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Clin Med III: MSK > Lower Extremity Disorders part 2 > Flashcards

Lower Extremity Disorders part 2 Flashcards

1
Q

How do we decide when to order a knee x-ray?

A

Ottawa Knee Rules: Radiograph if 1 criterion is met

  1. Patient age > 55 years
  2. Tenderness at the head of the fibula
  3. Isolated tenderness of the patella
  4. Inability to flex knee to 90 º
  5. Inability to bear weight for 4 steps both immediately after the injury and in the ED
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2
Q

a primary stabilizer of the knee preventing anterior translation of the tibia in relation to the femur

A

ACL

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3
Q

MOI of ACL tear

A

Sudden deceleration with rotational trauma or hyperextension force applied to the knee

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4
Q
  1. Twisting or hyperextension injury followed by:
    - Sudden pain & giving way of the knee
    - Audible “pop”
  2. Joint effusion within first few hours → increased pain
  3. Joint effusion
  4. Limited ROM → unable to bear full weight
  5. (+) Lachman, Anterior drawer, pivot shift tests

dx?
w/u and findings?
what imaging is often ordered to confirm dx?

A
  1. ACL tear
  2. XR Knee series - effusions, avulsion fracture of lateral capsular margin of tibia (Segond fracture), Tibial eminence fracture common in open growth plates
  3. MRI to confirm
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4
Q

pathology of ACL tear

A
  1. Complete rupture of ligament most often occurs
  2. Commonly associated with a meniscal tear - MCL, LCL, or PCL are rarely damaged
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5
Q

management for ACL tear

A
  1. Initial
    - RICE with knee immobilizer brace, +/- crutches
    - acetaminophen before NSAIDs
    - aspiration if large effusion
    - Start early ROM exercises as pain allows
  2. Refer to ortho
    - Young → reconstruction with graft
    - Older - PT to strengthen surrounding muscles to improve stability
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6
Q

for ACL reconstruction with graft in young patients, the graft is taken from patients ___, ___, or ___ from a cadaver

A

patellar, hamstring, or quadriceps tendon

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7
Q

Sequelae of conservative management for ACL tear (2)

A

Medial meniscus tear, secondary degenerative joint disease

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8
Q

what ligament prevents posterior translation of the tibia in relation to the femur

A

PCL

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9
Q

MOI of PCL tear (2)

A
  1. Direct blow to the tibia - Knee strikes dashboard in MVA or fall onto knee
  2. Extreme hyperextension (associated ACL rupture)
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10
Q

2 pathologies of PCL tears

A
  1. Injuries range from a stretch injury to a complete rupture
  2. Often associated with other injuries - Collateral ligaments, ACL ruptures
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11
Q
  1. Same as ACL (minus special tests unless ACL is ruptured as well)
  2. (+) Posterior drawer test
  3. Assess NV status if multiligamentous injury is suspected
    - Assess with ABI - if < 0.9 order arterial imaging to r/o intimal tear that could lead to thrombosis

dx?
w/u?
mgmt?

A
  1. PCL tear
  2. same as ACL
  3. RICE, Knee immobilizer; Begin ROM after 1-5 days
    - isolated PCL injuries - PT; reconstruction if PT fails
    - multiligamentous injuries - reconstruction
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12
Q

possible complication of PCL tear

A

Osteoarthritis

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13
Q

what ligaments provide stability from varus and valgus stress

A

collateral ligaments

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14
Q

MOI of collateral ligament tear

A
  1. Medial Collateral Ligament (MCL) - lateral (valgus) blow to the knee; Football clipping injury
  2. Lateral Collateral Ligament (LCL) - associated with other traumatic knee injuries; Much less common
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15
Q
  1. Localized pain, tenderness, swelling and stiffness along ligament course - Worsens over 6-8 hours
  2. may be able to bear weight after injury
  3. 1-2 days after injury ecchymosis noted along ligament course and a small effusion
  4. Assess uninjured extremity first to gage normal laxity
  5. Varus/valgus testing performed in extension and 30° flexion
    - Laxity noted in extension = more significant trauma
    - Instability may be masked by pain and involuntary muscle contraction

dx?
w/u?

