Foot / Ankle Flashcards
a patient with remote history of lateral ankle sprain continues to have medial ankle pain long after the initial injury. what etiology are you concerned about?
OCD
what is the MOI of a high ankle sprain?
eversion
what is the weightbearing portion of the distal tibia?
tibial plafond
what is the most anterior portion of the talus?
head
what are the two main articulations which comprise the transverse tarsal joint?
calcaneocuboid and talonavicular
why does the talus have risk of AVN?
retrograde blood supply from the neck
what is os trigonum?
unfused lateral tubercle of the talus
the talar head is supported by what ligament?
spring ligament
what is Kohler’s disease?
osteonecrosis of the navicular
t/f tibialis anterior and posterior insert on the medial cuneiform
true
what tendon runs between the medial and lateral tubercles on the posterior talus?
FHL
which bone is the sustenaculum talus a part of?
calcaneus
what is a normal syndesmosis width ?
< 6mm
what is a normal medial clear space width?
< 4mm
what are the Weber ankle fracture classifications?
A - distal to plafond
B - at the level of the plafond
C - proximal to plafond
what is the bohler angle of the ankle?
angle between the superior aspect of the calcanueus and the overlying talus
t/f the bohler angle is usually reduced in a calcaneus fracture
true
what is the normal bohler angle?
25-40 degrees
most talus fractures occur in what portion of the bone?
neck
in a talus fracture, you should look for displacement at what two joints?
subtalar and tibiotalar joints
what is the fleck sign in regards to a tarsometatarsal joint injury?
avulsion of the lisfranc ligament from the 2nd MT base
on XR, what degree / measurement of widening between the 2nd MT base and cuneiform will be indicative of Lisfranc injury?
> 2mm
what is the typical treatment for non displaced Lisfranc injury?
8 weeks, non weightbearing cast
if a lisfranc injury has > 2mm widening, what is the treatment?
surgery
what is a zone 1 5th MT fracture?
avulsion
what is a zone 2 5th MT fracture?
metadiaphyseal junction fracture
what is a zone 3 5th MT fracture?
proximal diaphysis fracture
what is the general treatment for a non displaced 5th MT fracture zone 1?
hard shoe
what is the general treatment for zone 2/3 5th MT fracture?
ortho referral
what are the two general principles of conservative treatment for a stable, non displaced phalangeal fracture of the foot?
hard shoe / buddy tape
what is the general treatment for intraarticular hallux fracture?
surgery referral
the AITFL is injured in what type of Weber ankle injury?
type C
What is a Tilaux fracture / fragment?
avulsion injury of the AITFL
t/f if the ankle syndesmosis is torn, then the mortise is disrupted
true
what are the peroneal retinaculums?
superior and inferior
tendon or ligament will generally appear how on MRI
black / dark
the Lisfranc ligament connects what two structures?
2nd MT base to the medial cuneiform
what is another name for the plantar calcaneonavicular ligament?
spring ligament
what portion of the calcaneus does the spring ligament attach to?
sustenaculum tali
what joint complex makes up the transverse arch of the foot?
tarsometatarsal joint
what is the keystone of the tarsometatarsal joint?
2nd MT base
Avulsion of the lisfranc ligament will result in what radiographic sign?
fleck sign
t/f fibularis longus attaches to the medial cuneiform
true
in a turf toe injury, hyperextension results in avulsion injury of the plantar plate resulting in avulsion of the ligament from which structure?
Metatarsal
what are the four anterior ankle tendons?
tibialis anterior, EHL, EDL, fibularis tertius
which sensory nerve is posterior to lateral malleolus?
sural nerve
which sensory nerve is superior to the medial malleolus?
saphenous nerve
what is the normal extension and flexion of the ankle ROM?
25 degrees dorsiflexion and 50 degrees plantarflexion
what is the normal amount of flex/extend ROM of the hallux at the MTPJ?
75 degrees in both extension and flexion
what peripheral nerve is responsible for foot eversion?
superficial peroneal nerve
what nerve supplies sensation to the lateral and medial foot, respectively?
lateral - sural
medial - saphenous
what are the three bands that make up the plantar fascia?
central, lateral, and medial
which muscles adduct the toes?
plantar interossei
which muscles abduct the toes?
dorsal interossei
the dorsal and plantar interossei are innervated by what nerve?
lateral plantar nerve
which nerve runs between the tibialis anterior and EHL tendon?
deep peroneal nerve
the lateral dorsal cutaneous nerve of the foot is a continuation of which nerve?
sural nerve
what are the functions of the medial and lateral branches of the deep peroneal nerve, respectively?
medial - sensory
lateral - motor
what nerves give rise to the medial sural cutaneous and lateral sural cutaneous nerve, respectively?
medial - tibial nerve
lateral- peroneal nerve
which artery gives rise to the dorsalis pedis artery?
anterior tibial artery
what is the diagnosis for end stage diabetic foot, consisting of osteopenia, fractures, callus, and joint destruction?
Charcot neuroarthropathy
what is the term for hyperkeratosis of skin due to excess pressure on bones?
corn
what are the two oral medication treatment options for acute gout?
nsaid/colchicine
what is the etiology of hallux rigidus?
DJD of the MTP joint
what two findings are you most likely to see on XR of a foot with hallux rigidus?
dorsal osteophyte at the joint space and OA
claw toes are associated with what underlying disease?
neurologic disease
what is the #1 cause of metatarsalgia?
callus
what focal site is the most common area affected by metatarsalgia?
2nd MT
what tendon is the major supporting structure of the midfoot arch due to its attachment to the navicular and al midtarsal bones?
tibialis posterior
Morton’s neuroma most commonly affects which space?
between 2nd/3rd MT
the single heel raise and too many toes sign are testing for function of what structure?
posterior tibialis
what is Haglund’s disease?
retrocalcaneal bursitis
generally, what are the two major causes of “runner’s foot?”
medial or lateral plantar nerve entrapment or stress injury
in the treatment of turf toe, what type of foot orthosis is needed?
blocking dorsiflexion
what is the #1 pediatric foot disorder?
metatarsus adductus
what are the three types of tarsal coalition?
bony, fibrous, and cartilaginous
A patient sustains 5th MT base fracture, non displaced, zone 2. If choosing conservative management at what two time periods should X-ray be repeated to look for healing?
1 week and 4-6 weeks
A patient sustains zone 2 fifth MT fracture , non displaced. If choosing conservative management how long should immobilization with boot last?
6-8 weeks
A patient sustains zone 2 fifth MT fracture , non displaced. If choosing conservative management how long should immobilization with boot last?
6-8 weeks
