Foot Disorders Flashcards
What is Achilles tendon known as?
Calcaneal tendon
What is the Px of achilles tendonitis
- repetitive action of calcaneal tendon
- microtears & inflammation
- Tendon thickens > lose elasticity
- tendon ruptures on sudden force
What are the RF for achilles tendonitis?
- unfit
- sudden increase in exercise frequency
- poor footwear
- male
- obesity
- fluoroquinolone
What are the clinical features of Achilles Tendonitis?
- gradual onset pain
- stiffness
- worsens on exertion
- tenderness on palpatation
What are the clinical features of ruptured achilles tendon?
- sudden onset pain @ posterior calf
- audible popping sound
- feeling of somethig went
- loss of plantarflexion
- simmonds test
What is Simmonds test
- Pt kneel on chair
- ankles hang off edge of chair
- squeeze calf
- if plantarflexion absent
What are the differentials for achilles tendonitis?
- ankle sprain
- tibial/calcaneal #
- OA
What Ix would you order for achilles tendonitis/rupture?
- clinically diagnosed
- USS - test severity of tear
What is the Mx for Achilles tendonitis?
- Stop exercise
- Ice
- NSAIDs
- Physiotherapy
What is the Mx for ruptured Achilles tendon?
If < 2 weeks
- Analgesia
- Splinted in plaster or aircast boot
- Crutches
If > 2 weeks
- Surgical fixation c end to end tendon repair
Which tarsal bone is most commonly fractured?
Calcaneal bone
What causes calcaneal #?
- Fall from height / significant axial loading
What are the classifications for calcaneal #
Intra-articular (Most common)
- Involve articular surface of subtalar joint
Extra-articular
- caused by avulsion injury
What classification is used for intra-articular calcaneal #?
Sanders classification
There are 4 types in the Sander’s clssifictaion. Describe them
Type I
- Nondisplaced posterior facet (regardless of number of fracture lines)
Type II
- One fracture line in the posterior facet (two fragments)
Type III
- Two fracture lines in the posterior facet (three fragments)
Type IV
- Comminuted with more than three fracture lines in the posterior facet (four or more fragments)
What are the clinical features of calcaneal #?
- pain
- tenderness
- inability of bear weight on calcaneal region
What will you find on Ex for calcaneal #?
- Swollen
- bruising
- Varus deformity
What are the differentials for calcaneal #?
- Talar #
- Ankle #
- Ankle sprain
What Ix would you order for clacaneal #?
- Radiograph (AP, Lat, oblique)
- dec Bohler’s angle
- calcaneal shortening
- varus tuberosity deformity
How would you Mx calcaneal #?
Intra-articular (majority require surgery)
- if <2mm displacement / near normal Bohler’s angle, do for conservative mx
Extra-articular (majority conservative)
- cast immobilisation
- non weight bearing 10-12 weeks
What are the surgical interventions for calcaneal #?
- Closed reduction with percutaneous pinning
- ORIF (most cases)
What is the Cx for calcaneal #?
- Subtalar arthritis
What is Bohler’s angle?
- posterior angle formed between one line from the anterior to middle facet, and one line from the posterior to middle facet;
- normally 20-40
- reduced Böhler’s angle can indicate a calcaneal fracture
What is the second most common tarsal bone #?
- Talar bone
What type of trauma causes talar #?
- HIgh energy trauma
- Ankle is forced into dorsiflexion
Which part of the Talus is commonly affected in a talar#?
- Talar neck
Less common
- body
- lateral process
- posterior process
What is the blood supply to Talus?
- Posterior Tibial Artery
- artery of tarsal canal
- deltoid artery
- Anterior Tibial Artery
- artery of tarsal sinus
- Perforating Peroneal Artery
What is the talus bone highly at risk of?
- Avascular necrosis
- extraosseous arterial supply highly susceptible to interruption in #
What are the clinical features of Talar #?
- Swelling around ankle
- Clear deformity
- Unable to plantarflex and dorsiflex
What are the differentials for Talar #?
- Ankle #
- Pilon # (distal tibia #)
What Ix would you order for Talar #?
- Plain radiograph
- AP
- Lat
- Plantar & Dorsiflex - to differentiate between type 1/2 injusries
- CT - for complex injuries
What classification is used for talar neck #? What is it for?
- Hawkins classification
- Determine risk of AVN
Describe the Hawkins classification
I
Undisplaced
0-15%
II
Subtalar dislocation
20-50%
III
Subtalar and tibiotalar dislocation
90-100%
IV
Subtalar, tibiotalar and talonavicular dislocation
100%
Mx of talar # based on Hawkins classification. How would you treat undisplaced talar #?
- Plaster
- non-weight bearing crutches - 3months
- assess for nonunion or AVN
How would you Mx type 2-4 Hawkins classification?
- Closed reduction - emergency setting
- ORIF
- Cast
- non weight bearing
What are the Cx of talar #?
- AVN - 17%
- OA
