Foot and ankle problems Flashcards
Usual mechanism of injury for ankle fractures
Eversion/inversion
What is commonly seen after ankle fractures?
fracture blisters - wait to heal until surgery
What is an open ankle fracture?
Skin breached direct communication of fracture with external environment
URGENT to reduce the risk of osteomyelitis (infection of bone)
Ankle joint ring
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)
What can often happen with fracture of ankle joint?
Ligament damage
Eversion causes damage to which ligament…
Medial (deltoid) ligaments
Inversion causes damage to which ligaments…
Lateral ligaments
What happens after mallelolus fracture or if medial or lateral ligaments are dusturbed?
Ankle mortise becomes unstable
Widens
Talus can shift medially/laterally =
(TALAR SHIFT)
How are stable ankle factures treated?
Non operatively - boot/fibreglass cast
How are unstable fractures treated?
Surgical stabilisation - high risk for diabetes/vascular disease
Factors that increase risk of ankle sprain
Weak muscles/tendons (peroneal muscles esp)
Laxity in ligaments
Inadequate shoe support
Running on uneven surfaces
High heeled shoes - ankle is week when plantarflexed
How do ankle sprains usually occur?
Excessive strain on ligaments
Over external rotation, inversion, eversion of foot
Most common mechanism of injury ankle sprain
Inversion affecting plantarflexed, weight bearing foot
ANTERIOR TALOFIBULAR LIGAMENT most at risk
What can occur during inversion ankle spraining?
Avulsion of 5th Metatarsal
Fibularis Brevis inserts here and when under tension can pull off fragment of bone
Caution with avulsion of 5th metatarsal
Children (10-16) unfused metatarsal apophysis can be confused for fracture
Achilles tendon rupture most common in…
Men 30-50 years Weekend warriors (sports) bursts of jumping
Mechanisms of achilles tendon rupture
Trauma Poor footwear Obesity Iatrogenic (quinalones affect tendons) Sudden increase in exercise
Site of achilles tendon rupture
Decreased vascular area
6cm above site of insertion (calcaneal tuberosity)
Symptoms and signs achilles tendon tear
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
Test for achilles tendon function
Thompsons test (knee on chair, squeeze calf, check for plantarflexion)
Diagnoses achilles tendon tear
MRI
Ultrasound
SOFT TISSUE!!!!
Treatment achiles tendon tear
Aircast boot to hold foot in position
Surgery = high complication rate
Bimalleolar fracture
Fracture both medial and lateral malleoli