A
  1. collateral ligament tear
  2. XR AP/Lat Knee; MRI to confirm
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16
Q

mgmt for collateral ligament tear grade I and II

A

Sprains-partial tear (Grade I and II)

  1. RICE, hinged knee brace, NSAIDs
  2. Early ROM exercises
  3. Crutches with weight-bearing as tolerated
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17
Q

mgmt for collateral ligament tear Grade III

A

Complete rupture (Grade III)

  1. Refer to ortho
  2. Tx varies based upon location of rupture - Conservative (hinged knee brace) vs. repair or reconstruction
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18
Q

gel-like pads that sit between the femur and tibia
Function as shock absorbers and provides a smooth gliding surface during ambulation

A

Menisci

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19
Q

MOI of meniscal injury (2)

A
  1. Rotational force of the knee while foot is planted
  2. Older patients (degenerative tear) - Minimal (squatting down) to no trauma
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20
Q
  1. Pain and stiffness following MOI that progressively worsens over 2-3 days
    - Ambulation after injury is possible
    - may report hearing a “pop”
  2. (+) Locking, catching, or popping noted more after effusion begins to resolve
  3. Tenderness along joint line of the affected meniscus - Medial meniscus MC affected
  4. Effusion (directly affects ROM)
    - Larger effusion MC in lateral tears (closer to joint capsule)
    - Small effusion seen with tears of avascular central body
  5. (+) McMurray - painful click noted on exam

dx?
w/u?

A
  1. meniscal injury
  2. XR; MRI knee
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21
Q

meniscal injury - Add a weight bearing AP with knee in 45° flexion if pt is how old?

A

> 40 y/o

Provides info on amount of osteoarthritis which directly affects surgical outcomes

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22
Q

mgmt for meniscal injury?

A
  1. initial - RICE, NSAIDS
  2. arthroscopic repair if indicate
  3. No indications for surgery → initial management then PT
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23
Q

Indications for referral to ortho for arthroscopic repair

A
  1. Young patients with traumatic tear
  2. Failure to conservative therapy (persistent joint line tenderness)
  3. Mechanical symptoms
  4. Evidence of ligamentous instability
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24
Q

MOI of knee dislocation

A

severe ligamentous disruption

  1. MVA
  2. Fall from height
  3. Trampoline falls
  4. Martial arts
  5. Spontaneous with walking in morbidly obese patients

MC in young males

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25
Q

how are knee dislocations characterized?
MC dislocation?

A

based upon direction of the tibia in relation to the femur

  1. anterior
  2. posterior
  3. lateral
  4. medial
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26
Q
  1. deformity with severe pain and limited ROM
    - 50% will spontaneously reduce
  2. Ecchymosis and swelling
  3. Assess NV status
    - Popliteal artery, common peroneal and tibial nerve injuries
    - Limb-threatening vascular injuries are common even with normal pulses
  4. Attempt ligamentous assessment
    - May be limited due to large effusions
    - Hyperextension >30° when leg is lifted by foot indicates gross instability

dx?
w/u?

A
  1. knee dislocation
  2. XR; CT/MRI after reduction and stabilization
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27
Q

management for knee dislocation

A
  1. Reduction - longitudinal traction
    - Procedural sedation
    - post-reduction NV check - If distal pulses are intact, assess by ABI / angiography
    - Immobilize knee in 20° flexion - Allow access to distal feet for serial NV assessment
    - Post reduction imaging
  2. Ortho and vascular surgery consultation
  3. Admit for serial NV checks
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28
Q

tibial plateau fx MOI (2)

A
  1. Valgus stress = lateral plateau fracture (MC)
    - High-energy trauma in young patient
  2. Low-energy trauma in osteoporotic geriatric pt - Twisting or fall
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29
Q
  1. Sudden onset of pain after trauma with the inability to bear weight
  2. Swelling, joint effusion
  3. (+/-) deformity
  4. Limited ROM
  5. Assess NV status with ABI
  6. Look for evidence of open fx
  7. Assess for associated injuries
  8. Assess for compartment syndrome

dx?
w/u?

