Foot/ankle Flashcards
Ligament injuries - inversion ( lateral)
Inversion injury- lateral ligament injury
70% of ankle ligament ruptures involve only the anterior talo- fibular ligament
20% are combined anterior talo- fibular and calcaneo- fibular lig injuries
10% of ankle injuries will involve the anterior tib- fib lig
Posterior talo- fib lig rarely ruptures
Achilles’ tendon injury
- differentiate between partial and full thickness tears
- if complete tendon rupture measure the gap in the tendon with the foot dorsiflexed and plantarflexed
- Thompson’s test - Achilles tendon rupture- squeeze belly of calf muscle, positive if no plantarflexion of foot
Mimicking Achilles’ tendon tears
- false negative Thompson test with complete rupture of Achilles but intact Plantaris
-distension of retrocalcaneal bursa due to inflammation or haemorrhaging bursitis with a normal Achilles tendon
-ruptured bakers cyst can track to the level of the Achilles tendon.
Check the popliteal fossa if the Achilles’ tendon and retrocalcaneal bursa are normal
- madrigal gastrocnemius tear
Ligament Injuries- Eversion Injuries
Eversion Injuries - medial ligament injury
Deltoid ligament injury usually associated with a fracture of the proximal or distal fibula. Posterior tibial tendon rupture may mimic a deltoid rupture
- always check peroneal tendons, Achilles tendon and retrocalcaneal bursa for concurrent injury
Anterior tibia-talar joint injury
- simple joint effusion causes capsule to bulge
- complex joint effusions- heterogenous fluid collection due to: infection, inflammatory conditions, haemorrhage, intra- articular air, pigmented villonodular synovitis, synovial osteochondromatosis- FNA for diagnosis
Septic tenosynovitis
- extensive hypoechoic tenosynovitis
- can mimic a septic joint
- FNA with U/S important- blind aspiration could infect an aseptic joint
Foreign bodies
Can cause tendon tears
Chronic Ankle Pain - Lateral
- Subluxation/ dislocation of perineal tendons
- Longitudinal split in peroneus brevis
- untreated injured ligaments
- non- union of ligament
Chronic lateral ankle pain caused by subluxation/ dislocation of perineal tendons
- from injury to superior perineal retinaculum- audible clicking in ankle
- or from a congenitally flat or convex fibular groove
Chronic lateral ankle pain due to longitudinal split in peroneus Brevis
- most often seen in athletes due to repetitive trauma and in the elderly due to degeneration
- peroneus longus will often insinuate itself into the cleft of the split of peroneus Brevis tendon
Chronic lateral ankle pain due to untreated injured ligaments
- hypertrophic response with excessive granulation formation and mucoid degeneration in ligament region
Chronic lateral ankle pain due to non- union of ligament
- no reparative activity
- on U/S gaps or focal thinning of ligament
Chronic medial ankle pain
- Tibialis posterior tendon
- tarsal tunnel syndrome
- FDL and FHL pathology
Chronic medial ankle pain due to Tibialus posterior tendon pathology
- Chronic spontaneous rupture Tibialis posterior tendon causing a flat foot deformity
- partial tear of Tibialis posterior tendon from overuse, trauma or mechanical impingement by a bony osteophyte or screw from previous surgery on adjacent tibial surface
- congenital tear in Tibialis posterior tendon
Chronic medial ankle pain due to tarsal tunnel syndrome
- compression of posterior tibial nerve causes pain, altered sensation and muscle function deficit
- compression can be due to: ganglion, neuromas, lipoma, post traumatic fibrosis, tendinous pathology and swelling of the plantar fascia which can compress branches of the posterior nerve
Chronic medial ankle pain due to FDL and FHL pathology
Pathology of FDL and FHL is uncommon.
