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MSK disorders > Foot and ankle problems > Flashcards

Foot and ankle problems Flashcards

1
Q

Compartment syndrome

A

Trauma to fascial compartment = haemorrhage or oedema = increase in intra-compartmental pressure

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2
Q

Short term consequences of compartment syndrome

A
  • Increased pressure = decreased muscle perfusion
  • Ischaemic muscle releases mediators = further increase cap permeability and rise in intra-compartmental pressure
  • Severe untreated = muscle necrosis resulting in acute kidney injury
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3
Q

Short term neurovascular signs of compartment syndrome

A
  • Loss of peripheral pulses and increased cap refill time
  • Nerves susceptible to ischaemia
  • Thin cutaneous affected more quickly than motor fibres = distal paraesthesia then loss of motor function
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4
Q

Long term consequences of compartment syndrome

A
  • Muscle necrosis can cause chronic kidney injury

- Volkmann’s isachaemic contracture = permanent and painful contracture of affected muscle groups

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5
Q

Rhabdomyolysis

A

Muscle necrosis

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6
Q

Causes of ankle fractures

A
  • Inversion or eversion injury

- Co-morbities - diabetes, neuropathy, peripheral vascular disease, smoking make fracture healing longer

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7
Q

Fracture blisters

A

Blister in overlying soft tissue of ankle fracture

  • Delay surgery until they have healed
  • If skin has become necrotic take longer to heal
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8
Q

Open ankle fractures

A

Fracture direct communication w external environment
Surgery w extensive irrigation and debridement (removal of foreign bodies) to reduce risk of osteomyelitis (bone infection)

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9
Q

Single fracture effect on ring

A

Ankle joint and ligaments = ring

Single fracture = in association w ligament damage somewhere else in the ring

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10
Q

Talar shift

A

Disruption of any 2 of either medial, lateral or syndesmosis ligaments = unstable ankle mortise
Mortise widens = talus can shift in joint

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11
Q

Treatment of stable ankle fractures

A

Aircast boot or fibreglass case

Can weight bear and low rate of complications

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12
Q

Treatment of unstable ankle fractures

A

Surgical stabilisation

High risk if have diabetes or peripheral vascular disease

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13
Q

Ankle sprain

A

Partial or complete tear in one or ligaments of ankle joint due to excessive strain on them.

Most heal w rest and time or will have late ankle instability and may need surgery.

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14
Q

Risk factors of ankle sprain

A
  • Weak muscles or tendons crossing ankle joint
  • Weak or lax ankle ligaments
  • Inadequate joint proprioception
  • Slow neuromuscular response to an off-balance position
  • Running on uneven surfaces
  • Shoes w inadequate heel support or wearing high heels
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15
Q

Most common mechanism of injury in ankle sprain

A

Inversion injury - anterior talofibular ligament most at risk

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16
Q

Severe ankle sprain and fracture of 5th metatarsal tuberosity

A

Brevis tendon attached to base of 5th metatarsal - in inversion injury is under tension and can pull off a fragment of bone

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17
Q

Causes of Achilles tendon rupture

A
  • Forceful push off w extended knee
  • Fall w foot outstretch and ankle dorsiflexed
  • Falling from heigh or abruptly stepping into hole or off curb
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18
Q

Symptoms and signs of Achilles rupture

A
  • Sudden pain in back of ankle or calf
  • Sound of pop/snap
  • Palpable gap in tendon
  • Initial pain and swelling then bruising
  • Inability to stand on tip toe or push off when walking
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19
Q

Treatment of Achilles rupture

A

Surgical reconstruction difficult = two ends frayed

  • Aircast boot w foot in correct position
  • Surgery also high risk as skin thin and poorly vascularised
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20
Q

Hallux valgus

A

Common cause of bunion

  • Varus deviation of first metatarsal
  • Valgus deviation of hallux (big toe)
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21
Q

Cause of hallux valgus

A
  • Trauma
  • Arthritis - rheumatoid or psoriatic
  • Gout
  • Connective tissue disorders that cause lax ligaments eg. Ehlers Danlos syndrome
22
Q

Treatment of hallux valgus

A

Metatarsal osteotomy = cut through bone and then realign the fragments
Never for cosmetic reasons