A
  1. Tibial Plateau Fractures
  2. XR; CT/MTI to evaluate amount of displacement before surgery; CTA if vascular comp
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30
Q

this XR is beneficial if AP/lateral are inconclusive in tibial plateau fx

A

oblique

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31
Q

mgmt for tibial plateau fx

A
  1. Initial - Compression, ice, analgesics, splinting in extension
  2. Displaced - Most all fractures will require ORIF
  3. Non-displaced
    - Long-leg posterior splint / knee immobilizer, crutches, strict non-weight bearing
    - F/u with ortho within 1 week
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32
Q

indications for emergent consultation in tibial plateau fx

A

Open fx, NV compromise, compartment syndrome

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33
Q

indications for urgent consultation (within 24-48 h) for tibial plateau fx

A
  1. Fractures with any displacement or depression
  2. Most all fractures will require ORIF
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34
Q
  • Sudden force to flexed knee with quadriceps contracted
  • Knee flexion at the beginning of a jump or an awkward landing

dx?

A

Tibial Tubercle Fracture

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35
Q
  1. MC in children - Bones with open growth plates
  2. Pain, tenderness, and swelling over tibial tuberosity
  3. Displacement of patella superiorly
  4. Loss of ROM

dx?
w/u?
mgmt?

A
  1. tibial tubercle fx
  2. XR knee - 2 views
  3. mgmt
    - Incomplete/small avulsion: RICE; Knee immobilizer, long leg posterior splint, no weight bearing; Refer to ortho within 1 week
    - Complete avulsion: RICE; Knee immobilizer, long leg posterior splint, no weight bearing; Urgent ortho consult for ORIF (24-48 h)
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36
Q

Most common long bone fracture
Most often in association with fibular fracture

A

Tibial Shaft Fracture

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37
Q

MOI of Tibial Shaft Fracture (adults & children)

A
  • Adults: high-energy direct blow to the tibia
  • Children: twisting injury
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38
Q

presentation of tibial shaft fx

A
  1. inability to bear weight
  2. Pain, swelling, deformity
  3. Assess for common complications: Open fracture, NV compromise, Compartment syndrome
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39
Q

diagnostics for tibial shaft fx

A
  1. AP and Lateral Tibia/Fibula XR - Add on knee and ankle if associated injury is suspected
  2. Add oblique XR / CT - Further evaluate complexity of fracture
  3. Bone scan if occult fx is suspected
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40
Q

mgmt for tibial shaft fx

A
  1. Initial - RICE, analgesics, long leg posterior splint
  2. Emergent consultation - Open fx, Tib/fib fracture, NV compromise, compartment syndrome
  3. Displaced
    - Closed reduction and long leg splinting (posterior + stirrup)
    - Admit for observation and monitoring of complications
    - Consult ortho
  4. Non-displaced
    - Long-leg posterior splint, crutches, strict non-weight bearing
    - F/u with ortho within 1 week
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41
Q
  • Isolated fracture uncommon, most often associate with tibia fx
  • MOI: Direct blow to the lower leg; Rotational force

dx?

A

fibula fx

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42
Q
  1. May be able to bear weight - if isolated
  2. Point tenderness and localized pain with swelling
  3. Deformity may be noted if displaced
  4. Assess for Maisonneuve fx

dx?
w/u?

A
  1. fibula fx
  2. XR - 2 views tib/fb; isolated knee/ankle if needed
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43
Q

Proximal fibula fx with associated medial malleolus fx or ligament disruption of ankle without fx

what type of fx?

A

Maisonneuve fracture

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44
Q

mgmt for fibula fx

A
  1. RICE, analgesics, long leg posterior splint
  2. Emergent consultation - Open fx, tib/fib fracture, NV compromise, crush injuries, compartment syndrome
  3. Displaced/Maisonneuve - Posterior long leg splint; Refer within 24-48 hours
  4. Fibular head/neck fx - Knee immobilizer splint / long leg posterior; Ortho within 1 week
  5. Distal fibula fx - Stirrup splint / air-cast splint; Ortho within 1 week
45
Q

what type of fibula fx may begin early weight bearing using crutches as needed

A

Isolated, non-displaced fibular fractures

46
Q

how to inspect/palpate anterior view, standing, and supine for foot and ankle exam

