MSK 11 - Foot + Ankle Injuries

Question 1

What determines whether an ankle fracture is stable or not?

What is a talar shift?

Answer 1

• Bones in ankle held together by ligaments (deltoid and lateral) to form a circular structure (like a polo). If it breaks in 1 part then the fracture is stable, if in 2 parts, fracture is unstable, so has to be treated differently.
• Talar shifts occur during ankle fractures, where the talus shifts to one side creating a large gap on one side (typically a lateral shift)

Question 2

What is the treatment strategy (and complications) of stable + unstable ankle fractures?

Answer 2

Stable = Cast/boot for comfort, low rate of complications or arthritis.
Unstable = Need surgical stabilisation, can be high risk surgery in diabetics/poor blood supply.

Question 3

How do ankle sprains occur + what is the most common ligament affected?
Who do achilles tendon ruptures occur in + what test is used to diagnose them?

Answer 3

• Similar to fractures but ligaments fail first. 90% heal with rest and time. Anterior talofibular most common (going over on your ankle).
• 30-50 Y.O’s, use Thompson’s test - squeeze calf lying flat, there will be no plantarflexion in those with ruptures achilles tendon.

Question 4

How is diagnosis of achilles tendon ruptures made?

What is the treatment strategy?

Answer 4

• Diagnosis made through history + examination - confirmed by MRI or ultrasound.
• Mostly conservatively, 5-10% wound complications with surgery.

Question 5

Name 4 toe deformities and their causes.

Answer 5

1) Claw toe- neurological abnormality
2) Hammer toe - idiopathic imbalance or hallux valgus
3) Mallet toe - idiopathic
4) Curly toe - congenital

see slide 20 for pics

Question 6

What is hallux valgus?
What is it caused by?
What is the treatment?

Answer 6

• A bunion - deformity of the big toe away from the midline.
• Caused usually by shoe-wear (stilettos)
• Rarely surgery but can be done, change shoes and attitude …

Question 7

What is hallux rigidus?

What are the X-ray presentations of hallux rigidus?

Answer 7

• Osteoarthritis of the 1st meta-tarsal pharyngeal joint. Causes pain in 1st MTPJ and lump over the big toe.
• Loss of joint space, osteophytes, cysts + subchondral sclerosis (typical of OA).

Question 8

What are the treatment options for hallux rigidus (arthritis)?

Answer 8

• Conservative option includes orthotics/aids, painkillers and activity modifications.
• Gold-standard for surgery is 1st MTP joint fusion, create a fracture and stabilise it.

Question 9

What is “pes planovalgus”?
When is this feature normal?
Are all types of the condition the same?

Answer 9

• flat feet
• In toddlers + young children, arch begins to form in school age children
• No, you can get normal flexible flatfeet or abnormal rigid flat feet (normal flexible means you get arch appearing and heels swinging in when going on tip toes, this is absent in abnormal rigid).

Question 10

What is the name given to adult onset/acquired flat feet?
What causes this?
How is it treated?

Answer 10

• Planovalgus - usually in middle aged females, pain behind the medial malleolus
• Posterior tibial tendon dysfunction
• Insoles to support medial arch + physiotherapy. Reconstructive surgery is an option.

Question 11

How does diabetes affect the feet?

Answer 11

• 15% of diabetes experience foot problems + 25% of diabetic hospitalisations are for the foot.
• Causes loss of protective sensation in the foot, leading to severe infections - known as Charcot Arthropathy - causes massive deformity and bone loss.