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MSK > Foot And Ankle Problems > Flashcards

Foot And Ankle Problems Flashcards

1
Q

What is the usual mechanism for an ankle fracture

What can form after ankle fractures

A

Inversion or Eversion injury

Fracture blisters

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2
Q

When viewing ankle and its ligaments as a ring in the coronal plane, what comprises the following;

Proximal ring part
Medial ring part
Lateral ring part
Inferior ring part

In how many places does the ring break when broken

A

Proximal: Inferior tibiofibular joint
Medial: Deltoid ligament
Inferior: Subtalar joint
Lateral: Lateral ligament complex

2 places

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3
Q

What can cause the mortise to become unstable/ wider?

How does this affect the talus? What is this condition called

A

Disruption of any 2 out of the Syndesmosis, Medial or Lateral ligaments

Talus can shift medially/ laterally= Talar shift

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4
Q

Compare stable and unstable ankle fractures in terms of treatment, and risk of complications

Can they bear weight

A

Stable;

  • Aircast boot/ fibreglass cast for comfort
  • Can bear weight
  • Low risk of complications

Unstable:

  • Surgical stabilisation
  • Can’t bear weight
  • High risk of complications if patient has diabetes/ peripheral vascular disease
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5
Q

What is an ankle sprain
How are they treated usually? What is caused if this doesn’t work

Why and how do they usually occur

A

Partial or complete tear of one or more ligaments of the ankle joint

90% heal with rest and time, can cause ankle instability

Excessive strain on ligaments caused by excessive internal rotation, inversion or eversion due to an external force

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6
Q

Identify 5 risk factors for ankle sprains

A
  • Running on even surface
  • High heeled shoes
  • Inadequate heel support
  • Weak/ lax ankle ligaments
  • Weak muscles that cross ankle joint
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7
Q

What is the most common mechanism of injury in an ankle sprain?

Which ligament is at most risk of injury

A

Inversion injury affecting a plantar-flexed and weight bearing foot

Anterior Talofibular ligament

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8
Q

How can a severe ankle sprain lead to an avulsion fracture of their 5th metatarsal

What can this be mistaken for

A

In an inversion injury, Fibularis Brevis (attached to 5th metatarsal) is under tension and can pull a bone fragment off

An unfused 5th metatarsal apophysis in children (10-16)

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9
Q

Identify 2 mechanisms of injury of a Rupture of the Achilles Tendon

What is the usual site of rupture

A
  • Pushing off forcefully with an extended knee
  • Fall with foot outstretched in front and ankle dorsiflexed (Tendon stretched)
  • The Vascular Watershed Area (6cm above Calcaneal Tuberosity, an area of decreased vascularity and thickness of tendon)
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10
Q

What are 5 signs of Rupture of the Achilles Tendon

Is a complete or partial tear more common

A
  • Sudden, severe pain at back of ankle/ in calf
  • Loud pop/ snap
  • Palpable gap/ depression in tendon
  • Initial Pain, Swelling-> bruising
  • Can’t stand on tip toe or push off when walking

Complete tear

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11
Q

Describe Thompson’s/ Simmon’s test being used to check for a ruptured Achilles tendon

Why is surgical reconstruction hard
How are these ruptures treated

A

Squeeze calf muscle;

  1. If intact, plantar flexion
  2. If ruptured, no movement of foot

2 ends are frayed like a mop
Conservatively with an aircast boot

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12
Q

What are 3 signs of Hallux Valgus ( Bunions)
What 2 things make it worse

Why should surgery not be carried out for purely cosmetic reasons

A
  • Varus deviation of metatarsal 1
  • Valgus deviation and/or lateral rotation of hallux
  • Prominence of 1st metatarsal head
  • Line of pull from tendons
  • High heeled/ tight shoes
  • Painless foot may be converted to painful foot
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13
Q

What is Hallux Rigidus

What is 1 symptom and how do patients compensate for this

A
  • Osteoarthritis of the 1st Metatarsophalangeal joint, resulting in stiffness
  • Pain in the 1st MTPJ on walking and attempting dorsiflexion
  • Walking on the lateral border of foot
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14
Q

In Hallux Rigidus;

