Foot, Ankle And Compartment Injuries

Question 1

What is compartment syndrome

Answer 1

A rise in intracompartmental pressure due to trauma to a fascial compartment

Question 2

What are the clinical signs of compartment syndrome

Answer 2

Severe pain excessive for the degree of injury
Not relieved by analgesia
Exacerbated by passive stretch of the muscles

Question 3

How do you treat compartment syndrome

Answer 3

Fasciotomy - surgical decompression

Question 4

What are the short term consequences of compartment syndrome

Answer 4

Rhabdomyolysis

Acute kidney injury

Question 5

Long term consequences of compartment syndrome

Answer 5

Acute kidney injury becomes chronic

Volkmanns ischaemic contracture

Question 6

In compartment syndrome, which consequence comes first, distal paraesthesia or loss of motor function

Answer 6

Distal paraesthesia

Question 7

How is an open ankle fracture dealt with

Answer 7

Urgent surgery, extensive irrigation, debridement

To reduce the risk of osteomyelitis

Question 8

The ankle joint and associated ligaments can be visualised as a ring in the coronal plane, describe the ligament arrangement

Answer 8

Proximal part of the ring: inferior tibiofibular joint:
Syndesmotic ligaments

Medial side of the ring: medial (deltoid) ligament

Inferior part of the ring: subtalar joint

Lateral side of the ring: lateral ligament complex (anterior talofibular, talocalcaneal, posterior talofibuar)

Question 9

What is Talar shift:

Answer 9

When there is disruption of any two ligaments (out of syndesmosis, medial and lateral) the ankle mortise becomes unstable and widens and the talus can shift medially or laterally

Question 10

What factors increase the risk of an ankle sprain

Answer 10

Weak muscles and tendons crossing the joint; esp peroneal
Weak or or lax ligaments: hereditary or overstretching
Inadequate joint proprioception
Slow neuromuscular response to an off balance position
Running on uneven surface
High heels

Question 11

What is the most common mechanism of ankle sprain and what ligament is most commonly affected

Answer 11

Inversion affecting a plantar-flexed and weight bearing foot

Anterior talofibular ligament

Question 12

In a severe sprain of the ankle, the patient can have an avulsion fraction where? And why?

Answer 12

Fibularis brevis tendon attached to a tubercle on the base of the 5th metatarsal

Question 13

What is a Thompsons test

Answer 13

Test for a ruptured Achilles’ tendon
Squeeze the calf and the foot should plantar flex.
If its ruptured, no plantar flex

Question 14

Mechanism of injury for an Achilles’ tendon rupture

Answer 14

Forceful push off with extended knee
Falling on outstretched foot ad ankle dorsiflexed
Falling from height or abruptly stepping into a hole or off a kerb

Question 15

Why is surgical reconstruction of the Achille’s tendon difficult

Answer 15

The two ends are frayed

Wouund complications use to the thin skin and poor vascularisation

Question 16

Describe the positions of the bones in hallux valgus

Answer 16

Varus deviation of first metatarsal
Valgus deviation &/or lateral rotation of the hallux
Prominence of the first metatarsal head, with or without an overlying callus

Question 17

What is hallux rigidus

Answer 17

OA of the 1st MTPJ resulting in stiffness

Question 18

What is a rigid sole orthotic

Answer 18

A very stiff shoe insert that prevents motion at the 1st MTPJ in hallux rigidus

Question 19

What is the major difference between OA of the ankle and that of the hip or knee?

Answer 19

Nearly all cases of OA in the ankle are secondary arthritis - post traumatic

Question 20

What is the gold standard treatment for OA of the ankle joint

Answer 20

Arthrodesis

Question 21

Describe a claw toe

Answer 21

Hyperextended at the MTPJ
Flexed at the PIP joint

The toes curl under the foot

Question 22

What normally causes Claw Toes

Answer 22

A muscle imbalance which causes the ligaments and tendons to become unnaturally tight, usually due to neurological damage

Question 23

Describe a hammer toe

Answer 23

Flexed at the PIPJ

Question 24

Describe a Mallet Toe

Answer 24

Flexed at the DIPJ

Question 25

Describe how curly toes occur

Answer 25

3rd-5th digits
Bilateral
The tendons of the flexor digitorum longs or flexor digitorum brevis are too tight

Question 26

What is Achilles Tendinopathy

Answer 26

Degeneration of the Achilles Tendon

Question 27

An Achilles Tendinopathy can develop at two different points, describe where

Answer 27

Insertional Tendinopathy; at the point of insertion of the Achilles’ tendon into the calcaneum

Non insertional Tendinopathy; at the vascular watershed area within the tendon

Question 28

What are the signs and symptoms of Achilles Tendinopathy

Answer 28

Pain and stiffness in the morning
Pain in tendon or back of heel that worsens with activity
Severe pain 24hrs after exercising
Thickening of the tendon
Swelling present at all times, worsens with activity
Palpable Bone spur with insertional

Question 29

What is the Latin name for flat feet and what does this mean

Answer 29

Pes Planovalgus

Pes = foot
Plano = flat
Valgus = lateral angulation

Question 30

In flat foot, which arch has collapsed

Answer 30

Medial

Question 31

When does the medial longitudinal arch of the foot start to develop

Answer 31

5 yrs of age

Question 32

What are flexible flat feet

Answer 32

No medial arch when standing normally, but when on tip toes a normal medial arch appears and the hind foot returns from valgus alignment to normal alignment

Question 33

Rigid flat feet are always abnormal, how do they develop

Answer 33

Tarsal coalition - failure of the tarsal bones to separate during embryonic development

Question 34

What happens in adult acquired flatfoot

Answer 34

Dysfunction of the tibialis posterior tendon which usually supports he medial longitudinal arch of the foot

Question 35

What is Charcot Arthropathy

Answer 35

A condition resulting from the progressive destruction of bones, joints and soft times seen in diabetes