Foot, Ankle And Compartment Injuries Flashcards
What is compartment syndrome
A rise in intracompartmental pressure due to trauma to a fascial compartment
What are the clinical signs of compartment syndrome
Severe pain excessive for the degree of injury
Not relieved by analgesia
Exacerbated by passive stretch of the muscles
How do you treat compartment syndrome
Fasciotomy - surgical decompression
What are the short term consequences of compartment syndrome
Rhabdomyolysis
Acute kidney injury
Long term consequences of compartment syndrome
Acute kidney injury becomes chronic
Volkmanns ischaemic contracture
In compartment syndrome, which consequence comes first, distal paraesthesia or loss of motor function
Distal paraesthesia
How is an open ankle fracture dealt with
Urgent surgery, extensive irrigation, debridement
To reduce the risk of osteomyelitis
The ankle joint and associated ligaments can be visualised as a ring in the coronal plane, describe the ligament arrangement
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)
What is Talar shift:
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
What factors increase the risk of an ankle sprain
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
What is the most common mechanism of ankle sprain and what ligament is most commonly affected
Inversion affecting a plantar-flexed and weight bearing foot
Anterior talofibular ligament
In a severe sprain of the ankle, the patient can have an avulsion fraction where? And why?
Fibularis brevis tendon attached to a tubercle on the base of the 5th metatarsal
What is a Thompsons test
Test for a ruptured Achilles’ tendon
Squeeze the calf and the foot should plantar flex.
If its ruptured, no plantar flex
Mechanism of injury for an Achilles’ tendon rupture
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
Why is surgical reconstruction of the Achille’s tendon difficult
The two ends are frayed
Wouund complications use to the thin skin and poor vascularisation
Describe the positions of the bones in hallux valgus
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
What is hallux rigidus
OA of the 1st MTPJ resulting in stiffness
What is a rigid sole orthotic
A very stiff shoe insert that prevents motion at the 1st MTPJ in hallux rigidus
What is the major difference between OA of the ankle and that of the hip or knee?
Nearly all cases of OA in the ankle are secondary arthritis - post traumatic
What is the gold standard treatment for OA of the ankle joint
Arthrodesis
Describe a claw toe
Hyperextended at the MTPJ
Flexed at the PIP joint
The toes curl under the foot
What normally causes Claw Toes
A muscle imbalance which causes the ligaments and tendons to become unnaturally tight, usually due to neurological damage
Describe a hammer toe
Flexed at the PIPJ
Describe a Mallet Toe
Flexed at the DIPJ