A
  1. Note the alignment of the toes, the position of the foot in relation to the limb, and the medial curvature of the forefoot
  2. Palpate plantar fascia, MTP joints, and head of metatarsal for sesamoid bone tenderness
47
Q
  • how to inspect and palpate posterior view in foot and ankle exam?
  • what is normal?
A
  1. Assess heel alignment - while standing
    - Nml: neutral or slight valgus (turned-out heel) with no more than 1-2 lateral toes visible from behind
  2. Palpate Achilles tendon insertion
48
Q

how to inspect and palpate medial view in foot and ankle exam

A

inspect while standing

  1. Arch
    - Should be symmetric
    - High arch (pes cavus)
    - Flatfoot posture (pes planus)
  2. Prominence of medial midfoot - Accessory navicular bone
  3. Palpate for perimalleolar tenderness.
49
Q

how to inspect and palpate lateral view in foot and ankle exam

A

inspect while standing

  1. Inspect for calluses, ankle swelling, or prominence of the posterior calcaneus
  2. Palpate for perimalleolar tenderness
50
Q

how to inspect pt while standing on their toes

A
  1. Note symmetry
  2. Heels should move into a normal slight-varus position
51
Q

how to assess gait in foot and ankle exam

A
  1. Analyze alignment of the foot during the different phases of gait - Heel strike, mid stance, toe-off, swing phase
  2. Look for obvious limp, lurch, dragging of the feet, in-toeing, out-toeing, and drop-foot gait
52
Q
  1. how to assess ROM in foot and ankle exam?
  2. normal degree of range of ankle, foot, and toes?
A

Starting position - the foot is perpendicular to the tibia

  1. Ankle: Plantar Flexion 0-50°; Dorsiflexion 0-20°
  2. Foot: Inversion 0-35°; Eversion 0-25°
  3. Toes: Flexion 0–30°; Extension 0–80°
53
Q

specific muscle testing for Posterior tibialis

A

Resist as patient inverts and plantar flexes

54
Q

specific muscle testing of Anterior tibialis

A

Resist as patient inverts and dorsiflexes the foot

55
Q

specific muscle testing of Peroneus longus and brevis

A

resist eversion

56
Q

specific muscle testing of Extensor hallucis longus

A

Resist dorsiflexion of the great toe

57
Q

specific muscle testing of Flexor hallucis longus

A

Resist plantar flexion of the great toe

58
Q

3 special tests of foot and ankle exam

A
  1. Anterior Drawer Test
  2. Talar Tilt Test
  3. Thompson’s Test
59
Q

Excessive anterior translocation of the foot is indicative of anterior talofibular ligament instability

what test?

A

Anterior Drawer Test

60
Q

what is the talar tilt test?

A

Tests integrity of the calcaneofibular ligament, deltoid ligament, anterior, and posterior talofibular ligaments

  • Calcaneofibular - inversion from anatomical position
  • Deltoid - eversion from anatomical position
  • Anterior talofibular - plantarflexion and inversion
  • Posterior talofibular ligament - dorsiflexion with inversion and eversion
61
Q

what is the thompson’s test?

A

Compression of the calf in a prone position should produce plantar flexion. Absence of this finding indicates achilles tendon rupture

62
Q

imaging choice for the ankle?

A

Ankle Series

  1. AP
  2. Lateral
  3. Mortise: Provides a better view of the ankle joint
63
Q

Ottawa ankle rules for XR

A

Radiograph if 1 is present

  1. Pain at the malleoli
  2. Inability to bear weight 4 steps
  3. Tenderness posteriorly or inferiorly at the malleoli
64
Q

imaging choice for the foot

A

Foot Series

  1. AP
  2. Oblique
  3. Lateral
65
Q

ottawa foot rules for XR

A

Radiograph if 1 is present

  1. Inability to bear weight for 4 steps
  2. Tenderness at base of 5th metatarsal
  3. Tenderness over navicular bone
66
Q
  • Occurs 5-7 cm from insertion site on calcaneus
  • MOI → Direct (blow) or indirect (forced dorsiflexion - stop and go sports)

which type of achilles tendon injury?

