ortho- foot and knee Flashcards
bunion presentation
- deformity of great toe
- medial deviation of 1st metatarsal
- lateral deviation of toe itself
bunion management
- Conservative= wider + deeper shoes
2. Surgical= osteotomies
where is a stress fracture most commonly found?
2nd metatarsal
presentation of Morton’s neuroma?
- burning pain in affected toe
- most commonly in 3rd/4th metatarsals
what is a mortons neuroma?
-irritated and swollen nerves from a neuroma
what causes stress fractures?
repetitive activity
treatment for Mortons neuroma?
conservative:
- pad or insole
- steroids/ LA injections
Surgical:
-excision of neuroma
what is Charcot joint?
- diabetic neuropathic joint
- damaged 2ndry to sensory loss
what is Talipes Equinovarus?
club foot
treatment of Talipes Equinovarus?
- manipulation + progressive casting (soon after birth) for 6 to 10 weeks
- 85% need achilles tenotomy
what increases risk of Achilles tendon rupture?
- Ciprofloxacin use
- repetitive strain
what test is +ve for Achilles tendon rupture?
Simmons test
-squeeze calf muscle to move foot
treatment for achille’s tendon rupture?
- series of casts with foot plantarflexed
- surgical tendon repair
most common cause of heel pain?
-plantar fascitis
cause of plantar fascitis?
-repetitive stress/ overload
presentation of plantar fascitis?
-pain felt on instep of foot
management of plantar fascitis?
- rest feet
- insoles and heel pads
when should ankle fracture get an Xray?
Ottawa Ankle Rules
Refer for Xray if they have pain in malleolar zone (lateral or medial) and one of:
- cannot wait bear for 4 steps
- distal tibia tenderness
- distal fibula tenderness
most common ankle inversion injury?
Anterior inferior tibiofibular ligament (AITFL)- 90%
what causes low/high ankle injuries?
low= inversion high= eversion
(high-eeee E=eversion)
name 1, 2, 4, 6
1= PCL 2= ACL 4= lateral meniscus 6= medial meniscus
what is 8, 10, 11, 12 and 14?
8= lateral collateral ligament 10= medial collateral ligament 11= patellar tendon (cut) 12= head of fibula 14= iliotibial band insertion
- twisting injury
- POP noise
most likely?
ACL injury
investigations ACL injury?
+ve Anterior drawer test (90 degrees)
+ve Lachman test (30 degrees)
Lachman= go to man= more reliable
management for ACL injury?
-ask patient to return in 6 to 7 days to re examine (to allow swelling to go down)
most common cause of PCL injuries?
dashboard injuries (patient has feet on dashboard)
test for PCL injury?
posterior drawer test
- Skiing injury
- Valgus stress (lateral force)
most likely?
MCL injury
M= mountain= skiiing
what type of knee injury is commonly least commonly found as an isolated injury?
LCL
cause of patella fracture?
-direct blow or sudden twist of knee
which way doe the patella commonly dislocate?
-laterally
cause of quadriceps tendon rupture?
- landing injury on partially bent knee
- Ciprofloxacin use (fluroquinolones)
how does quadriceps tendon rupture present?
-cannot extend knee
what is seen on Xray of quadriceps tendon rupture?
-inferiorly displaced patella
treatment of quadriceps tendon rupture?
- knee immobilization brace
- surgical repair
who is IT band syndrome common in?
runners
where does IT band syndrome pain present?
in the knee
treatment for IT band syndrome?
- iliotibial band stretches
- physiotherapy
presentation of meniscus tears?
- usually caused by twisting injuries
- locking, giving way
- tenderness across joint line
+ve Thessaly’s test= knee pain weight baring at 20 degrees holding onto doctor
+ve McMurray’s test= painful click upon bending and rotating knee
Medial meniscus tear= pain + swelling (highly vascular)
Lateral meniscus teat= no pain or swelling
(Lateral is more laid back, medial makes you moan)
