Foot And Ankle Problems Flashcards
What is the usual mechanism for an ankle fracture
What can form after ankle fractures
Inversion or Eversion injury
Fracture blisters
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
Proximal: Inferior tibiofibular joint
Medial: Deltoid ligament
Inferior: Subtalar joint
Lateral: Lateral ligament complex
2 places
What can cause the mortise to become unstable/ wider?
How does this affect the talus? What is this condition called
Disruption of any 2 out of the Syndesmosis, Medial or Lateral ligaments
Talus can shift medially/ laterally= Talar shift
Compare stable and unstable ankle fractures in terms of treatment, and risk of complications
Can they bear weight
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
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
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
Identify 5 risk factors for ankle sprains
- Running on even surface
- High heeled shoes
- Inadequate heel support
- Weak/ lax ankle ligaments
- Weak muscles that cross ankle joint
What is the most common mechanism of injury in an ankle sprain?
Which ligament is at most risk of injury
Inversion injury affecting a plantar-flexed and weight bearing foot
Anterior Talofibular ligament
How can a severe ankle sprain lead to an avulsion fracture of their 5th metatarsal
What can this be mistaken for
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)
Identify 2 mechanisms of injury of a Rupture of the Achilles Tendon
What is the usual site of rupture
- 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)
What are 5 signs of Rupture of the Achilles Tendon
Is a complete or partial tear more common
- 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
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
Squeeze calf muscle;
- If intact, plantar flexion
- If ruptured, no movement of foot
2 ends are frayed like a mop
Conservatively with an aircast boot
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
- 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
What is Hallux Rigidus
What is 1 symptom and how do patients compensate for this
- 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
In Hallux Rigidus;
- How is dorsiflexion affected
- How is plantar-flexion affected
- What may form on top of the joint
Suggest 1 conservative and 1 surgical treatment
- Reduced dorsiflexion (Due to arthritis)
- Unaffected plantarfelxion
- Dorsal bunion may form
Conservative: A rigid sole orthotic (Stiff shoe insert that prevents motion at the 1st MTPJ)
Surgical: Arthrodesis of 1st MTPJ
Define;
Arthroplasty
Arthrodesis
Excision arthroplasty
Osteotomy
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
What is Claw Toe
What causes it
What is it usually due to
which toes are affected
- 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
What are hammer toe and mallet toe
Which toe are they most common in
What are 2 causes for these deformities
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
Which toes are affected in Curly Toes, what is the cause?
What are the symptoms
Toes 3-5, congenital tightening of Flexor Digitorum Longus
No symptoms, until after 6 years old, as pain may be induced due to activity
What is Achilles tendonopathy
Where can it develop
Name 1 cause and 2 risk factors
Degeneration of the Achilles Tendon
- At insertion of the tendon
- At Vascular Watershed Area
- Many years of overuse
- Obesity and diabetes
Identify 6 signs of Achilles Tendonopathy
- 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)
How does Flat Floot (Pes Planovalgus) appear
Up to when is is this normal and why
- Medial arch has collapsed
- Hindfoot shows valgus angulation
Up to adolescence, as medial arch only begins to form around age of 5
Compare Rigid and Flexible Flat Feet
What usually causes Rigid Flat Feet
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)
Explain the cause of Adult Acquired Flatfoot
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
What is Charcot Arthropathy and how does diabetes cause it
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.
