Leg And Foot Flashcards
What is compartment syndrome?
Trauma to fascial compartments causing haemorrhage or oedema leading to a rise in intra-compartmental pressure
What are the signs of compartment syndrome?
Severe, excessive pain in limb
Exacerbated pain by passive stretch of muscles
What are short term consequences of compartment syndrome?
Increased pressure= reduced muscle perfusion
Rhabdomyolysis and acute kidney injuries
If compartment pressure > systolic loss of peripheral pulses
Increases cap refill times
Distal paraesthesia following loss motor function
What are the long term consequences of compartment syndrome?
Rhabdomyolysis- a true kidney injury- chronic
Volkmann’s ischeamic contracture (painful and permanent contracture of muscle groups)
What causes ankle fractures?
Inversion (medial malleoulus damaged)
Eversion (lateral melleoulus damaged)
What is talar shift?
Disruption to any 2 of the syndesmosis ligaments
Ankle mortise becomes unstable and widens so talus can shift medially and laterally
What is an ankle sprain?
Partial or complete tear of one or more of the ligaments of the ankle joint
What factors increase your chance of ankle sprains?
Weak muscles and tendons Weak ankle ligaments Running on uneven surfaces Shoes that have bad heel support Wearing high heels
Which ligament is most at risk in inversion sprains?
Anterior talofibular
Why is a 5th metatarsal fracture common in severe sprains?
Fibularis breves tendon attached to tubercle on base 5th metatarsal
In inversion it is under tension and can pull of fragment of bone at insertion site
What are the mechanisms of Achilles’ tendon rupture?
Forceful push off with extended knee
Fall with foot outstretched in front and ankle dorsiflexed
Falling from height
Where is the common site of Achilles’ tendon (calcaneal) rupture?
Vascular watershed area
Due to decreased vascularity and thickness
What are symptoms of an Achilles’ tendon rupture?
Sudden and severe pain
Pop sound
Palpable gap in tendon
Initial pain and swelling followed by bruising
Inability to stand/ push off while walking
What test is done for a ruptured Achilles’ tendon?
Thompson’s/ Simmond’s test
What is the common term for Hallux Valgus?
Bunion
How does a Hallux valgus appear?
Varus deviation 1st metatarsal
Valgus deviation / lateral rotation of Hallux
Prominence of 1st metatarsal head
What does Hallux valgus cause?
Painful movement of 1st MTPJ joint
Pain wearing shoes
Exacerbated by line of pull of extrinsic tendons
What is Hallux rigidus?
OE of 1st MTPJ joint
Causing joint stiffness and pain when walking
What can develop in Hallux rigidus?
A dorsal bunion
What movement is severely effected by Hallux rigidus?
Dorsiflexion of 1st MTPJ joint
Wear stiff shoe sole to prevent this
What are most causes of ankle OA due to?
Secondary arthritis after trauma
Obesity
Joint stress
What are the nest treatments for ankle OA?
Ankle fusion
Joint replacement
What is claw toe?
Hyperextension of MTPJ and flexed at PIP joint (sometimes at DIP too)
In the 2nd to 5th toes
What causes claw toe?
Neurological damage causing ligaments and tendons to become unnaturally tight
Eg. Stroke, cerebral palsy ect.
What is hammer toe?
Flexed PIPJ
Common in 2nd toe
What is Mallet toe?
Flexed DIPJ
Most common in 2nd toe
What causes hammer and mallet toe?
Pressure on 2nd toe from Hallux causing toe to stay flexed
Muscles contract and shorten
Harder to extend toe
Eg, in ill fitting pointed shoes
What is curly toe?
Congenital of 3rd and 5th toes
Tendons in flexor digorum longus or brevis too tight
What is Achilles tendinopathy?
Degenerative condition
At point of insertion of tendon or in watershed area
What are the signs/ symptoms of Achilles tendinopathy?
Pain and stiffness in morning and severe after exercise
Thickening of tendon
Swelling that worsens on exercise
Palpable bone spur
What is flat foot?
When the medial arch of the floor has collapsed so medial border almost touches ground
Why is flexible flat foot?
No medial arch when standing but one appears when standing on tip toes
What is the cause of rigid flat foot?
Tarsal coalition (failure of tarsal bones to separate)
What causes flexible flat foot in adults?
Dysfunction of tibialis posterior tendon
Causes stretching of spring ligament and plantar aponeurosis
Taylor head displaced inframedially flattening medial longitudinal arch
What causes foot injuries in diabetics?
Loss of sensation due to peripheral neuropathy
Ischeamia due to pot microvasculature
Immunosuppression
Causes loss of protective sensation so will still use injured foot worsening it
What is Charcot arthropathy?
Progressive destruction of bones, joints and soft tissue
What causes Charcot arthropathy?
Neuropathy
Abnormal loading on foot
Repeated micro trauma
Metabolic abnormalities
Lead to inflammation causing osteolysis
Why is Charcot foot worse in diabetics?
Due to neuropathy have reduced sensations in foot
Continue to walk on this foot
Neuropathy causes muscle spasticity which exacerbates
