Lower Extremity Conditions

Question 1

What occurs with avascular necrosis at the hip?

Answer 1

Disruption of blood supply to the femoral head

Question 2

List 4 symptoms associated with AVN at the hip.

Answer 2

1. Hip ROM is decreased in flexion, IR and abduction
2. Coxalgic gait
3. Pain the groin/thigh
4. Tenderness with palpation at the hip joint

Question 3

What is the difference between coxa vara and coxa valga?

Answer 3

Coxa Vara = Angle of femoral neck with shaft of femur is < 115 degrees

Coxa Valga = Angle of femoral neck with shaft of femur is >125 degrees

Question 4

Describe the difference between the 2 types of femoral acetabular impingement.

Answer 4

CAM = impingement of a large aspherical femoral head in a constrained acetabulum

Pincer = over-coverage of the femoral head by a prominent acetabular rim

Question 5

What is the difference between patella alta and patella baja?

Answer 5

Alta = malalignment in which patella tracks superiorly in femoral intercondylar notch

Baja = malalignment in which patella tracks inferiorly in femoral intercondylar notch

Question 6

What may occur as a result of patella alta?

Answer 6

May result in chronic patellar subluxation or patellar tendon rupture

Positive camel back sign (two bumps over anterior knee region instead of typical one)

Question 7

What may occur as a result of patella baja?

Answer 7

Abnormal knee extension with abnormal cartilaginous wear

Question 8

What is medial tibial stress syndrome?

Answer 8

Overuse injury of the posterior tibialis and/or the medial soleus, resulting in periosteal inflammation at the muscular attachments

Thought to be caused by excessive pronation

Question 9

49% of all stress fractures involve the _____ and only 10% involve the _____.

Answer 9

49% = tibia
10% = fibula

Question 10

What structures are affected by a trimalleolar fracture?

Answer 10

Medial malleolus
Lateral malleolus
Posterior tubercle of the distal tibia

Question 11

The Ottawa ankle and foot rules indicate the need for ______.

Answer 11

An ankle and/or foot x-ray

Question 12

What are the Ottawa ankle rules?

Answer 12

An ankle x-ray series is only required if there is any pain in the malleolar zone and any of these findings:

1. Bone tenderness from the posterior edge or tip of the lateral malleolus extending 6cm proximally, or
2. Bone tenderness from the posterior edge or tip of the medial malleolus extending 6cm proximally, or
3. Inability to take 4 complete steps both immediately and in the emergency department.

Question 13

What are the Ottawa foot rules?

Answer 13

An foot x-ray series is only required if there is pain in the midfoot zone and any of these findings:

1. Bone tenderness at the base of the 5th metatarsal or,
2. Bone tenderness of the navicular or,
3. Inability to take 4 complete steps both immediately and in the emergency department.

Question 14

What is hallux valgus?

Answer 14

A medial deviation of head of first metatarsal from midline of body; metatarsal and base of proximal first phalanx move medially, while distal phalanx then moves laterally

Question 15

What is the normal metatarsophalangeal angle?

Answer 15

8-20 degrees

Question 16

What is the most common complaint associated with metatarsalgia?

Answer 16

Pain at first and second metatarsal heads after long periods of weight bearing

Question 17

What is Charcot-Marie-Tooth disease?

Answer 17

Peroneal muscular atrophy that affects motor and sensory nerves

Initially affects muscles in the lower leg and foot, but eventually progresses to muscles of hands and forearm

Question 18

What position is the calcaneus positioned in with rearfoot varus versus valgus?

Answer 18

Varus = rigid inversion of the calcaneus 
Valgus = rigid eversion of the calcaneus

Question 19

What are the Ottawa knee rules?

Answer 19

A knee x-ray series is only required for patients with knee injury and who have any of the following:

1. Age 55 years or older, or
2. Isolated patellar tenderness without other bone tenderness, or
3. Tenderness of the fibular head, or
4. Inability to flex knee to 90 degrees, or
5. Inability to bear weight immediately after injury and in the emergency department