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msk clinical conditions > FOOT + ANKLE DISORDERS > Flashcards

FOOT + ANKLE DISORDERS Flashcards

1
Q

What is compartment syndrome

A

Rise in intra-compartmental pressure due to trauma (blunt or penetrating) of a fascial compartment which led to haemorrhage or oedema.

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2
Q

Clinical signs of compartment syndrome?

A

-Severe pain in the limb (excessive for the degree of injury) increasing and not releived by analgesia.

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3
Q

What exacerbates pain in compartment syndrome?

A

-Pain is classically exacerbated by passive stretch of the muscles

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4
Q

How is compartment syndrome treated?

A

Treated by surgical decompression (fasciotomy) should be performed for all affected compartments.

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5
Q

What are the short term consequences of compartment syndrome?

A

-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.

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6
Q

Long term consequnces of compartment syndrome

A

-Acute kidney injury
-Fibrosis of the necrotic muscle leading to volkmann’s ischaemic contracture.

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7
Q

Cause of ankle fractures

A

usually caused by excessive inversion/eversion of the foot.

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8
Q

Consequences of ankle fractures

A

-Fracture blisters may delay surgery.
-Skin over fracture may become nectrotic the healing time is increased.
-Open ankle fractures have the risk of osteomyelitis.

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9
Q

What are open ankle fractures

A

Where the skin is breached and there is direct communication between the fracture and the external environment.
(entry for pathogens)

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10
Q

What are sprained ankle and 5th metatarsal fracture?

A

An ankle sprain refers to a partial or complete tear of one or more ligaments of the ankle joint.

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11
Q

What are risk factors for sprained ankle and 5th metatarsal fracture?

A

-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

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12
Q

What is most common cause of sprained ankle and 5th metatarsal fracture?

A

-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.

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13
Q

Other causes of sprained ankle and 5th metatarsal fracture?

A

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.

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14
Q

Treatment of sprained ankle and 5th metatarsal fracture?

A

90% heal with rest + time
those that do not heal= ankle instability= somtimes require surgery.

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15
Q

Describe achilles tendon rupture

A

Most commonly occurs in men aged 30-50yrs during recreational sports that require bursts of jumping + running

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16
Q

Mechanism of injury for Achilles tendon rupture?

A

Forceful push off with an extended knee
Fall with the foot outstretched in front and the ankle dorsiflexed
Falling from height

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17
Q

Signs and Symptoms of Achilles tendon rupture?

A

-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

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18
Q

How is achilles tendon rupture confirmed?

A

Confirmed by Thompsons test also with use of MRI and ultrasound.

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19
Q

Treatment of achilles tendon rupture?

A

-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.

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20
Q

What is Hallux valgus?
(Hallux= big toe)

A

-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.

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21
Q

Symptoms of hallux valgus

A

-Painful movement of the first metataesal phalangeal joint
-Difficulty with footwear
-Cosmetically unattractive (patient implications)

22
Q

Causes of hallux valgus

A

-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

23
Q

Treatment of hallux valgus

A

-Surgery should not be carried out for cosmetic reasons alone as it may make that painful.

24
Q

What is Hallux rigidus

A

-OA of the first metatarsophalangeal joint resulting in stiffness of this joint.

25
Q

Causes of Hallux rigidus

A

-Secondary trauma
-Gout
-Previous septic arthritis
-This joint os normally under tremendous stress and during walking so is easily damaged,

26
Q

What are the symptoms of Hallux rigidus?

A

-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.

27
Q

Surgical Treatment of Hallux rigidus?

A

-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)

28
Q

Describe the interposition of soft tissue in excision arthroplasty

A

-a rolled up tendon between the bone ends

29
Q

Describe some non surgical treatment of Hallux rigidus.

A

-Activity modification
-Analgesia + Orthotics
-Intra-articular steroid injection
-Rigid orthotics to prevent motion injury in 1st MTPJ

30
Q

Describe OA of the ankle joint?

A

-Nearly all cases= secondary arthritis
-Most cases that occur in the joints that have previously suffered trauma
(PT arthritis)

31
Q

What are risk factors of OA of ankle joint?

A

-Joint stress e.g. footballers, ballet dancers
-Obesity

32
Q

What is treatment of OA of ankle joint?

A

Arthrodesis, patients can walk well following this ankle fusion.
Alternative:
Ankle arthroplasty but this carries more risk

33
Q

What is Claw toe?

A

-Affect all four of the small toes, all hyperextended at the MTPJ and flexed and PIPJ

34
Q

What are consequences of Claw toe?

A

Corns may develop over the dorsum the toe

35
Q

What causes Claw toe?

A

-Muscle imbalance= ligaments + tendons to become unaturally tight.
-Trauma, inflammation, RA

36
Q

What is the difference between hammer toe and mallet toe

A

Hammer toe= flexed at PIPJ
Mallet toe= flexed at the DIPJ
-deformities most commonly affect the second toe.

37
Q

What are causes of hammer and mallet toe?

A

-ill fitting shoes + pointed shoes
-Pressure on 2nd toe from adjacent hallux valgus.
-Muscle contraction + shortening making it harder to extened the toe.

38
Q

What are curly toes?

A

-Congenital
-Involve 3-5th digits
-Usually bilateral more common when there is family history.

39
Q

Causes of curly toes

A

Tendon of Flexor digitorum longus/ flexor digitorium brevis are too tight.

40
Q

Symptoms of curly toes

A

Most children are asymptomatic

41
Q

Treatment of curly toes

A

-Conservative with passive extension of toes + stretching of flexor tendons.
-Surgery rarely nedded (only if pain on activity)

42
Q

What is Achilles tendinopathy?

A

-Degenerative not an inflammatory process
Can develop:
-@ point of insertion of tendon into calcaneus
-At the vascular watershed area within tendon

43
Q

Causes of Achilles tendinopathy?

A

-Many years of overuse e.g. long distance runners + sprinters
-Inactive patients

44
Q

Risk factors of Achilles tendinopathy?

A

-Obesity
-Diabetes

45
Q

Sign + Symptoms of Achilles tendinopathy?

A

-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

46
Q

Treatment of achilles tendinopathy?

A

-Physiotherapy
-Eccentric stretching exercises
-Improving vascularity of the tendon

47
Q

What is flat foot?

A

-Medial arch of foot collapsed so medial border almost touches the ground.

48
Q

Describe diabetes mellitus + the foot

A

Foot diseases include:
-Infection
-Ulceration
-Destruction tissues of the foot

49
Q

Causes of diabetes mellitus + the foot

A

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

50
Q

Reduce effects of diabetes mellitus + the foot

A

Attend fiabetic foor clinics
Educating patients on how to look after their feet to reduce complications
Tight glycaemic control

51
Q

What are causes of Charcot Athropathy?

A

-Poorly controlled diabetes
-Progressive destruction of bone + soft tissue
-Neuropathy
-Abnormal loading of the foot
-Repeated micro-trauma
-Metabolic abnormalities lead to inflammation

52
Q

Treament of Charcot Athropathy

A

Optimisation of glycaemic control
Reduction of the load placed on affected joints

msk clinical conditions (8 decks)

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