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
