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
Trimalleolar fracture
Fracture lateral, medial and posterior malleoli (posterior aspect of tibia)
Hallux Valgus
Angle between 1st metatarsal and proximal phalnx
Lateral deviation of distal phalanx (toe outwards)
Medial deviation of metatarsal
What happens to joint in Hallux Valgus?
Joint subluxation (moves out of alignment)
Hallux valgus lay mans
Bunion
Bony deformity at 1st Metatarsophalangeal joint
Causes of Hallux valgus
Trauma
Arthiritis
Connective tissue disorders
Metabolic conditions (gout, RA)
Common Hallux Valgus presentation
Female >65 years old
Treatment Hallux Valgus
Analgesia
Supportive footwear
Surgical correction (BUT NOT OFTEN can cause pain)
Hallux rigidus
OA of 1st Metatarsophalangeal joint
resulting in stiffness
Common symptom hallux rigidis
Pain walking, dorsiflexion
Walking on outside of feet (inversion)
Dorsal bunion?
Surgical management any OA
AAEO
Arthroplasty (joint replacement) Arthrodesis (joint fusion) Excision arthroplasty (removal of joint with soft tissue replacement) Osteotomy (surgical cutting of bone to allow realignment)
Treatment Hallux rigidus (conservative)
Activity modification, analgesia, orthotics (rigid insertion in shoe to prevent dorsiflexion), intraarticular steroids
Surgery Hallux Rigidus
Arthrodesis (fusion of joint)
Joint removed, replaced with fracture
Fracture stabilised with screws
OA of ankle joint presentation
All almost secondary arthritis - caused by trauma
OA ankle treatment
Arthrodesis (fusion) or Arthroplasty (MORE risks)
Complications of mid foot arthiritis
Arch collapse
Complications of MTPJ OA
Hallux Valgus
Ligament weakness
Corns and callouses
Claw toe look
Dorsiflexion of MTPJ
Plantarflexion of proximal interphalangeal joint
plantarflexion of distal interphalangeal joint
Hammer toe look
Dorsiflexion of MTPJ
plantarflexion proximal IPJ
Claw toe and hammer toe due to
Neurological damage
Ill fitting shoes
Diabetes
Trauma
Achilles tendinopathy
Many years overuse
Or if inactive
Obese
Diabetes
Symptoms/signs achilles tendinopathy
Pain/stiffness in morning along tendon
severe pain 24 hours after exercising
thickening tendon
Curly toes
Congenital (3rd to 5th digits)
tendons of flexor digitorum longus too tight
Adult acquired - failure of tibialis posterior (usually supports medial longitudinal arch)Tre
Flat foot
Medial longitudinal arch collapsed
Flat foot risk factors
Genetics - marfans/down syndrome Tight achilles tendon Ligament laxity Obesity Diabetes
Treatment flat foot
Physiotherapy and analgesia
Diabetic foot causes
Peripheral neuropathy - no protection
ischaemia (macrovascular damage)
Immunosuppression (poor glycaemic control)
Diabetic foot involves
Ulcers
Infections
Reduce risk of diabetic foot
Diabetic foot check ups
Tight glycaemic control
Suitable footwear
what can poorly controlled diabetes lead to in foot?
Charcot arthropathy
Charcot athropathy
Progressive destruction of bone and soft tissue in foot
Multiple dislocations, fractures and deformities
Rocker bottom foot
Causes charcot athropathy
Neuropathy and Neurovascular:
repeated trauma
Inflammation
Osteolysis
Compartment syndrome
Increased pressure within closed fascial compartment that compromises neurovascular bundle
often caused by long bone fracture
6 P’s of CS
Pain Parasthesia Pulselessness Perishingly cold Paralysis Pallor
Compartment syndrome treatment
Fasciotomy
Flat foot cause
Flexible flat foot (when on tip toes) arch exists = normal
Rigid flat foot no arch = failure of separation of tarsal bones in embryonic development
