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Lower Extremity Anatomy II > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Heel pain differential (posterior or plantar os calcis)

A
  • Achilles insertional tendinopathy
  • Retrocalcaneal bursitis
  • Haglund’s Syndrome
  • Os trigonum syndrome
  • FHL tendinopathy or tenosyvitis
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2
Q

Achilles insertional tendinopathy often accompanied by

A
  • Calcification (spur) at tendon attachment
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3
Q

Haglund’s Syndrome

A
  • Enlarged posterior superior margin of calcaneus

- Can impinge upon retrocalcaneal bursa and Achilles tendon

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4
Q

Os trigonum syndrome

A
  • Presence of os trigonum usually not painful
  • Usually triggered by an ankle injury
  • Repeated plantarflexion causes ossicle to become impinged
  • Posterior ankle impingement
  • The connective tissue connection between the ossicle and talus is damaged
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5
Q

FHL tendinopathy or tenosynovitis

A
  • Not common

- Seen in dancers

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6
Q

Other possible heel pain diagnoses

A
  • Plantar fasciitis (inferior heel)
  • Calcaneal stress fracture
  • Calcaneus fracture
  • Tarsal tunnel syndrome
  • Other arthropathies
  • Infection
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7
Q

Calcaneal apophysitis (Sever’s Disease)

A
  • Overuse/overload injury to the posterior apophysis (posterior growth plate)
  • Xrays can rule out other conditions
  • Secondary center is usually fragmented (not always)
  • Diagnosis is clinical
  • Treated conservatively
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8
Q

Calcaneal apophysitis (Sever’s Disease) causes

A
  • Achilles tendon (traction apophysitis)

- Mechanical compression

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9
Q

Calcaneal apophysis ossification

A
  • Secondary center appears mostly btwn ages 6-9 (almost always appears by age 11)
  • Fuses btwn 12-18 (most fused by 15)
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10
Q

Calcaneal apophysitis (Sever’s Disease) symptoms

A
  • Pain localized to posterior/plantar heel

- Elicited during weightbearing

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11
Q

Calcaneal apophysitis (Sever’s Disease) most commonly seen in

A
  • Children and adolescents during growth
  • Especially ages 9-13 who are active in sports
  • Boys > girls
  • Both heels commonly affected
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12
Q

Haglund’s deformity (pump bump, Mulholland deformity)

A
  • Bony enlargement of the back of the heel (posterior superior calcaneus)
  • Soft tissue surrounding (Achilles, bursa) can become irritated leading to Haglund’s syndrome
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13
Q

Haglund’s Syndrome symptoms

A
  • Retrocalcaneal pain
  • Abnormal protuberance of the posterosuperior border
  • Retrocalcaneal bursitis and swelling
  • Achilles tendinosis
  • Pumps or shoes with rigid shoe backs aggravate the enlargement (shoes with a hard back)
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14
Q

Haglund’s Syndrome clinical appearance

A
  • Can be difficult to distinguish Haglund’s syndrome from other causes of hindfoot pain
  • Prominent calcaneal posterosuperior protuberance
  • Usually on the lateral side
  • Swelling and inflammation
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15
Q

Haglund’s Syndrome predisposing factors

A
  • Wearing tight, stiff shoes
  • Pes cavus
  • Forefoot varus
  • Tight Achilles
  • Walking on lateral side of foot
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16
Q

Haglund’s Syndrome usually affects

A
  • Middle-aged individuals
  • F > M
  • Often bilateral
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17
Q

Conservative treatment of Haglund’s Syndrome

A
  • Shoe modification
  • Orthotics: heel pads and lifts
  • PT: Achilles stretching, anti-inflammatories, ice
  • Local injections (bursa)
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18
Q

Surgical treatment of Haglund’s Syndrome

A
  • Removal of bony enlargement (calcaneal osteotomy)
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19
Q

AP view x-ray

A
  • Foot positioned in dorsiflexion

- Toes toward ceiling

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20
Q

Mortise view x-ray

A
  • AP with foot internally rotated ~ 15-20ᵒ
  • Brings malleoli parallel to each other
  • Allow visualization of mortise (tibial plafond, malleoli, talar dome, clear space)
  • Allows assessment of distal tib/fib syndesmosis
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21
Q

Lateral view x-ray

A
  • Calcaneus/talus profile
22
Q

Tibiofibular overlap

A
  • Overlap of fibula and anterior tubercle of tibia (anterior aspect of fibular notch of tibia)
  • Overlap should be at least ≥ 6mm on AP, ≥ 1mm on mortise view
23
Q

Tibiofibular clear space

A
  • Distance between medial border of fibula and lateral border of posterior tubercle (posterior aspect of fibular notch of tibia)
  • <6mm on both AP and Mortise view
24
Q

