Leg And Foot

Question 1

What is compartment syndrome?

Answer 1

Trauma to fascial compartments causing haemorrhage or oedema leading to a rise in intra-compartmental pressure

Question 2

What are the signs of compartment syndrome?

Answer 2

Severe, excessive pain in limb

Exacerbated pain by passive stretch of muscles

Question 3

What are short term consequences of compartment syndrome?

Answer 3

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

Question 4

What are the long term consequences of compartment syndrome?

Answer 4

Rhabdomyolysis- a true kidney injury- chronic

Volkmann’s ischeamic contracture (painful and permanent contracture of muscle groups)

Question 5

What causes ankle fractures?

Answer 5

Inversion (medial malleoulus damaged)

Eversion (lateral melleoulus damaged)

Question 6

What is talar shift?

Answer 6

Disruption to any 2 of the syndesmosis ligaments

Ankle mortise becomes unstable and widens so talus can shift medially and laterally

Question 7

What is an ankle sprain?

Answer 7

Partial or complete tear of one or more of the ligaments of the ankle joint

Question 8

What factors increase your chance of ankle sprains?

Answer 8

Weak muscles and tendons 
Weak ankle ligaments 
Running on uneven surfaces 
Shoes that have bad heel support 
Wearing high heels

Question 9

Which ligament is most at risk in inversion sprains?

Answer 9

Anterior talofibular

Question 10

Why is a 5th metatarsal fracture common in severe sprains?

Answer 10

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

Question 11

What are the mechanisms of Achilles’ tendon rupture?

Answer 11

Forceful push off with extended knee
Fall with foot outstretched in front and ankle dorsiflexed
Falling from height

Question 12

Where is the common site of Achilles’ tendon (calcaneal) rupture?

Answer 12

Vascular watershed area

Due to decreased vascularity and thickness

Question 13

What are symptoms of an Achilles’ tendon rupture?

Answer 13

Sudden and severe pain
Pop sound
Palpable gap in tendon
Initial pain and swelling followed by bruising
Inability to stand/ push off while walking

Question 14

What test is done for a ruptured Achilles’ tendon?

Answer 14

Thompson’s/ Simmond’s test

Question 15

What is the common term for Hallux Valgus?

Answer 15

Bunion

Question 16

How does a Hallux valgus appear?

Answer 16

Varus deviation 1st metatarsal
Valgus deviation / lateral rotation of Hallux
Prominence of 1st metatarsal head

Question 17

What does Hallux valgus cause?

Answer 17

Painful movement of 1st MTPJ joint
Pain wearing shoes

Exacerbated by line of pull of extrinsic tendons

Question 18

What is Hallux rigidus?

Answer 18

OE of 1st MTPJ joint

Causing joint stiffness and pain when walking

Question 19

What can develop in Hallux rigidus?

Answer 19

A dorsal bunion

Question 20

What movement is severely effected by Hallux rigidus?

Answer 20

Dorsiflexion of 1st MTPJ joint

Wear stiff shoe sole to prevent this

Question 21

What are most causes of ankle OA due to?

Answer 21

Secondary arthritis after trauma
Obesity
Joint stress

Question 22

What are the nest treatments for ankle OA?

Answer 22

Ankle fusion

Joint replacement

Question 23

What is claw toe?

Answer 23

Hyperextension of MTPJ and flexed at PIP joint (sometimes at DIP too)
In the 2nd to 5th toes

Question 24

What causes claw toe?

Answer 24

Neurological damage causing ligaments and tendons to become unnaturally tight

Eg. Stroke, cerebral palsy ect.

Question 25

What is hammer toe?

Answer 25

Flexed PIPJ

Common in 2nd toe

Question 26

What is Mallet toe?

Answer 26

Flexed DIPJ

Most common in 2nd toe

Question 27

What causes hammer and mallet toe?

Answer 27

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

Question 28

What is curly toe?

Answer 28

Congenital of 3rd and 5th toes

Tendons in flexor digorum longus or brevis too tight

Question 29

What is Achilles tendinopathy?

Answer 29

Degenerative condition

At point of insertion of tendon or in watershed area

Question 30

What are the signs/ symptoms of Achilles tendinopathy?

Answer 30

Pain and stiffness in morning and severe after exercise
Thickening of tendon
Swelling that worsens on exercise
Palpable bone spur

Question 31

What is flat foot?

Answer 31

When the medial arch of the floor has collapsed so medial border almost touches ground

Question 32

Why is flexible flat foot?

Answer 32

No medial arch when standing but one appears when standing on tip toes

Question 33

What is the cause of rigid flat foot?

Answer 33

Tarsal coalition (failure of tarsal bones to separate)

Question 34

What causes flexible flat foot in adults?

Answer 34

Dysfunction of tibialis posterior tendon

Causes stretching of spring ligament and plantar aponeurosis
Taylor head displaced inframedially flattening medial longitudinal arch

Question 35

What causes foot injuries in diabetics?

Answer 35

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

Question 36

What is Charcot arthropathy?

Answer 36

Progressive destruction of bones, joints and soft tissue

Question 37

What causes Charcot arthropathy?

Answer 37

Neuropathy
Abnormal loading on foot
Repeated micro trauma
Metabolic abnormalities

Lead to inflammation causing osteolysis

Question 38

Why is Charcot foot worse in diabetics?

Answer 38

Due to neuropathy have reduced sensations in foot
Continue to walk on this foot

Neuropathy causes muscle spasticity which exacerbates