A

rupture

67
Q
  1. Occurs at insertion site
  2. MOI: indirect as above

which type of achilles tendon injury?

A

tear

68
Q
  1. Often reports “pop” sound with sudden severe pain
  2. Difficulty bearing weight
  3. Palpable defect
  4. Weak active plantar flexion
  5. (+) Thompson test

dx?

A

achilles tendon rupture

69
Q

Less acute/severe pain than a rupture
Localized tenderness over insertion site
No palpable defect

dx?

A

achilles tendon tear

70
Q

w/u and mgmt for achilles tendon injury

A
  1. Diagnostics - Ankle x-ray; MRI/US confirms
  2. RICE, Follow up with ortho within 1 wk
    - Rupture: Short leg posterior splint in slight plantar flexion; Non-weight bearing; Surgical vs non-surgical management
    - Tear: Controlled Ankle Motion (CAM) boot and PT
71
Q

MOI of achilles tendonitis

A

Microtrauma from repetitive stress who has increased their training program or is training rigorously for a long period of time

72
Q
  1. Burning pain and stiffness 2-6 cm above posterior calcaneus - Worse with activity and relieved with rest
  2. (-) Thompson test
  3. No defect noted
  4. ROM and MS normal
  5. Long-standing dx may result in palpable calcaneal spur

dx?
w/u?
mgmt?

A
  1. achilles tendonitis
  2. clinical dx
  3. Rest, ice, NSAIDs x 7-10 d; Chronic or no improvement - Refer to PT
73
Q

classifications of ankle sprains?
MC?

A

Classified based upon location & severity

  1. Lateral ankle sprain - MC
  2. Medial ankle sprain
  3. High ankle sprain
74
Q

cause of lateral ankle sprain?
damage of what ligaments?

A

Inversion injury
Damaged to anterior talofibular ligament or calcaneofibular ligament

75
Q

cause of medial ankle sprain?
damage to what ligament?

A
  • Eversion injury
  • Damage to the deltoid ligament
76
Q

cause of high ankle sprain?
damage to which structure?

A
  • Severe inversion
  • Damage to the tibiofibular syndesmosis
77
Q
  1. h/o fall / twisting injury
  2. pain, swelling, ecchymosis, difficulty ambulating
  3. Localized point tenderness over involved ligament - Assess both malleoli and 5th metatarsal base
  4. Decreased ROM
  5. Squeeze test - Pain over the distal tib/fib (damage to tibiofibular syndesmosis)
  6. (+) Talar Tilt with pain with individualized tendon maneuver
  7. (+) Anterior drawer with anterior talofibular injury

dx?
w/u?

A
  1. ankle sprain
  2. ankle series - if fits ottawa ankle rules; nml unless high ankle sprain (Tibiofibular syndesmosis widening)
78
Q

phase 1 mgmt of ankle sprain

A

most important in management plan

  1. RICE with NSAIDs
  2. Aircast splint or ankle brace (rarely a cast for high grade injuries)
  3. wt bearing as tolerated - crutches if severe pain
79
Q

phase 2 mgmt for ankle sprain

A
  1. start once wt bearing w/o pain (appx. 2-4 wks after injury)
  2. Continue splint
  3. Start strengthening exercises and achilles stretching
    - Writing “ABC’s”, ROM with elastic band, heel raise
80
Q

phase 3 mgmt for ankle sprain

A
  1. Start once full ROM has returned and strength is up to 80% of normal
  2. Wean ankle bracing
  3. Increased strength exercise intensity - One leg balance, running figure eights
  4. Refer to PT if limited ROM and pain after 2-3 wks of home therapy
81
Q

Indications for referral to ortho for ankle sprains

A

Nerve injury, hx of chronic instability, failure to improve after 6 wks

82
Q

classifications of ankle fx

A

Classified based upon location and ligamentous involvement

  1. Unilateral fracture without ligament disruption (stable)
  2. Bimaleolar (unstable)
    - Both medial and lateral malleoli fractured
    - Unilateral malleoli with ligament disruption
    Trimaleolar (unstable)
    - Both malleoli with posterior lip of tibia
    - Both malleoli with ligament disruption
83
Q
  1. Pain and swelling
  2. Point tenderness and limited ROM
    - Identify if point tenderness is only over the malleoli or if ligaments are affected
  3. Palpate proximal fibula for tenderness (Maisonneuve fx)
  4. Assess NV status

dx?
w/u?

