Foot and ankle problems

Question 1

What is compartment syndrome?

Answer 1

Haemorrhage and/or oedema leading to increased intracompartmental pressure caused by trauma to any fascial compartment

Question 2

What are the signs of compartment syndrome?

Answer 2

• Severe pain
• Pain not relieved by analgesics
• Pain exacerbated by passive stretching

Question 3

How is compartment syndrome treated?

Answer 3

Surgical decompression (fasciotomy)

Question 4

What are the possible short term and long term consequences of untreated compartment syndrome

Answer 4

• Decreased perfussion of muscle (S)
• Rhabdomyolysis = muscle necrosis (S)
• Acute kidney injury (S/L)
• Ischaemia to nerve fibres = loss of motor function (L)
• Fibrosis of necrotic muscle tissue = Volkmann’s ischaemic contracture (L)

Question 5

What is the usual mechanism for an ankle fracture?

Answer 5

Inversion or eversion injury

Question 6

How are ankle fractures treated?

Answer 6

Stable = aircast boot or fibreglass cast
Unstable = surgical stabilisation

Question 7

What is a sprained ankle?

Answer 7

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

Question 8

What factors increases the risk of a sprained ankle?

Answer 8

• Weak muscles/tendons
• Weak or lax ligaments
• Inadequate joint proprioception
• Slow neuromuscular response
• Running on uneven surfaces
• Shoes with inadequate heel support
• High heeled shoes

Question 9

Why is it common to find a fifth metatarsal fracture with sprained ankle?

Answer 9

Peroneus/fibularis brevis tendon is attached to the tubercles on the base of the 5th metatarsal

Question 10

What are the signs and symptoms of an achilles tendon rupture?

Answer 10

• Sudden severe pain
• Loud pop sound
• A palpable gap/depression
• Inability to stand on tip toe

Question 11

What tests can be used to diagnose an achilles tendon rupture?

Answer 11

Thompson’s test (no plantarflexion when pressing calf)

-Can also use MRI and ultrasound to show gap

Question 12

How are achilles tendon rupture treated?

Answer 12

Surgical reconstitution

Aircast boot

Question 13

What is hallux valgus?

Answer 13

When the big toe (distal part) is deviated laterally

• Varus deviation of first metatarsal
• Valgus deviation of hallux

Question 14

What is a hallux rigidus?

Answer 14

Osteoarthritis of the 1st metatarsophalangeal joint

Question 15

What is arthroplasty?

Answer 15

Joint replacement for osteoarthritis

Question 16

What is arthrodesis?

Answer 16

Joint fusion for osteoarthritis

Question 17

What is excision arthroplasty?

Answer 17

Surgical removal of the joint in OA with interposition of soft tissue

Question 18

What is osteomy?

Answer 18

Surgical cutting of a bone to allow realignment

Question 19

What are the 4 types of toe deformities affecting the 2nd to 5th toes?

Answer 19

• Claw toe (hyperextended MTPJ and flexed PIPJ)
• Hammer toe (flexed PIPJ)
• Mallet toe (flexed DIPJ)
• Curly toes

Question 20

What is an achilles tendinopathy

Answer 20

Degenerative disorder of the achilles tendon causing swelling and pain (not inflammatory)

Question 21

What are the signs and symptoms of achilles tendinopathy?

Answer 21

• Pain and stiffness in the morning
• Thickening of the tendon
• Swelling
• A palpable bone spur

Question 22

What is a flat foot (Pes planovalgus)?

Answer 22

Collapsed medial longitudnial arch of the foot with valgus angulation of hindfoot

Question 23

What are the two types of flat foot?

Answer 23

1) Flexible flat feet = medial arch appears when standing on tip-toes
2) Rigid flat feet = no medial arch at all
- usually results from tarsal coalition (failure of tarsal bones to separate during embryonic development)
- often symptomatic

Question 24

What is charcot arthropathy?

Answer 24

Progressive destruction of the bones, joints and soft tissues commonly from diabetic foot diseases