FOOT + ANKLE DISORDERS

Question 1

What is compartment syndrome

Answer 1

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

Question 2

Clinical signs of compartment syndrome?

Answer 2

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

Question 3

What exacerbates pain in compartment syndrome?

Answer 3

-Pain is classically exacerbated by passive stretch of the muscles

Question 4

How is compartment syndrome treated?

Answer 4

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

Question 5

What are the short term consequences of compartment syndrome?

Answer 5

-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.

Question 6

Long term consequnces of compartment syndrome

Answer 6

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

Question 7

Cause of ankle fractures

Answer 7

usually caused by excessive inversion/eversion of the foot.

Question 8

Consequences of ankle fractures

Answer 8

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

Question 9

What are open ankle fractures

Answer 9

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

Question 10

What are sprained ankle and 5th metatarsal fracture?

Answer 10

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

Question 11

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

Answer 11

-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

Question 12

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

Answer 12

-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.

Question 13

Other causes of sprained ankle and 5th metatarsal fracture?

Answer 13

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.

Question 14

Treatment of sprained ankle and 5th metatarsal fracture?

Answer 14

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

Question 15

Describe achilles tendon rupture

Answer 15

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

Question 16

Mechanism of injury for Achilles tendon rupture?

Answer 16

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

Question 17

Signs and Symptoms of Achilles tendon rupture?

Answer 17

-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

Question 18

How is achilles tendon rupture confirmed?

Answer 18

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

Question 19

Treatment of achilles tendon rupture?

Answer 19

-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.

Question 20

What is Hallux valgus?
(Hallux= big toe)

Answer 20

-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.

Question 21

Symptoms of hallux valgus

Answer 21

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

Question 22

Causes of hallux valgus

Answer 22

-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

Question 23

Treatment of hallux valgus

Answer 23

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

Question 24

What is Hallux rigidus

Answer 24

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

Question 25

Causes of Hallux rigidus

Answer 25

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

Question 26

What are the symptoms of Hallux rigidus?

Answer 26

-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.

Question 27

Surgical Treatment of Hallux rigidus?

Answer 27

-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)

Question 28

Describe the interposition of soft tissue in excision arthroplasty

Answer 28

-a rolled up tendon between the bone ends

Question 29

Describe some non surgical treatment of Hallux rigidus.

Answer 29

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

Question 30

Describe OA of the ankle joint?

Answer 30

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

Question 31

What are risk factors of OA of ankle joint?

Answer 31

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

Question 32

What is treatment of OA of ankle joint?

Answer 32

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

Question 33

What is Claw toe?

Answer 33

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

Question 34

What are consequences of Claw toe?

Answer 34

Corns may develop over the dorsum the toe

Question 35

What causes Claw toe?

Answer 35

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

Question 36

What is the difference between hammer toe and mallet toe

Answer 36

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

Question 37

What are causes of hammer and mallet toe?

Answer 37

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

Question 38

What are curly toes?

Answer 38

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

Question 39

Causes of curly toes

Answer 39

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

Question 40

Symptoms of curly toes

Answer 40

Most children are asymptomatic

Question 41

Treatment of curly toes

Answer 41

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

Question 42

What is Achilles tendinopathy?

Answer 42

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

Question 43

Causes of Achilles tendinopathy?

Answer 43

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

Question 44

Risk factors of Achilles tendinopathy?

Answer 44

-Obesity -Diabetes

Question 45

Sign + Symptoms of Achilles tendinopathy?

Answer 45

-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

Question 46

Treatment of achilles tendinopathy?

Answer 46

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

Question 47

What is flat foot?

Answer 47

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

Question 48

Describe diabetes mellitus + the foot

Answer 48

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

Question 49

Causes of diabetes mellitus + the foot

Answer 49

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

Question 50

Reduce effects of diabetes mellitus + the foot

Answer 50

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

Question 51

What are causes of Charcot Athropathy?

Answer 51

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

Question 52

Treament of Charcot Athropathy

Answer 52

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