Foot And Ankle Problems

Question 1

Are fracture blisters common after ankle fracture and how do they affect surgery?

Answer 1

Fracture blisters are relatively common after ankle fractures and have to heal before surgery can be performed

Question 2

What is there a risk of with open ankle-fractures?

Answer 2

Osteomyelitis- infection of the bone

Question 3

What are the ligaments likely to be broken in an ankle fracture?

Answer 3

Deltoid ligament, lateral ligament complex and syndesmotic ligaments

Question 4

What is an ankle sprain?

Answer 4

A partial or complete tear of one or more ligaments of the ankle joint

Question 5

What are some factors that increase the risk of ankle sprains?

Answer 5

Weak muscles/tendons, weak ligaments, running on uneven surface, shoes with inadequate heel support/high heels

Question 6

What is the most common mechanism of injury in ankle sprains?

Answer 6

Inversion injury of a plantar-flexed and weight bearing foot

Question 7

When there is inversion of the ankle which ligament is at the greatest risk?

Answer 7

The anterior talofibular ligament

Question 8

In a severe sprain of the ankle why can the patient have an allusion fracture of their fifth metatarsal?

Answer 8

The fibularis brevis tendon is attached to tuberosity of fifth metatarsal and is under high tension in an inversion injury

Question 9

In what patients do Achilles’ tendon rupture most commonly occur?

Answer 9

Men aged 30-50 (weekend warriors)

Question 10

What actions can give rise to Achilles’ tendon rupture?

Answer 10

Forceful push-off (e.g jumping), a fall on outstretched dorsiflexed foot (overstretches tendon), stepping into a hole or off a kerb

Question 11

What is the common site of rupture called and why is the rupture likely to occur here?

Answer 11

The site is called ‘vascular watershed’, this area has decreased vascular ivy and thickness

Question 12

Is it more common to have a complete or partial tear of the Achilles’ tendon?

Answer 12

Complete

Question 13

What are the signs and symptoms of Achilles’ tendon rupture?

Answer 13

Sudden severe pain in back of ankle/ calf (kick to heel), loud pop sound, palpable gap in tendon, pain, swelling, later bruising, inability to stand on tip toe

Question 14

What test can you perform on the patient to check Achilles rupture?

Answer 14

Thompson’s test, patient lays on their front with foot hanging off bed, squeeze their calf and if Achilles intact foot should platarflex

Question 15

How are most Achilles’ tendon ruptures treated?

Answer 15

Conservatively with foot being held in position in an air cast boot

Question 16

What is the most cause of a bunion?

Answer 16

Hallux valgus

Question 17

Why is a patient with hallux valgus advices not to wear heels?

Answer 17

Exacerbates already present condition

Question 18

How can hallux valgus be treated surgically?

Answer 18

A metatarsal osteotomy and realignment of the fragments

Question 19

What is hallux rigidus?

Answer 19

Osteoarthritis of the first metatarsophalangeal joint

Question 20

How is hallux rigidus?

Answer 20

Activity modification, analgesia, orthotics/aids and sometimes intra-articular steroid injections

Question 21

What percentage of osteoarthritis cases of the ankle joint are post-traumatic arthritis cases?

Answer 21

70-80% with a further 12% are secondary to rheumatoid arthritis

Question 22

What is the gold standard treatment for OA of the ankle joint?

Answer 22

Arthrodesis (fusion)

Question 23

What are some toe deformities?

Answer 23

Claw, mallet, hammer and curly toes

Question 24

A what is Achilles tendonitis?

Answer 24

A degenerative condition leading to a thickened and degenerated Achilles’ tendon

Question 25

What are some signs and symptoms of Achilles tendonitis?

Answer 25

Pain and stiffness of tendon in mornings, pain that worsens on activity, severe pain 24 hours after exercising, thickening of tendon, swelling which worsens on activity

Question 26

What is the difference between rigid and flexible flat feet?

Answer 26

When heel is raised off floor in flexible feet a normal medial arch appears, not in rigid

Question 27

What causes rigid flat foot?

Answer 27

Tarsal coalition, the tarsal bones haven’t separated during embryonic development

Question 28

What is the cause and some symptoms of adult acquired flat foot?

Answer 28

Tibialis posterior tendon disfunctioning

Symptoms: change in foot shape and pain behind medial malleolus

Question 29

How is adult acquired flat foot treated?

Answer 29

Orthotics (insoles) help 80% rest may need surgical reconstruction

Question 30

What symptoms of diabetes lead to foot ulcers and serious infection?

Answer 30

Loss of sensation, peripheral arterial disease, microvascular disease, immunosupression

Question 31

What is Charcot arthropathy?

Answer 31

Progressive destruction of the bones, joints and soft tissues of the foot