Foot/Ankle Pathology

Question 1

what are the key signs of fractures?

Answer 1

swelling, tenderness, gait change, reproduction of cc by performing activity

Question 2

what bones do the greatest percentage of fxs occur?

Answer 2

metatarsals
fibula (lateral malleolus) –> prone to torsion

Question 3

what is the cause & pathology for fxs?

Answer 3

• 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)

Question 4

what is the gold standard to diagnose stress fxs?

Answer 4

Bone scan (pos at 1 week)

Question 5

what are common sites for stress fxs?

Answer 5

5th Metatarsal (Jones fx) → Zone 2
Bad lateral vascularity so bad at healing
Stress Fxs of metatarsals (march fx)
Calcaneus

Question 6

what is the treatment of stress fxs?

Answer 6

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

Question 7

why are stress fxs very painful?

Answer 7

Periosteum is highly innervated

Question 8

what is the MOI for a tarsometatarsal (Lisfranc) injury?

Answer 8

• 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

Question 9

what are the signs & symptoms of a tarsometatarsal (Lisfranc) Injury?

Answer 9

• 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

Question 10

what is the MOI of a calcaneal fx?

Answer 10

occurs from jumping from a high height
Motor vehicle collision

Question 11

what are the signs & symptoms of calcaneal injury?

Answer 11

• 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

Question 12

what is the difference b/w a Bimalleolar & Trimalleolar fx?

Answer 12

Bimalleolar –> Fx of medial & lateral malleolus
Trimalleolar –> Fx of medial, lateral & posterior malleolus

Question 13

what is the Danis weber classification system?

Answer 13

• Fibular location relative to syndesmosis

Question 14

what is the Lauge-Hansen?

Answer 14

Foot position & force application

Question 15

what is the surgical treatment for ankle fractures?

Answer 15

• 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

Question 16

what is the conservative treatment of ankle fractures?

Answer 16

• 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

Question 17

According to the Ottawa Foot & Ankle rule when is X-Ray of the ankle is required?

Answer 17

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)

Question 18

According to the Ottawa Foot & Ankle rule when is X-Ray of the foot required?

Answer 18

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)

Question 19

what is the MOI of achilles tendon rupture?

Answer 19

trauma (from jumping or landing), prolonged steroid or h/o certain antibiotic use

Question 20

what are the symptoms of achilles tendon rupture?

Answer 20

‘’hit’’ in back of ankle, reports hearing loud “pop”

Question 21

what age do people normally experience achilles tendon ruptures?

Answer 21

Males > 40

Question 22

what is a DVT?

Answer 22

• 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

Question 23

where is pain found in an anterior & medial tibial stress syndrome?

Answer 23

Shin splints more proximal pain

Question 24

what is an anterior & medial tibial stress syndrome?

Answer 24

• Inflammation & degeneration of the “prox” anterior compartment muscles
• Periosteal irritation → bone pulls on it
• Tibialis Anterior & Extensor Hallucis Longus

Question 25

where is the pain found in medial tibial stress syndrome?

Answer 25

shin splints more distal shin pain

Question 26

what is medial tibial stress syndrome?

Answer 26

• Inflammation & degeneration of the “distal” anterior compartment muscles
• Periosteal irritation
• Tibialis Posterior or Medial soleus

Question 27

what is the chief complaint of shin splints?

Answer 27

• Pain during or after activity
• Pain anterior shin (sharp, localized or dull, throbbing)
• Tenderness along tibialis anterior muscle or anterior tibia

Question 28

what are examination finding of shin splints?

Answer 28

• (anterior) AROM DF/PF pain, PROM PF pain, PROM DF pain free
• Weak DF/ Inversion
• (posterior) PROM PF/inv pain free, weak PF/inversion
• Flat feet
• Non-supportive or old running shoes