Foot/Ankle Flashcards
Foot bone at risk of AVN and why?
Talus, retrograde blood supply
Which tendon passes through groove on cuboid bone?
Peroneus longus
Which muscle inserts on the tuberosity of naviular
Posterior tibialis
Which muscle inserts on base of 5th MT?
Peroneus brevis
Contents of tarsal tunnel?
Within medial malleolus:
Tibialis posterior
FDL
Posterior tibial A, V, N
FHL
2nd MT aligns with which bone?
medial cuneiform
Weber/AO classification
Ankle fx (fibula) based on relation to plafond
A: distal to plafond (tibial plane)
B: at plafond
C: proximal to plafond (torn syndesmosis common)
Classification for ankle fractures?
Lange-Hansen classification
Ankle fx based on foot position and mechanism
SA: supination/adduction I-II
SER: supination/ER I-IV
PER: pronation/ER I-IV
PA: pronation/abduction I-III
Essex-Lopresti fx
Fx of calcaneus Either tongue-type or joint depression
Sanders fx
Calcaneus based on coronal CT findings
I-IV: how many fragments/fracture lines
A-C: lateral to medial
Rule out with ankle fx?
Spine injury
Bohler’s angle
Lines drawn tangential to anterior and posterior aspects of the calcaneus. May indicate fx if too low
What is the classification of talus neck fractures? AVN percentages?
Hawkins classification
Predicts AVN risk
I: 10%
II: 40%
III: 70%
IV: 100%
Hawkin’s sign
Resorption of subchondral bone in talus (lucency on XR) indicates fracture healing
Fleck sign
Avulsion of lisfranc ligament from 2nd MT base
Lisfranc (TMT joint) classification
Isolated, homolateral, divergent
5th MT base fx classification
Zone 1: avulsion fx
Zone 2: metadiaphyseal jxn (Jones fx)
Zone 3: proximal diaphysis (stress fx)
Jones fx?
Zone 2 fx of 5th MT base (metadiaphysial)
1 and # 2 injured ligaments in ankle sprains
ATFL #1, CFL #2
Action of ATFL?
Resists anterior motion
Action of CFL?
Resists inversion
Action of deltoid ligament?
Resists eversion
Ankle relocation blocked by which tendons?
EDB (medial) or PT (lateral)
Morning foot pain?
Plantar faciitis
Thompson test
Squeeze calf, absent foot plantarflexion = achillies tendon rupture
Ankle anterior drawer
Stabilize tibia, PF foot, anterior force. Tests lateral ligament (esp. ATFL)
Talar tilt
Stabilize tibia, DF foot, invert foot. Tests lateral ligaments (esp. CFL)
Ext. rotation stress test: how to do + ligaments tested
Stabilize tibia, ER foot. Tests deep deltoid and syndesmotic ligaments
Eversion stress test: how to +ligament tested
Stabilize tibia evert foot. tests superficial deltoid ligament
Squeeze test
Compress distal tibia/fibula. Pain may indicate syndesmosis injury
Heel rise test: how to + whats tested
Standing, rise onto toes. Heel should go into varus. No varus in posterior tibiasis tendon dysfuction.
Coleman block test: how to + what tested
Lateral foot and heel on block; 1st ray hands free.
Flexible hind foot varus: ankle will go into valgus or neutral on block.
Fixed hind foot varus: ankle will stay in varus on the block.
Tinel’s sign (ankle): how to + tests what
Tap nerve posterior to MM. Tingling may indicate tibial nerve entrapment in tarsal tunnel.
Compression test ankle: how to + tests what?
Squeeze foot at MT heads.
Pain or numbness/tingling may indicated interdigital (Morton’s) neuroma
Phases of gait (8) and important muscles
1: heel strike (TA)
2: Foot flat (gastroc)
3: Midstance
4: Heel off (PT+gastroc)
5: Toe off 6: preswing
7: midswing
8: terminal swing
1st layer of foot and innervation
Abductor hallucis (medial plantar) Flexor digitorum brevis (medial plantar) Adbuctor digiti minimi (lateral plantar 1st branch)
Nerves come from tibial
2nd layer of foot and innervation
Quadratus plantae (LP) Lumbricals (1 - MP, 2-4 - LP) FHL, FDL tendons
3rd layer of foot and innervation
Flexor hallucis brevis (MP) Adductor hallucis (LP) Flexor digiti minimi brevis (LP)
4th layer of foot an innervation
Plantar interossei (3) (LP) Dorsal interossei (4) (LP) PL and TP tendons
Possible entrapment of lateral plantar n?
Abductor Digiti Minimi fascia
What artery supplies talar head and neck?
dorsalis pedis –> direct talar branches
Does surgery decrease achilles tendon rerupture?
Yes
1 musculoskeletal injury?
Ankle sprain
Gout: findings physical exam and labs
1st MTPJ, negatively birefringent crystals (yellow when parallel)
Hallux rigidus findings on XR?
Dorsal osteophyte or OA
Hallux Valgus angle?
>15°
Morton neuroma locations?
2nd and 3rd interdigital space
Acquired hindfoot cause and stages?
Posterior tibialis tendon failure
Stage 1: tenosynovitis, no deformity
Stage 2: Pes planus, flexible hindfoot, no single heel raise
Stage 3: rigid hindfoot,
Haglund’s disease
Retrocalcaneal bursitis
Baxter’s nerve?
lateral plantar nerve: 1st branch of
Seronegative spondyloarthropathy, findings?
Psoriasis: Sausage digit, pencil in cup deformity’ Neg RF
Deformity of clubfoot?
CAVE
Cavus midfoot forefoot
Adductus subtalar
Varus hindfoot
Equinus
Rigid flatfoot types
1) Tarsal coalition: fusion of two tarsal bones Calcaneonavicular #1, Talocalcaneal #2.
2) Congenital vertical talus
Anterolateral approach to ankle IN planes, dangers
IN planes - peroneals (superficial peroneals) Extensor digitorum longus (deep peroneal)
Dangers: Deep peroneal n, anterior tibial artery
Arthroscopy portals ankle (3)
Anteromedial - Saphenous nerve and vein
Anterolateral - superficial peroneal nerve
Posterolateral - sural nerve, lesser saphenous vein
