November 13, 2015 - Foot and Ankle

Question 1

Normal Hindfoot Alignment

Answer 1

Slightly valgus

Question 2

Ankle Joint

Answer 2

The main dorsoflexor and plantarflexor of the foot.

Question 3

Achilles Tendon Rupture

Answer 3

Missed 25% of the time.

Easy to diagnose with the Thompson test.

Can be treated with a plantarflexion split or through surgery.

Question 4

Achilles Tendon Rupture - Treatment

Answer 4

Treated non-surgically (ideal) through a plantarflexion splint.

Or treated surgically.

Big risk of DVTs (30%)

Question 5

Ankle Sprain

Answer 5

Usually due to plantarflexion/inversion.

Commonly anterior tibiofibular ligament is damaged.

Question 6

Ankle Sprain - Treatment

Answer 6

RICE followed by early functional rehabilitation.

99% successful

Question 7

Sprain Not Getting Better

Answer 7

May be a bad actor of a sprain…

Could be a bone injury, a tendon injury, or a ligament injury.

Question 8

Malleoli

Answer 8

Three Musketeers

Lateral

Medial

Posterior

Question 9

Treatment for Broken Ankle

Answer 9

Reduce it before you take X-rays

Call orthopedics if you need to

Question 10

Hallux Valgus

Answer 10

aka Bunion

Medial deviation of the first metatarsal and lateral deviation of the hallux.

Most common risk factor is genetics.

Question 11

Hallux Vangus - Treatment

Answer 11

Other than surgery, nothing has been shown to slow the progression or correct the bunion.

Surgical indications are pain not cosmesis.

Non-operative management can include analgesia, activity modification, and accommodative footwear.

Question 12

Hallux Rigidus

Answer 12

Degenerative arthritis and stiffness due to bone spurs that affect the MTP which can range in severity from mild to completely ankylosed.

Can be caused by trauma, or idiopathy.

This is NOT the end-stage of a bunion, but the two may co-exist sometimes.

Question 13

Hallux Rigidus - Treatment

Answer 13

Rest, NSAIDS, and activity modification are the first line treatments.

Cortisone injections may also be used.

Surgery is a really good option too (but NOT arthroplasty; 50% failure with bad salvage). For surgery, it can range from a “bumpectomy” to MTP fusion.

Question 14

Pes Planovalgus

Answer 14

Flat foot.

Not necessarily a problem; many people have flat feet with no symptoms. Usually, patients just need reassurance that having flat feet can be normal.

Except, pediatric stiff flatfeet and flatfeet that have emerged.

Question 15

Pes Planovalgus - Cause

Answer 15

Usually (99%) due to tibialis posterior tendon dysfunction.

Degenerative is more common than traumatic.

Question 16

Ples Planovalgus - Treatment

Answer 16

Start off non-operatively (big operation).

Early stages you can use RICE, anti-inflammatory drugs, corrective orthotics.

Later, you can use ankle supports, or surgery.