Medial clear space

A
  • Between lateral border of medial malleolus and medial border of talus
    <4mm on AP
  • Should be equal to superior clear space on mortise view
25
Q

Stress x-rays

A
  • Positioned for mortise view and then the foot is stressed into external rotation
26
Q

Conservative treatment of ankle sprain

A
  • Pressure, rest, ice, compression, stabilization
  • Non-weight-bearing immobilization
  • Progressed to functional brace and physiotherapy
27
Q

Syndesmotic ankle sprains

A
  • Less common than lateral ankle sprains (1-18% of all ankle sprains)
  • Athletic population incidence increases up to 12-32%
  • More difficult to diagnose and usually require longer recovery periods vs. lateral ankle sprain
28
Q

Uncorrected unstable injuries can lead to

A
  • Chronic instability

- Degenerative OA

29
Q

Common causes of syndesmotic ankle sprains

A
  • External rotation of a planted foot (rotation of talus widens ankle mortise)
  • Pivoting internally on an externally rotated foot
  • Valgus load to the leg with planted foot
  • Lateral blow to ankle in external rotation
30
Q

Foot position (pronation vs supination) and deforming force (abduction,adduction, internal or external) rotation can influence other tissues that are damaged

A
  • Deltoid ligament (syndesmosis injury + deltoid rupture usually causes instability)
  • Malleoli and fibular fractures
  • Very common to have frxs and other ligamentous injuries, need all 3 x-ray views
  • Advanced imaging can be very helpful
31
Q

Usually the 1st ligament to tear

A
  • Anterior inferior tibiofibular ligament
32
Q

Maisonneuve fracture

A
  • Combination of proximal 1/3 of fibula and unstable ankle injury (widening of ankle mortise)
  • Usually involves ligament injuries and/or frx
33
Q

Ligament injuries and fractures often associated with Maisonneuve fracture

A
  • Distal tib/fib syndesmosis
  • Deltoid ligament
  • Medial malleolus frx
34
Q

Ankle stability depends on

A
  • Congruency of bone: ankle mortise
  • Joints and ligaments
  • Joint capsule
35
Q

Deltoid ligament resists

A
  • Eversion, lateral translation, and external rotation of talus
36
Q

Distal tib/fib syndesmosis

prevents

A
  • Separation of tibia and fibula

- Talar wedging

37
Q

Interosseous border of tibia (lateral border) ends as

A
  • The fibular notch
38
Q

Anterior tubercle of tibia (Chaput’s tubercle)

A
  • Large tubercle that projects laterally
  • Overlaps the fibula (supramalleolar shaft)
  • Posterior tubercle of tibia (Volkmann’s tubercle) is smaller
39
Q

Anterior inferior tibiofibular ligament

A
  • Multiple bands that form a trapezoidal shaped ligament
40
Q

Anterior inferior tibiofibular ligament attachments

A
  • Medially to Chaput’s tubercle on distal anterolateral tibia (anterior fibular notch of tibia)
  • Courses distolaterally to anterior border of fibula/lateral malleolus (Wagstaffe’s tubercle)
  • Distal fascicle is known as Bassett ligament
41
Q

Posterior inferior tibiofibular ligament attachments

A
  • Trapezoidal shaped
  • Distolateral margin of posterior fibular notch on tibia (Volkmann tubercle) and posterior malleolus of tibia
  • Courses distolaterally to attach to posterior lateral malleolus
42
Q

Chaput’s, Wagstaffe’s, and Volkmann’s tubercles

A
  • Can be sites of avulsion fractures
43
Q

Fibular notch is also known as

A
  • Incisura fibularis tibiae (fibular incisure of tibia)
44
Q

Inferior transverse tibiofibular ligament

A
  • Deep inferior fibers of PIFL

- Deepens posterior ankle mortise

45
Q

Inferior transverse tibiofibular ligament attachments

A
  • Posterior inferior fibular notch

- Superior aspect of fibular fossa

46
Q

Interosseous tibiofibular ligament

A
  • Lower margin of interosseous membrane

- Spring-like function allows slight separation during dorsiflexion

47
Q

Interosseous membrane and deltoid ligament

A
  • Also support the syndesmotic joint
48
Q

Synovial recess

A
  • Extends from from tibiotalar to interosseous ligament
49
Q

Synovial lined plica

A
  • Extends proximally from tibiotalar joint into distal tib/fib joint
50
Q

Synovial recess and fold (fringe)

A
  • Interposed between tibia and fibula

- Contains adipose and fibrous tissue, nerves, vessels

51
Q

Synovial recess and fold (fringe) movements

A
  • Retracts between tib/fib during dorsiflexion

- Descends during plantarflexion

52
Q

Synovial recess and fold (fringe) function

A
  • Believed to aid in synovial fluid distribution and protection of dital tib/fib edges
  • Possible source of pain in ankle impingement

Lower Extremity Anatomy II (9 decks)

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