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ORTHO > FOOT & ANKLE > Flashcards

FOOT & ANKLE Flashcards

1
Q

movement in which the top of your foot points away from your leg.

A

PLANTAR FLEXION

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2
Q

where the toes are brought closer to the shin

A

DORSIFLEXION

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3
Q

curving of the nail margin that pushes under the paronychium and results in infection (paronychia)

A

ingrown toenail

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4
Q

temporary treatment for ingrown toenail

A
  • try to get the nail out of the paronychium - can use pieces of cotton or gauze
  • avoid narrow toed shoes
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5
Q

permanent treatment for ingrown toenail

A
  • remove the lateral margin of the nail by resection or phenolization (applied to nail matrix - will never grow back)
  • make sure nails are trimmed straight across and not curved
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6
Q

deformity of the PIP joint, causing it to be permanently bend

A

HAMMER TOE

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7
Q

HAMMER TOE

A
  • deformity of the PIP joint (flexion), causing it to be permanently bend, resembling a hammer
  • abnormal flexion of PIP joint of one of the four toes
  • the flexion deformity of the PIP joint may be fixed or supple
  • may involve contracture of FDL (flexor digitorum longus tendon), synovial contracture, poor fitting shoes, long 2nd metatarsal
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8
Q
  • hyperextension at the MTP joint and flexion at the PIP (and DIP) joint
A

CLAW TOE

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9
Q

CLAW TOE = have to remember to think about what?

A
  • claw toe = common feature of a neuropathic foot or pes cavus (high arches)
  • need to think about autoimmune too - RA / DM - Charcot foot, poor balance (neuropathy)
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10
Q

high arch

flat foot

A

high arch = pes cavus

flat feet = pes planus

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11
Q
  • flexion at DIP joint
A

MALLET TOE

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12
Q

MALLET TOE = most often occurs in which location

A

2nd toe DIP joint

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13
Q

MALLET TOE

A
  • flexion at DIP joint
  • usually due to tight fitting shoes
  • occurs most often in 2nd toe, which is frequently the longest, and is therefore impinged in a tight fitting shoe, causing DIP flexion
  • common in diabetics with peripheral neuropathy, and corns/calluses in this population may become infected
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14
Q

mallet toe is usually due to

A

ill-fitting shoes

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15
Q

treatment of toe deformities (hammer / claw / mallet)

A

⦁ wide shoes
⦁ have shoes stretched over toe
⦁ pads to decrease friction on shoe
⦁ keep mobile deformities mobile
⦁ splints / braces (to help keep the toes straight)
⦁ surgery (condylectomy - straightens toe)

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16
Q

METATARSALGIA

A

pain into the forefoot(ball of foot).

Most common location for foot pain in adults

Associated with increased stress over the metatarsal head region.

Partial or complete collapse of the transverse arch formed by the metatarsal heads

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17
Q

“SPLAYED TOE SIGN”

A

METATARSALGIA

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18
Q

most common location of pain with metatarsalgia

A

-The second and third metatarsal heads are the most common location of the pain.

Tenderness under the MP joint

Pain with plantarflexion

-The pain is often described as feeling like they are stepping on a stone.

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19
Q

TREATMENT OF METATARSALGIA

A

PADS
NSAIDS
INJECTIONS

surgical repair

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20
Q

BUNION

A

hallux valgus

WHAT HELPS?
Wide shoes 
Orthotics
Pads
Low (1” )heels
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21
Q

whether or not to have surgery with a bunion

A

Reasons to have surgery
Pain
Can’t wear shoes
Diabetic, and it may lead to an ulcer

When to avoid surgery
bunion, but tolerable or no pain
changes in shoes or inserts suffice

22
Q

BUNIONETTE - TAILOR’S BUNION

A

bunion of the 5th MTP joint

WHAT HELPS
Wide shoes** - always pick wide shoes on exam
Orthotics
“corn” pad
Surgery, when pads and shoes no longer help.

23
Q

MORTON’S NEUROMA

A

Collapse of the transverse arch that places traction and increased pressure on the interdigital nerve.

Overpronation and tight shoes are often associated with the condition.

nerves that run between metatarsals
if certain metatarsal heads roll inwards - nerve gets pinched
every time you step = get a zinger through the foot / feels like stepping on stone in shoe,etc.

24
Q

most common Morton’s neuroma location

A

3rd metatarsal space

Most commonly complains of a burning pain in the third intermetatarsal space (between the third and fourth distal metatarsals) that may radiate towards the toes.

25
Q

MULDER’S SIGN

A

MORTON’S NEUROMA

Examination may reveal a clicking sensation (Mulder’s sign) when palpating the involved interspace while simultaneously squeezing the metatarsal joints.

26
Q

TREATMENT OF MORTON’S NEUROMA

A

Wide shoes
Orthotic (with metatarsal bar)
Anti-inflammatory medicines
Cortisone injection( dorsal, not plantar, approach)

Surgery – Patients who remain symptomatic after 9 to 12 months of nonoperative therapy.
- > 95% pain free, but space between toes remains numb

Possible recurrence 1-3 years

27
Q

PLANTAR FASCITIS

A

Inflammation that develops at the calcaneal origin of the plantar fascia

28
Q

RISK FACTORS FOR PLANTAR FASCITIS

A

obesity, prolonged standing or jumping, flat feet, and reduced ankle dorsiflexion

29
Q

symptoms of plantar fascitis

A

pain in the front of the heel, especially bad first thing in the morning and when rising from a chair.

then gets better after being up/moving

worsens toward the end of the day with prolonged weight bearing.