23
Q

Hallux rigidus

A

OA of first MTPJ caused by gout and previous septic arthritis

24
Q

Symptom of hallux rigidus

A

Pain on walking and dorsiflexion of toe - walk on outside of foot to compensate
May look like there is a bunion

25
Q

Arthroplasty

A

Joint replacement

26
Q

Arthrodesis

A

Joint fusion

27
Q

Excision arthroplasty

A

Surgical removal of joint and then putting soft tissue in between

28
Q

Osteotomy

A

Surgical cut in bone to allow realignment

29
Q

Treatment of hallux rigidus

A

Normal OA treatments - activity modification, pain relief, steroid infections
Also rigid sole orthotic that prevents motion of 1st MTPJ
Arthrodesis - cut joint and then stabilise w screws and normal fracture healing refuses
Can also replace joint

30
Q

OA of ankle joint

A

Majority of cases caused by trauma = post traumatic arthritis
Also caused by inflammation of ankle joint, joint stress and obesity

31
Q

Treatment of OA of ankle joint

A

Arthrodesis

Can do arthroplasty but risks of prosthetic loosening or being infected

32
Q

Claw toe

A

Hyperextended MTPJ and flexed PIP joint

Muscle impaclance = ligaments too tight due to neurological damage eg. cerebral palsy, stroke

33
Q

Hammer toe

A

Toe flexed in PIPJ

34
Q

Mallet toe

A

Toe flexed in DIPJ

35
Q

Causes of hammer and mallet toe

A
  • Ill fitting shoes - too tight = muscles contract and shorten so can’t extend toe
  • Pressure from adjacent hallux valves
36
Q

Curly toes

A

Congenital, 3rd and 5th digits, bilateral

Tendon of FDL and flexor digitorum brevis too tight

37
Q

Treatment of curly toes

A

Passive extension of toes and stretching of flexor tendons

Surgery rarely needed

38
Q

Achilles tendinopathy

A

Overuse w poor training regiment
Also in inactive people, obesity and diabetes
Degenerate condition

39
Q

Sites of Achilles tendinopathy

A
  • Insertional tendinopathy = at site of insertion

- Non-insertional tendiopathy = at vascular watershed

40
Q

Symptoms and signs of Achilles tendinopathy

A
  • Pain and stiffness in morning and worse w activity
  • Severe pain after activity
  • Thickening of tendon
  • Swelling always, worse in activity
  • Palpable bone spur
41
Q

Treatment of Achilles tendinopathy

A

Physiotherapy

42
Q

Flexible flat feet

A

No medial arch when standing normally but when on tip toes normal medial arch appears

43
Q

Rigid flat feet

A

Tarsal coalition = tarsal bones don’t separate in utero
When on tip toes no arch
Symptomatic and needs treating

44
Q

Adult acquired flat foot

A

Dysfunction of tibialis posterior tendon
Change in shape of foot
Risk factors = obesity, hypertension, diabetes and pregnancy

45
Q

Treatments of adult acquired flat foot

A

Orthotics and surgical reconstruction

46
Q

Diabetic foot disease

A

Infection, ulceration or destruction of foot tissue caused by:

  • Loss of sensation (peripheral neuropathy) - still weight bear = problem worse
  • Ischaemia (peripheral vascular disease)
  • Immunosuppression (poor glycemic control)
47
Q

Reduce risk of foot disease

A
  • Diabetic foot clinics for screening
  • Check sensation and perfusion of feet
  • Get shoes
  • Education of patients
  • Tight glycemic control
48
Q

Charcot arthropathy

A

Progressive destruction of bones, joints and soft tissues due to poorly controlled diabetes

Neuropathy + abnormal loading + repeated micro trauma + metabolic abnormalities = inflammation causing osteolysis, fractures, dislocation and deformity

49
Q

Rocker bottom foot

A

Neuropathy = muscle spasticity eg. tight Achilles which makes deformity of Charcot foot worse

50
Q

Treatment of Charcot foot

A
  • Glycaemic control

- Reduction of load

51
Q

Risk factors of Charcot foot

A
  • Obesity = increase loan of softened bones
  • Poor glycemic control
  • Secondary immunosuppression

MSK disorders (8 decks)

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