A
  1. ankle fx
  2. Ankle XR series; CT ankle
84
Q

mgmt for ankle fx

A
  1. Emergent ortho evaluation: Open fracture, NV compromise, associated dislocation
    - Unstable and displaced - ORIF
  2. Unstable, nondisplaced fracture
    - Short / long leg splint/cast; non-weight bearing
    - F/u with ortho with in 7 days
  3. Stable fracture: wt-bearing splint/cast x 4-6 weeks
  4. Suspected occult fracture
    - Short leg splint and repeat x-ray in 10-14 d
    - Repeat x-ray in 10-14 days will reveal a bony callus around occult fracture as healing begins
85
Q

MC calcaneal fx?

A

tarsal bone fx

86
Q

MOI of calcaneal fx

A

Results from axial loading
Often associated with vertebral fx

87
Q
  1. Severe pain in heel with inability to bear weight
  2. Swelling, ecchymosis and deformity may be present
  3. Assess NV status
    - Cap refill preferred or doppler - Distal pulses may be diminished due to swelling
  4. Assess lumbar spine for tenderness

dx?
w/u?

A
  1. calcaneal fx
  2. XR - foot & ankle series, lumbar XR if (+) exam; CT for further eval or need for surgery
88
Q

mgmt for calcaneal fx

A
  1. RICE
  2. Well padded posterior short leg splint
  3. Non-weight bearing
  4. Ortho consult with in 24 hours
    - Displaced fractures require ORIF
    - Non-displaced fx may be tx conservatively with serial XR to ensure displacement doesn’t occur
89
Q

2nd MC tarsal fx

A

talar fx

Anatomic Considerations: Extensive blood supply; At risk for AVN

90
Q

MOI of talar fx

A

High force plantarflexion, dorsiflexion or inversion force

presentation as same as calcaneal fx

91
Q

w/u & mgmt for talar fx

A
  1. Foot & ankle series; CT for further evaluation of fracture is surgery is considered
  2. Same as calcaneal fx
92
Q

Displacement of the talus from the tibia

dx?

A

ankle dislocation

93
Q

types of ankle dislocation?
which is MC?
MOIs of each?

A
  1. Posterior - MC
    - MOI: Posterior force on plantar flexed foot
  2. Lateral
    - MOI: Forced inversion, eversion, or external or internal rotation of ankle

highly unstable - Disruption of lateral or medial ligaments and/or the tibiofibular syndesmosis

94
Q
  1. Grossly deformed
  2. Posterior dislocation - Locked in plantar flexion with the anterior tibia easily palpable
  3. Assess NV status - If vascular compromise, reduction should not be delayed for imaging

dx?
w/u?
mgmt?

A
  1. ankle dislocation
  2. Ankle/foot series; CT/MRI often needed to further assess associated fx or ligamentous damage
  3. reduction; consult ortho ASAP
    - Procedural sedation
    - Grasp heel and foot and apply downward traction
    - posterior leg splint
    - Reassess NV status
    - Obtain post reduction films
95
Q
  1. MOI: Twisting or rotational force; Blunt trauma (item dropped on foot)
  2. Pain with weight bearing
  3. Swelling, ecchymosis, and tenderness over site - In stress fractures, may only demonstrate tenderness
  4. Fracture at base of 5th metatarsal = Jones fracture

dx?
w/u?
mgmt?

A
  1. metatarsal fx
  2. foot series; CT if XR nml and still sus
  3. mgmt
    - Single nondisplaced metatarsal neck and shaft fx: Short leg posterior cast or fx brace; wt-bearing is permitted
    - Multiple fx or displaced/angulated fx: Consult for open/closed reduction
96
Q

AKA: Lisfranc joint
A disruption of tarsometatarsal joint (Lisfranc injury)
often associated with fx of the metatarsals and tarsals

dx?