30
Q

diagnosis of PF

A

can push on medial sides of plantar fascia

diagnostics = not helpful

31
Q

plantar fasciitis treatment

A 
Calf stretching+
Orthotics+
NSAID X 1 month
Night splints
Steroid injection

Surgery > 1 year

32
Q

POSTERIOR TIBIAL TENDON DYSFUNCTION

A

pain on inside of ankle

Gradual falling arch

Eventually pain on the outside of the foot and a severely flat and rotated foot

33
Q

treatment of posterior tibial tendon dysfunction

A

Orthotics – need to support arch extrinsically to give Post. Tib a chance to heal

Cast boot immobilization

Surgery

34
Q

most common ankle sprain ligament

A

MC = ATF with ankle sprain

75% of ankle “sprains” have at least one ligament completely ruptured (the remainder are partial or capsular injuries)

2/3 of those rupture only the ATFL

35
Q

MOI for ankle sprain

A

plantar flexion - anterior

inversion of hindfoot = CFL

internal rotation = syndesmotic rupture

36
Q

treatment of ankle sprain

A

RICE

Protection

Early mobilization and rehab (peroneal strengthening).

IF SEVERE
Cast or boot brace immobilization X 5-7 days, then reassess

Begin rehab when acute inflammation recedes.

Continue RICE.

  • avoid plantar flexion position with cast/brace/boot
  • want neutral position to slightly dorsiflexed to allow scar to heal
37
Q

WHAT ELSE TO ASSESS WITH SPRAINED ANKLE

A

On every ankle sprain asses for peroneal tendon injury and 5th metatarsal injury.

Also evaluate proximal fibula for pain and possible Maisonneuve fracture.

38
Q

DEGENERATIVE ARTHRITIS OF THE FOOT

A

symptoms of ankle arthritis

Stiffness in the ankle

Pain across the front of the ankle

Swelling, especially that comes and goes with use

TREATMENT
Anti-inflammatory medicines
Brace (to limit movement)
Cortisone injections

Surgery (fusion or ankle replacement)

ankle replacement = remove ends of bone and apply metal caps and plastic liner

39
Q

STANDARD TREATMENT FOR ANKLE ARTHRITIS

A

ANKLE FUSION

Decreases motion 60%

30% develop arthritis of the subtalar joint in 5-10 years

40
Q

HAGLUND SYNDROME

A

An enlargement of the bony section of the heel (where the Achilles tendon is inserted) triggers this condition.

The soft tissue near the back of the heel can become irritated

Clinical feature of this condition is pain in the back of the heel, which is more after rest.

  • It may be associated with limping and swelling/Inflammation
  • Rheumatologic conditions like gout, rheumatoid arthritis, or seronegative spondyloarthropathies should be considered
41
Q

increased pain in back of heel after rest

A

Haglund syndrome

42
Q

TALUS NECK FRACTURES

A

Severe dorsiflexion injury

Usually needs surgery

Interrupts blood supply

Can cause late ankle arthritis

43
Q

calcaneous fractures - 10% are associated with

A

spinal fractures

caused by axial loading injury

44
Q

jones fracture

A

5th metatarsal fracture

in an area of poor blood supply
notorious for not healing

need to immobilize the peroneal ligaments

surgery often indicated

45
Q

5th metatarsal base fracture

A

more in kids

lower down compared to jones fracture, towards base

heal fine - boot brace

46
Q

TOE FRACTURES

A

Rarely need surgery
Tape the toe to the next one
They hurt a long time (4-6 weeks)

47
Q

Thompson test

A

achilles tendon rupture

48
Q

achilles tendon rupture

A 
Middle aged athletes
Preceding pain and swelling (tendonosis)
“Someone kicked me”
Audible pop or tear
Thompson test
Palpate the tendon
49
Q

achilles tendon rupture treatment

A

surgery - faster recovery, more strength, lower re-rupture rate

non-surgery = works, but painful!

50
Q

LISFRANC SPRAIN

A

severe flexion injury to midfoot

can look really subtle - but can mess up mechanics for life

***break in 2nd tarsal/metatarsal area, then everything else shifts (toe part shifts laterally)

look for gap between 1st and 2nd metatarsal area

51
Q

SYMPTOMS OF LISFRANC SPRAIN/FRACTURE

A

The top of foot may be swollen and painful.

  • There may be bruising on both the top and bottom of the foot. Bruising on the bottom of the foot is highly suggestive of a Lisfranc injury.
  • Pain that worsens with standing, walking or attempting to push off on the affected foot. -The pain can be so severe that crutches may be required.
52
Q

LISFRANC TREATMENT

A

Non displaced injuries can be treated in a cast but many require late arthrodesis

Displaced injuries require surgery (sometimes twice)

ORTHO (15 decks)

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