FOOT + ANKLE DISORDERS Flashcards
What is compartment syndrome
Rise in intra-compartmental pressure due to trauma (blunt or penetrating) of a fascial compartment which led to haemorrhage or oedema.
Clinical signs of compartment syndrome?
-Severe pain in the limb (excessive for the degree of injury) increasing and not releived by analgesia.
What exacerbates pain in compartment syndrome?
-Pain is classically exacerbated by passive stretch of the muscles
How is compartment syndrome treated?
Treated by surgical decompression (fasciotomy) should be performed for all affected compartments.
What are the short term consequences of compartment syndrome?
-Decreased perfusion of the muscle leading to ischaemia.
-Rhabdomyolysis and acute kidney injury
-Loss of the peripheral pulses and increased capillary refill time
-Ishcaemia of nerve fibres
-distal paraesthesia preceding loss of motor function.
Long term consequnces of compartment syndrome
-Acute kidney injury
-Fibrosis of the necrotic muscle leading to volkmann’s ischaemic contracture.
Cause of ankle fractures
usually caused by excessive inversion/eversion of the foot.
Consequences of ankle fractures
-Fracture blisters may delay surgery.
-Skin over fracture may become nectrotic the healing time is increased.
-Open ankle fractures have the risk of osteomyelitis.
What are open ankle fractures
Where the skin is breached and there is direct communication between the fracture and the external environment.
(entry for pathogens)
What are sprained ankle and 5th metatarsal fracture?
An ankle sprain refers to a partial or complete tear of one or more ligaments of the ankle joint.
What are risk factors for sprained ankle and 5th metatarsal fracture?
-Weak muscles that cross ankle joint
-Lax ankle ligaments
-Inadequate joint proprioception
-Slow neuromuscular response to and off balance position
-Running on uneven surfaces
-Shoes with bad heel support
-High heels
What is most common cause of sprained ankle and 5th metatarsal fracture?
-Most common mechanism of injury is an invesrion injury affecting the plantarflexed and weight bearing forr, anterior talo-fibular ligaments is most at risk of sprain.
Other causes of sprained ankle and 5th metatarsal fracture?
Excessive strain on the ligaments of the ankle
Excessive external rotation, inversion or eversion of the foot due to an external force
When a foot is foreced past normal range of motion.
Treatment of sprained ankle and 5th metatarsal fracture?
90% heal with rest + time
those that do not heal= ankle instability= somtimes require surgery.
Describe achilles tendon rupture
Most commonly occurs in men aged 30-50yrs during recreational sports that require bursts of jumping + running
Mechanism of injury for Achilles tendon rupture?
Forceful push off with an extended knee
Fall with the foot outstretched in front and the ankle dorsiflexed
Falling from height
Signs and Symptoms of Achilles tendon rupture?
-Sudden and severe pain at the back of the ankle
-Loud pop or snap
-Palpable gap in the tendon
-Intial pain and swelling followed by bruising
-Inability to stand on your tiptoes
How is achilles tendon rupture confirmed?
Confirmed by Thompsons test also with use of MRI and ultrasound.
Treatment of achilles tendon rupture?
-Two ends of Achilles are frayed making surgical reconstriction difficult.
-Treated conservatively with the foot being held in the correct position in an aircast boot.
What is Hallux valgus?
(Hallux= big toe)
-Involves the distal part of the toe being deviated laterally including:
>varus devation of 1st metatarsal
>valgus deviation of lateral rotation of the hallux
>prominence of the 1st metatarsal head with or without overlying callus
=> most common in middle aged females.
Symptoms of hallux valgus
-Painful movement of the first metataesal phalangeal joint
-Difficulty with footwear
-Cosmetically unattractive (patient implications)
Causes of hallux valgus
-High heel shoes or tight fitting shoes will not causes the condition but can exacerbate.
-Secondary to trauma
-Arthritic/ metabolic conditions
-Connective tissue disorder that cause ligament as laxity
Treatment of hallux valgus
-Surgery should not be carried out for cosmetic reasons alone as it may make that painful.
What is Hallux rigidus
-OA of the first metatarsophalangeal joint resulting in stiffness of this joint.
