Foot and ankle problems Flashcards by Rebekah Agunede

Usual mechanism of injury for ankle fractures

Eversion/inversion

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What is commonly seen after ankle fractures?

fracture blisters - wait to heal until surgery

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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)

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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)

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What can often happen with fracture of ankle joint?

Ligament damage

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Eversion causes damage to which ligament…

Medial (deltoid) ligaments

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Inversion causes damage to which ligaments…

Lateral ligaments

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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)

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How are stable ankle factures treated?

Non operatively - boot/fibreglass cast

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How are unstable fractures treated?

Surgical stabilisation - high risk for diabetes/vascular disease

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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

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How do ankle sprains usually occur?

Excessive strain on ligaments

Over external rotation, inversion, eversion of foot

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Most common mechanism of injury ankle sprain

Inversion affecting plantarflexed, weight bearing foot

ANTERIOR TALOFIBULAR LIGAMENT most at risk

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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

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Caution with avulsion of 5th metatarsal

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

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Achilles tendon rupture most common in…

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

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Mechanisms of achilles tendon rupture

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

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Site of achilles tendon rupture

Decreased vascular area

6cm above site of insertion (calcaneal tuberosity)

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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

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Test for achilles tendon function

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

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Diagnoses achilles tendon tear

MRI
Ultrasound
SOFT TISSUE!!!!

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Treatment achiles tendon tear

Aircast boot to hold foot in position

Surgery = high complication rate

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Bimalleolar fracture

Fracture both medial and lateral malleoli

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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