A

Tarsometatarsal Injury

97
Q
  1. An axial load placed on a plantar-flexed foot, followed by forcible rotation, bending, or compression. - Crush injuries, high-impact accidents such as a MVA, or high-impact sports
  2. Midfoot pain/tenderness
  3. Inability to bear weight
  4. (+) deformity, swelling, ecchymosis
  5. Assess for compartment syndrome and NV injury

dx?
w/u?

A
  1. Tarsometatarsal Injury
  2. Wt bearing foot series, Often BL images for comparison; CT/MRI if clinical suspicion but nml x-rays
98
Q

mgmt for tarsometatarsal injury

A
  1. Non-displaced
    - Non-wt bearing splint/cast (short-leg posterior) x 6-8 wks
    - rigid arch support x 3 mo
  2. Displaced fracture/TMT joint
    - Splint as above
    - ORIF
99
Q

MC phalangeal fx

A

5th phalanx

100
Q

MC phalangeal dislocation

A

MTP of the 1st joint

101
Q

presentation of phalangeal injury?
w/u?
mgmt?

A
  1. Pain/tenderness, swelling, ecchymosis, deformity, limited ROM
  2. Foot series
  3. Mgmt
    - Non-displaced fx: buddy tape
    - Displaced/angulated: reduce w/ local anesthesia and buddy tape
    - Dislocation: digital block with traction reduction - Repeat post reduction films
102
Q

what is Hallux Valgus?
MC in who?
cause?

A

AKA: Bunion

  1. Lateral deviation of great toe at metatarsophalangeal (MTP) joint
  2. 10x in females
  3. Caused by tight fitting shoes and osteoarthritis
103
Q

presentation of hallux valgus
w/u?
mgmt?

A
  1. Pain and swelling of 1st MTP joint - Aggravated by shoe wear; most have nml ROM
  2. Foot series - Measure valgus angulation at the MTP joint
  3. Pt ed: shoe wear mods (wide shoes, stitching patterns over bunion, avoid high heels); refer to ortho for surgery (still symptomatic even with conservative tx)
104
Q

nml angle measurement of MTP joint

A

< 15°

105
Q

what is Morton’s Neuroma?
MC where?
MC in who?

A
  1. A perineural fibrosis of common digital nerve as it passes between the metatarsal heads
  2. MC base of 3rd & 4th toes - 3rd web space
  3. 5x females - Likely related to compression of the nerve by tight shoes
106
Q
  1. Plantar pain in the forefoot - Burning; Aggravated by activity, wearing high heeled or tight shoes; Relief with rest
  2. Dysesthesias into affected two toes
  3. feel as though they are “walking on a marble” or there is a wrinkle in their sock
  4. (+) Interdigital Neuroma Test - increased tenderness and pain radiating into the toes

dx?
w/u?
mgmt?

A
  1. Morton’s Neuroma
  2. XR (nml), MRI/US can detect neuroma but findings are inconsistent
  3. MC nonsurgical tx - pt ed (low heeled, well cushioned, wide toe box, metatarsal padding); CSI; surgical excision if sx persist or recur
107
Q
  1. One of the MCC of heel pain in adults
  2. Peak incidence between ages 40-60
  3. Etiology not well understood
  4. Risk factors: Obesity, flat feet, prolonged standing/jumping

dx?

A

Plantar Fasciitis

108
Q

presentation of plantar fasciitis?
w/u?

A
  1. Insidious onset
  2. Heel pain - worse when initiating walking
    - most severe during their 1st steps in AM (or after long period of inactivity/sitting)
    - lessens with walking
    - Worsens toward end of day d/t prolonged wt bearing
    - Relieved by sitting
  3. Tenderness directly over medial calcaneal tuberosity and 1-2 cm along the plantar fascia
  4. Passive dorsiflexion of toes may cause increased pain

XR to r/o other conditions

109
Q

mgmt of plantar fasciitis

A
  1. Non-surgical MC
    - Initial: OTC orthotic heel pad and home stretching program
    - Avoid barefoot walking & flat shoes, activities that may be causative (dancing, running)
    - Ice and NSAIDs
    - May take 6-12 mo to resolve
  2. Unresponsive
    - CSI into heel
    - Custom orthotic
    - Surgical: partial release of plantar fascia

Clin Med III: MSK (14 decks)

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