- FHL tendinitis seen in ballet dancers and soccer players
- longitudinal splits in FHL from prolonged walking or running
Chronic posterior ankle pain
Chronic rupture of Achilles’ tendon due to chronic tendinosis
Haglunds Syndrome
- compression of Achilles’ tendon and soft tissues between calcaneus and shoe
- on ultrasound thickened Achilles’ tendon, distended bursa and soft tissue bump
Chronic joint and anterior ankle pain
- Bony intra-articular loose body
- Bone spur on tibio-talar capsule causing impingement of extensor tendons
- extensor tendon pathology is the least common of all ankle tendon pathologies
- rupture of Tibialis anterior usually due to blunt or penetrating trauma. Bulbous retraction of the proximal tendon will usually be seen with a complete rupture
- Tendinosis of Tibialis anterior is rare- pain with dorsiflexion
Chronic heel and foot pain
- Plantar Fascitis
- Plantar fibromatosis
- Mortons Neuroma
Chronic heel pain due to plantar fascitis
- due to inflammation of the plantar fascia- seen commonly in runners
- hypoechoic thickening of the fascia> 4 mm
- Assess the entire length of the fascia. inflammation may be at insertion only or continue into the mid-foot
Chronic foot pain due to plantar fibromatosis
- firm single or multinodular lesion in the middle of the plantar surface of the foot
- May cause pain with walking or be asymptomatic
- hypoechoic lesions superficial to or within the plantar fascia
Chronic foot pain due to Mortons neuroma
- no true neuroma present
- swelling, degeneration and fibrosis of digital nerve
- entrapment neuropathy from repetitive compression of digital nerve against the transverse metatarsal ligament
- most commonly seen between 2-3and 3-4 web spaces
- on U/S - ovoid area of hypoechoic thickening in central web space
Soft tissue masses of the foot
- ganglia
- lipomas
- plantar fibroma
- abcess
- haemangioma
- A-V malformations
Tibialis anterior
O- lateral condyle of tibia
I- 1st cuneiform and 1st MT
A-dorsiflexed and inverts foot
N- deep Peroneal
Extensor Hallucis Longus
O- anterior surface of mid fibula
I- dorsal surface of distal phalanx of great toe
A- dorsiflexes and inverts foot
N- deep Peroneal
Extensor Digitorum Longus
O- lateral tib condyle, anterior surface of fibula
I- dorsal surface of the 2nd to 5 th phalanges
A-dorsiflexes, everts foot and extends toes
N- deep peronealN
Petronius tertius
O- distal third anterior surface of fib
I- dorsal surface of 5 th MT
A- dorsiflexes and everts foot
N- Peroneal N
Peroneus Longus
I- prox 2/3 rds of lateral fib
O- ventral surface of 1 st MT and medial cuneiform
A- plantar flexes and everts foot
N- superficial Peroneal
Peroneus Brevis
O- distal 2/3rds of fibula
I- lateral side of 5th MT
A- plantar flexes and everts foot
N- superficial Peroneal N
Gastrocnemius
O- medial and lateral femoral condyles
I- calcaneus via calcaneal tendon
A- flexes ankle, dorsiflexes foot
N- tibial
Soleus
O- posterior surface of tib and fib
I- calcaneus via calcaneal tendon
A- plantar flexes the foot
N- tibial
Plantaris
O - posterior surface of femur above condyle
I- calcaneus
A- flexes leg, plantar flexes foot
N- Tibial
Flexor Hallucis
Longus
O- lower 2/3rds of fibula
I-distal phalanx of great toe
A- flexes great toe, plantar flexes and inverts foot
N- tibial
Flexor Digitorum Longus
I- posterior surface of tibia
O- distal phalanx of the 2 nd to 5 th toes
A- flexes the toes, plantar flexes and inverts the foot
N- Tibial
Tibialis posterior
O- posterior surface of IOM, the tibia and fibula
I- navicular, cuneiform a, cuboid: 2nd to 4th Mt
A- plantar flexes and inverts the foot
N- tibial
