MSK - foot and ankle Flashcards
Name 2 common red flag hypothesis for the foot and ankle, and what mechanism they are, who they are common in and the pain that occurs
- Inflammation or infection
- sudden onset, usually trauma
- pain increases in pm, am stiffness
- hot, red swelling - Fracture
- trauma mechanism
- common in younger men and older women (osteoporosis)
Name 2 common arthrogenic hypothesis for the foot and ankle, and what mechanism they are, who they are common in and the pain that occurs
- Intra-articular (OA)
- insidious mechanism
- common over 55
- deep ache and stiffness - Ligamentous
- caused by trauma or repetitive instability
- common under the age of 40
- associated with inflammation
Name a common myogenic hypothesis for the foot and ankle, and what mechanism it is, who it is common in and the pain that occurs
Compartment syndrome
- caused by over-load or change in activity
- common under the age of 55
- pain increases with activity and eases with rest
Define the Ottawa ankle rules
A validated tool to identify those needing ankle/foot X-rays
What are the guidelines of the Ottawa ankle rules for an ankle x-ray?
Ankle X-ray is needed if the pain in the malleolar zone and any of:
- bone tenderness - distal 6cm of posterior edge of the tibia or tip of the medial malleolus
- bone tenderness - distal 6cm of posterior edge of the fibula or tip of the lateral malleolus
- unable to weight bear immediately after injury and in the department for 4 steps
What are the guidelines of the Ottawa ankle rules for a foot x-ray?
Foot x-ray needed if the pain in mid-foot and:
- bone tenderness at base of 5th metatarsal
- bone tenderness at the navicular base
- unable to weight bear immediately and in the department for 4 steps
What are some limitations of the Ottawa ankle rules?
- intoxicated or uncooperative patients
- distracting painful injuries
- poor sensation in legs
- gross swelling preventing palpation of bone tenderness
What is rheumatoid arthritis and what are some common signs and symptoms?
RA is the most common type of inflammatory arthritis
- warmth
- swelling
- change of foot shape
- nodules
- morning stiffness > 30 mins
- fatigue
What is Charcot Marie Tooth, give another name for it and what are some common signs and symptoms?
One of the most common inherited neurological disorders. Progressive loss of function to peripheral nerves due to a genetic fault.
AKA hereditary motor & sensory neuropathy (HMSN)
- foot drop
- high stepping gait
- progressively high or low arch foot
- progressive weakness
What are some specific questions for the foot and ankle?
Have you experienced any problems with this area before? Any family history? Locking or frequent instability? Persistent loss of ROM post-trauma? Unexplained swelling/warmth?
What do you ask for in a patients previous medical history?
THREADS Thyroid Heart conditions Rheumatoid (or other) arthritis Epilepsy Asthma Diabetes Surgery
What safety questions should be asked to bring up red flags?
Previous history of cancer
Unexplained weight loss
Night pain and sweats
Recently unwell
What are the supporting arches of the foot called and where are they found?
- Transverse Arch
formed by metatarsal bones, 3 cuneiform bones, and the cuboid. lies below the ball of the foot - Longitudinal Arch
- medial = formed by calcaneus, talus, navicular, 3 cuneiform bones and first 3 metatarsals
- lateral = formed by calcaneus, cuboid and 4th and 5th metatarsal
What do you look for in a physical examination of the feet?
- Hematomma - colour and location
- Condition of feet
- Calf bulk/ muscle atrophy
- Symmetry
- Position of feet
- Hip/spinal posture
Name the ligaments of the ankle
Lateral ankle ligaments: - anterior talofibular - posterior talofibular - calcaneofibular Medial ankle ligaments: DELTOID LIGAMENT - anterior tibiotalar - posterior tibiotalar - tibionavicular - tibiocalcaneus