Causes of Hallux rigidus
-Secondary trauma
-Gout
-Previous septic arthritis
-This joint os normally under tremendous stress and during walking so is easily damaged,
What are the symptoms of Hallux rigidus?
-Pain in MTPJ on walking + on attempted dorsiflexion of the toe.
-Pain ar rest in several cases
-Pain releived by walking on the outside of the foot
-A dorsal bunion (osteophyte) may develop on the top of the joint and rub on patients shoes.
Surgical Treatment of Hallux rigidus?
-Arthroplasty= Joint replacement
-Arthrodesis= Joint fusion
-Excision arthroplasty= surgical removal of joint with interposition of soft tissue.
-Osteotomy= surgical cutting of a bone to allow realignment (take load off affected part of joint)
Describe the interposition of soft tissue in excision arthroplasty
-a rolled up tendon between the bone ends
Describe some non surgical treatment of Hallux rigidus.
-Activity modification
-Analgesia + Orthotics
-Intra-articular steroid injection
-Rigid orthotics to prevent motion injury in 1st MTPJ
Describe OA of the ankle joint?
-Nearly all cases= secondary arthritis
-Most cases that occur in the joints that have previously suffered trauma
(PT arthritis)
What are risk factors of OA of ankle joint?
-Joint stress e.g. footballers, ballet dancers
-Obesity
What is treatment of OA of ankle joint?
Arthrodesis, patients can walk well following this ankle fusion.
Alternative:
Ankle arthroplasty but this carries more risk
What is Claw toe?
-Affect all four of the small toes, all hyperextended at the MTPJ and flexed and PIPJ
What are consequences of Claw toe?
Corns may develop over the dorsum the toe
What causes Claw toe?
-Muscle imbalance= ligaments + tendons to become unaturally tight.
-Trauma, inflammation, RA
What is the difference between hammer toe and mallet toe
Hammer toe= flexed at PIPJ
Mallet toe= flexed at the DIPJ
-deformities most commonly affect the second toe.
What are causes of hammer and mallet toe?
-ill fitting shoes + pointed shoes
-Pressure on 2nd toe from adjacent hallux valgus.
-Muscle contraction + shortening making it harder to extened the toe.
What are curly toes?
-Congenital
-Involve 3-5th digits
-Usually bilateral more common when there is family history.
Causes of curly toes
Tendon of Flexor digitorum longus/ flexor digitorium brevis are too tight.
Symptoms of curly toes
Most children are asymptomatic
Treatment of curly toes
-Conservative with passive extension of toes + stretching of flexor tendons.
-Surgery rarely nedded (only if pain on activity)
What is Achilles tendinopathy?
-Degenerative not an inflammatory process
Can develop:
-@ point of insertion of tendon into calcaneus
-At the vascular watershed area within tendon
Causes of Achilles tendinopathy?
-Many years of overuse e.g. long distance runners + sprinters
-Inactive patients
Risk factors of Achilles tendinopathy?
-Obesity
-Diabetes
Sign + Symptoms of Achilles tendinopathy?
-Pain + stiffness along the tendon (morning)
-Pain in tendon worsens with activtiy
-Severe pain after exercise
-Swelling present all the time but worse with activity
-Palpable bony spur
Treatment of achilles tendinopathy?
-Physiotherapy
-Eccentric stretching exercises
-Improving vascularity of the tendon
What is flat foot?
-Medial arch of foot collapsed so medial border almost touches the ground.
Describe diabetes mellitus + the foot
Foot diseases include:
-Infection
-Ulceration
-Destruction tissues of the foot
Causes of diabetes mellitus + the foot
Loss of sensation (peripheral neuropathy)
Ischaemia
Immunosupression= foot ulcers + severe infections
-Loss of protective sensation so patients will continue to weight bear on the affected foot
Reduce effects of diabetes mellitus + the foot
Attend fiabetic foor clinics
Educating patients on how to look after their feet to reduce complications
Tight glycaemic control
What are causes of Charcot Athropathy?
-Poorly controlled diabetes
-Progressive destruction of bone + soft tissue
-Neuropathy
-Abnormal loading of the foot
-Repeated micro-trauma
-Metabolic abnormalities lead to inflammation
Treament of Charcot Athropathy
Optimisation of glycaemic control
Reduction of the load placed on affected joints
