Foot and Ankle Sprains Flashcards
Inspection of the foot/ankle
- appearance
- gait (watch come in without them knowing!)
- overall alignment of LE
- alignment of foot and ankle
Vascular exam of foot/ankle
- dorsalis pedis pulse
- posterior tibial pulse
- cap refill
Sensory exam of foot/ankle
- light vs. deep pressure touch
- light: Semmes-Weinstein filament
- peripheral nerve distribution vs. nerve root level (Clowers prefers peripheral for his foot exams)
Motor exam of foot/ankle
- ankle dorsiflexion/plantar-flexion
- Hind-foot eversion/inversion
- Great toe and lesser toe flexion and extension
Palpation of foot/ankle
manual map of entire foot and ankle - this is what Clowers spends the majority of his exam doing
Special tests of foot/ankle
- stability
- Achilles
- at your discretion
What is the best radiographic imaging of foot and the ankle
- weight bearing
- 3 views of foot (AP, oblique, lateral)
- 2 views of ankle (AP and oblique)
Xray is usually sufficient, MRI/CT only after xray
what stress radiographs may be helpful in certain situations
- External rotation stress
- varus/anterior drawer
- pronation/abduction
What are the 4 main sprains of the foot and ankle
Ankel - lateral ligaments - syndesmosis - deltoid Midfoot
What usually causes an acute lateral sprain?
inversion that results in abrupt stretching or fractional lengthening of the ATFL and/or CFL
What are the three ligaments in the lateral ligamentous complex and what is their main role
- ATFL
- CFL
- PTFL (minor)
Static stabilizers (the seatbelt)
What is the anatomic purpose of the ATFL
- mostly resists anterior translation of talus
- resists inversion
What is the anatomic purpose of the CFL
resists inversion, varus stress
Lateral ankle sprain
- clinical exam findings
- swelling
- bruising
- lateral tenderness/pain MC, can be elsewhere in foot too
Lateral ankle sprain
- imaging
plain radiographs
What other potential injury can occur with lateral ankle sprain?
- peroneal tendon
- lateral process of talus
- anterior process of calcaneus
- cuboid/fibular contusion
- osteochondral defect
Lateral ankle sprain initial management
1 mitigate inflammatory response:
- immobilization
- cryotherapy
- limit weight-bearing
- NSAIDs
Lateral ankle sprain, when transition from both to brace?
When weightbearing in boot without pain
What formal therapy is needed for lateral ankle sprains?
- passive motion
- strengthening
- proprioception (once regained can resume athletic activities)
- PT
After how many weeks of no progression is it time to pursue advanced imaging?
6 weeks
Deltoid ligament injury
- how common?
- how treat?
- Much less common than lateral sprains
- Usually occur in conjunction with ankle fx/other injuries
- Tx usually conservative, similar to lateral sprain
- Immobilization and limited WB followed by functional rehab and bracing
- Heal very well
Deltoid ligament
- describe
- primary static restraint to valgus instability of tibio-talar joint
- four components
- two functional components - superficial and deep (primary portion)
Deltoid ligament injury
- commonly associated with what
- low E rotational ankle fractures
Tibia-Fibular syndesmosis
- joint formed between distal tibia and fibula
- Strong ligament complex: interosseous ligament, AITFL, PITFL, interior transverse
- runs to the knee
- takes a lot of force to injure
What is anatomical purpose of tibia-fibular syndesmosis
allows for accommodation of variable width of the taller body with varying angles of flexion
- allows talus to move up and down in ankle as foot dorsi- and plantar- flexes
What is a syndesmosis injury called?
high ankle sprain
What generally causes injury to syndesmosis? What is often seen in conjunction with this injury?
- eversion or external rotation
- bony injuries or other ligament injuries
What are the three grades of syndesmosis instability?
Grade I: stable radiographically, conservative tx
Grade II: unstable on stress radiograph
Grade III: diastasis on non-weightbearing radiograph
How to treat stable syndesmosis injuries
- conservative
- non-weightbearing and immobilization for 4-6 weeks
- then advance weight bearing and rehab
- return to play slower than lateral ankle sprain
How to treat unstable syndesmosis injuries
- operative repair if bony injuries present
- screw fixation
- suture button fixation
Lisfranc Injury
- describe
- Ligament on bottom of foot from median cuneiform to second metatarsal base
- injury usually from hyper-extension moment of midfoot
- easily missed. Bilateral comparison really helpful
Lisfranc injury
- clinical exam
- presentation similar to ankle sprains
- look for plantar ecchymosis
Lisfranc Injury
- radiographic eval
- Weightbearing image if possible
- pronation/abduction stress view
Lisfranc Injury
- stable injury tx
- conservative
- boot immobilization
- limited weight bearing
Lisfranc Injury
- unstable injury tx
- operative reduction and fixation
- chronic instability can lead to degenerative change
