Foot/Ankle Pathology Flashcards
what are the key signs of fractures?
swelling, tenderness, gait change, reproduction of cc by performing activity
what bones do the greatest percentage of fxs occur?
metatarsals
fibula (lateral malleolus) –> prone to torsion
what is the cause & pathology for fxs?
- Increase load on bone after fatigue of supporting structures (ligaments/tendons)
- Hypovascularity (Decrease blood supply) of certain areas of bone will create non-healing (navicular & proximal 5th metatarsal)
what is the gold standard to diagnose stress fxs?
Bone scan (pos at 1 week)
what are common sites for stress fxs?
5th Metatarsal (Jones fx) → Zone 2
Bad lateral vascularity so bad at healing
Stress Fxs of metatarsals (march fx)
Calcaneus
what is the treatment of stress fxs?
Reproduction of pain/cc should be avoided
Immobilization w/ walking boot
Require partial weight bearing
Healing times are usually based on chronicity of overload & symptoms as well as location
Can be up to 6-8 wks
why are stress fxs very painful?
Periosteum is highly innervated
what is the MOI for a tarsometatarsal (Lisfranc) injury?
- Direct force dropping heavy weight on foot
- Jumping down onto a plantarflexed foot
- Force up through the toes of a PF positioned foot
- Pronation of the RF on a fixed forefoot
- Supination of the RF on a fixed forefoot
- Violent abduction or plantarflexion of the forefoot
what are the signs & symptoms of a tarsometatarsal (Lisfranc) Injury?
- Severe pain in the forefoot (possible paraesthesia)
- Inability to bear weigh on the foot
- Swelling & deformity
- Tenderness, pain w/ passive motion of the forefoot
- Diagnosed through radiographs
what is the MOI of a calcaneal fx?
occurs from jumping from a high height
Motor vehicle collision
what are the signs & symptoms of calcaneal injury?
- Severe pain in rearfoot (possibly paraesthesia)
- Inability to bear weight on foot (severe limp)
- Deformity of the heel
- Bruising in heel & arch
- Diagnosed through radiographs
what is the difference b/w a Bimalleolar & Trimalleolar fx?
Bimalleolar –> Fx of medial & lateral malleolus
Trimalleolar –> Fx of medial, lateral & posterior malleolus
what is the Danis weber classification system?
- Fibular location relative to syndesmosis
what is the Lauge-Hansen?
Foot position & force application
what is the surgical treatment for ankle fractures?
- Indicated for unstable fractures, open fractures & multiple injuries
- Acceptable limits of displacement ranginging from 0-5mm
- Theoretical advantages to ORIF are shorter acute recovery time, & better maintenance of reduction decreasing chance of OA
what is the conservative treatment of ankle fractures?
- Long leg cast w/ knee flexed at 30° (non weight bearing)
- Radiographs can be taken on a weekly basis to confirm maintenance of reduction
- At 4 weeks, change to short leg walking cast
- After 4 additional weeks, radiographs are then taken. If bony union has been achieved, cast is removed & unprotected weight bearing begun
According to the Ottawa Foot & Ankle rule when is X-Ray of the ankle is required?
Pain in malleolar region (anterior aspect of medial or lateral malleoli & anterior talar dome area)
Bone tenderness: distal 6xm of
Posterior medial malleolus
Posterior lateral malleolus
Inability to bear weight (can’t progress forward)
According to the Ottawa Foot & Ankle rule when is X-Ray of the foot required?
Pain in metatarsal region (dorsal medial & lateral aspect of the mid-foot
Bone tenderness:
Base of 5th metatarsal
Navicular
Inability to bear weight (cant progress)
what is the MOI of achilles tendon rupture?
trauma (from jumping or landing), prolonged steroid or h/o certain antibiotic use
what are the symptoms of achilles tendon rupture?
‘’hit’’ in back of ankle, reports hearing loud “pop”
what age do people normally experience achilles tendon ruptures?
Males > 40
what is a DVT?
- Thrombus (blood clot) in deep vein causing leg pain or swelling but also can occur with no symptoms
- Embolism when blood clot breaks loose & travels through your bloodstream
- This can travel to lungs, causing PE
where is pain found in an anterior & medial tibial stress syndrome?
Shin splints more proximal pain
what is an anterior & medial tibial stress syndrome?
- Inflammation & degeneration of the “prox” anterior compartment muscles
- Periosteal irritation → bone pulls on it
- Tibialis Anterior & Extensor Hallucis Longus
