux Valgus

A

Analgesia
Supportive footwear
Surgical correction (BUT NOT OFTEN can cause pain)

31
Q

Hallux rigidus

A

OA of 1st Metatarsophalangeal joint

resulting in stiffness

32
Q

Common symptom hallux rigidis

A

Pain walking, dorsiflexion
Walking on outside of feet (inversion)
Dorsal bunion?

33
Q

Surgical management any OA

AAEO

A 
Arthroplasty (joint replacement)
Arthrodesis (joint fusion)
Excision arthroplasty (removal of joint with soft tissue replacement)
Osteotomy (surgical cutting of bone to allow realignment)
34
Q

Treatment Hallux rigidus (conservative)

A

Activity modification, analgesia, orthotics (rigid insertion in shoe to prevent dorsiflexion), intraarticular steroids

35
Q

Surgery Hallux Rigidus

A

Arthrodesis (fusion of joint)
Joint removed, replaced with fracture
Fracture stabilised with screws

36
Q

OA of ankle joint presentation

A

All almost secondary arthritis - caused by trauma

37
Q

OA ankle treatment

A 
Arthrodesis (fusion)
or Arthroplasty (MORE risks)
38
Q

Complications of mid foot arthiritis

A

Arch collapse

39
Q

Complications of MTPJ OA

A

Hallux Valgus
Ligament weakness
Corns and callouses

40
Q

Claw toe look

A

Dorsiflexion of MTPJ
Plantarflexion of proximal interphalangeal joint
plantarflexion of distal interphalangeal joint

41
Q

Hammer toe look

A

Dorsiflexion of MTPJ

plantarflexion proximal IPJ

42
Q

Claw toe and hammer toe due to

A

Neurological damage
Ill fitting shoes
Diabetes
Trauma

43
Q

Achilles tendinopathy

A

Many years overuse
Or if inactive
Obese
Diabetes

44
Q

Symptoms/signs achilles tendinopathy

A

Pain/stiffness in morning along tendon
severe pain 24 hours after exercising
thickening tendon

45
Q

Curly toes

A

Congenital (3rd to 5th digits)
tendons of flexor digitorum longus too tight

Adult acquired - failure of tibialis posterior (usually supports medial longitudinal arch)Tre

46
Q

Flat foot

A

Medial longitudinal arch collapsed

47
Q

Flat foot risk factors

A 
Genetics - marfans/down syndrome
Tight achilles tendon
Ligament laxity
Obesity
Diabetes
48
Q

Treatment flat foot

A

Physiotherapy and analgesia

49
Q

Diabetic foot causes

A

Peripheral neuropathy - no protection
ischaemia (macrovascular damage)
Immunosuppression (poor glycaemic control)

50
Q

Diabetic foot involves

A

Ulcers

Infections

51
Q

Reduce risk of diabetic foot

A

Diabetic foot check ups
Tight glycaemic control
Suitable footwear

52
Q

what can poorly controlled diabetes lead to in foot?

A

Charcot arthropathy

53
Q

Charcot athropathy

A

Progressive destruction of bone and soft tissue in foot
Multiple dislocations, fractures and deformities

Rocker bottom foot

54
Q

Causes charcot athropathy

A

Neuropathy and Neurovascular:

repeated trauma
Inflammation
Osteolysis

55
Q

Compartment syndrome

A

Increased pressure within closed fascial compartment that compromises neurovascular bundle

often caused by long bone fracture

56
Q

6 P’s of CS

A 
Pain
Parasthesia
Pulselessness 
Perishingly cold
Paralysis 
Pallor
57
Q

Compartment syndrome treatment

A

Fasciotomy

58
Q

Flat foot cause

A

Flexible flat foot (when on tip toes) arch exists = normal

Rigid flat foot no arch = failure of separation of tarsal bones in embryonic development

MSK IMPROVED CX CONDITIONS (2 decks)

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