  1. How is dorsiflexion affected
  2. How is plantar-flexion affected
  3. What may form on top of the joint

Suggest 1 conservative and 1 surgical treatment

A
  1. Reduced dorsiflexion (Due to arthritis)
  2. Unaffected plantarfelxion
  3. Dorsal bunion may form

Conservative: A rigid sole orthotic (Stiff shoe insert that prevents motion at the 1st MTPJ)

Surgical: Arthrodesis of 1st MTPJ

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15
Q

Define;

Arthroplasty
Arthrodesis
Excision arthroplasty
Osteotomy

A

Arthroplasty: Joint replacement
Arthrodesis: Joint fusion

Excision arthroplasty: Surgical removal of the joint, with interposition of soft tissue

Osteotomy: Surgical cutting of bone to allow realignment

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16
Q

What is Claw Toe
What causes it
What is it usually due to
which toes are affected

A
  • Hyperextended toes at MTPJ
  • Hyperflexed toes at PIP joint (Proximal Interphalangeal)

Muscle imbalance-> Ligaments and tendons become abnormally tight.

Usually due to neurological damage

Toes 2-5

17
Q

What are hammer toe and mallet toe
Which toe are they most common in

What are 2 causes for these deformities

A

Hammer: When toe is flexed at PIPJ
Mallet: When toe is flexed at DIPJ

In toe 2

  • Ill fitting pointed shoes
  • Pressure on toe 2 from a Hallux Valgus
18
Q

Which toes are affected in Curly Toes, what is the cause?

What are the symptoms

A

Toes 3-5, congenital tightening of Flexor Digitorum Longus

No symptoms, until after 6 years old, as pain may be induced due to activity

19
Q

What is Achilles tendonopathy
Where can it develop

Name 1 cause and 2 risk factors

A

Degeneration of the Achilles Tendon

  • At insertion of the tendon
  • At Vascular Watershed Area
  • Many years of overuse
  • Obesity and diabetes
20
Q

Identify 6 signs of Achilles Tendonopathy

A
  • Pain and stiffness along tendon in the morning
  • Pain that worsens with activity
  • Severe pain 24h after exercise
  • Thickening of tendon
  • Swelling that worsens during activity
  • Palpable bone spur (If develops at insertion)
21
Q

How does Flat Floot (Pes Planovalgus) appear

Up to when is is this normal and why

A
  • Medial arch has collapsed
  • Hindfoot shows valgus angulation

Up to adolescence, as medial arch only begins to form around age of 5

22
Q

Compare Rigid and Flexible Flat Feet

What usually causes Rigid Flat Feet

A

Flexible: No medial arch when standing normally, but when on tip-toes, normal medial arch appears and hindfoot returns to normal alignment

Rigid: Always abnormal, due to Tarsal Coalition (Failure of separation of tarsal bones)

(Rigid is symptomatic, needs treatment)

23
Q

Explain the cause of Adult Acquired Flatfoot

A

Dysfunction of tibialis posterior tendon, which usually supports the medial arch

This leads to a stretched Spring Ligament and Plantar Aponeuroses-> Talar head displaced inferomedially

24
Q

What is Charcot Arthropathy and how does diabetes cause it

A

Progressive destruction of bones, joints and soft tissues.

Diabetes-> Loss of sensation due to neuropathy can cause patient to weight-bear on soft tissue abnormalities.

25
Q

What is compartment syndrome

What are 3 signs

A

A rise in Intra-compartmental pressure
(Trauma-> Haemorrhage/ oedema->Rise in pressure)

  • Severe limb pain, excessive for the degree of injury
  • Pain increasing and not relieved by analgesia
  • Pain worsened by passive stretch of muscles
26
Q

Identify 2 short term consequences of Compartment syndrome not being adequately treated

A
  • Rhabdomyolysis and Acute kidney Injury

- Distal parasthesia before loss of motor function (Thin nerves affected before motor fibres from ischaemia)

27
Q

Identify 1 long term consequence of Compartment syndrome not being adequately treated

A

Fibrosis of necrotic muscle-> Volkman’s Ischaemic contracture

(Permanent painful contracture of affected muscle groups)

MSK (21 decks)

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