Foot Ankle Pathology

Question 1

What are the 5 types of fractures? How are they typically treated?

Answer 1

Isolated lateral malleolus: WBAT, immobilized for 6 weeks
Bimalleolar Ankle: ORIF
Trimalleolar Ankle: ORIF

Bimalleolar equivalent fracture
Pilon Fracture

Question 2

What is a bimalleolar equivalent ankle fracture? How is this treated?

Answer 2

Ruptured deltoid ligament + isolated lateral malleolus fracture

ORIF + syndesmotic screw (accounts for rupture)

Question 3

What is a pilon (distal tibia) fracture?

Answer 3

Tibial plafond shatters into multiple pieces

ORIF required

Question 4

What is an osteochondral defect (OCD)? How is it treated?

Answer 4

Subchondral bone and articular cartilage damage

Arthroscopy: Culture periosteum from NWB bone and inject cells into defect

Hyaline cartilage WILL NOT grow in defect, fibrocartilage will

Question 5

What is the difference between seronegative and septic arthritis?

Answer 5

Seronegative: arthritic antibodies are present in blood (RA, lupus etc.)

Septic: bacteria within joint

Question 6

What is hallux rigidus? What can develop as a result of this?

Answer 6

Arthritis of the 1st MTP joint

Bone spur develops on big toe (removed via cheilectomy)

Question 7

Is a total Ankle arthroplasty effective?

Answer 7

TOTAL FAILURE IN PAST

Now, successfully treats pain, but wears out quickly

Question 8

What is hallux valgus?

Answer 8

BUNION: abnormal prominence at 1st MTP

Abnormal angulation of 1st toe

Question 9

What is the incidence of hallux valgus? What is the MOI?

Answer 9

Incidence: 10:1 Female to Male ratio

MOI: Familial tendency; direct result of poorly fitting shoes

Question 10

What is the consensus on surgical treatment for hallux valgus?

Answer 10

Bunions are not painful and DO NOT NEED SURGICAL TREATMENT

Question 11

What is a interdigital neuroma?

Answer 11

Expansion of the plantar digital nerves

Question 12

What is tarsal tunnel syndrome?

Answer 12

Compression of the tibial nerve under laciniate ligament that leads to ankle pain

Question 13

What does peroneal nerve palsy lead to?

Answer 13

Foot drop

Question 14

What is reflex sympathetic dystrophy? CRPS

Answer 14

Chronic arm or leg pain resulting from poor sympathetic regulation

Question 15

What is the most common foot and ankle problem?

Answer 15

Plantar fasciitis

Question 16

What is plantar fasciitis? Who does it typically affect?

Answer 16

Inflammation and microtears in the plantar fascia

Affects middle aged adults (unilateral presentation)
Female=Male
Right=Left

Question 17

What may cause plantar fasciitis? What exacerbates the symptoms?

Answer 17

Obesity, prolonged standing, long distance running (cavus feet), systemic disease

Exacerbation via: toe dorsiflexion and tight Achilles’ tendon

Question 18

What are the typical symptoms associated with plantar fasciitis?

Answer 18

Pain with first few steps that subsides during day

Pain at end of day

Tenderness over fascia (+ calcaneal squeeze test)

Question 19

50% of patients with plantar fasciitis will also present with what?

Answer 19

Heel spur

Question 20

What is the optimal treatment for plantar fasciitis?

Answer 20

STRETCHING, STRETCHING, STRETCHING!!!

NSAIDs, comfortable shoe wear, night splints

Question 21

What treatment is NOT recommended for plantar fasciitis? Why?

Answer 21

Cortisone injections

Result in fat pad atrophy and 10% of plantar fascia ruptures

Question 22

What are the 4 complications of endoscopic release for PF?

Answer 22

1. Loss of arch
2. Nerve Injury
3. Lateral foot pain
4. Reoccurrence of heel pain