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med n surg S2 > ortho - foot & ankle > Flashcards

ortho - foot & ankle Flashcards

1
Q

lateral ligament injury

A
  • 14-21% of all sports injuries
  • 85% of all ankle injuries
  • 85% involve lateral inversion mechanism
  • Most resolve with little medical intervention, and recurrent instability occurs in 15% to 48% of these injuries
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2
Q

stabilisers of ankle

A

bony
- fibula (lateral malleolus)
- tibia (articular surface & medial malleolus)
- talus

soft tissue stabilisers (static& dynamic)
- talofibular ligament
- calcaneal fibular ligament

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3
Q

lateral ankle ligaments

A
  • Anterior talofibular ligament (ATFL)
  • Calcaneofibular ligament (CFL)
  • Posterior talofibular ligament (PTFL)
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4
Q

medial ankle ligaments

A
  • superficial deltoid
  • deep deltoid
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5
Q

ankle syndesmosis ligaments

A
  • Anterior-inferior tibiofibular ligament (AITFL), - posterior-inferior tibiofibular ligament (PITFL),
  • distal interosseous ligament (IOL)
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6
Q

acute injury

A
  • mechanism of injury: inversion & plantar flexion
  • pain
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7
Q

chronic injury

A
  • instability (1/more injuries, repeated sprains)
  • swelling
  • pain
  • locking (osteochondral #)
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8
Q

Factors Contributing to Chronic Ankle Instability

A
  1. Mechanical
    * Pathologic laxity
    * Arthrokinetic restriction
    * Synovial changes
    * Degenerative changes
  2. Functional
    * Impaired proprioception
    * Impaired neuromuscular control
    * Impaired postural control
    * Strength deficits
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9
Q

ankle clinical examination

A
  1. INSPECTION
    * Ecchymosis
    * Swelling
    * Blister formation
    * Gross deformity
  2. PALPATION
  3. MOVEMENT
    * Pt. seated & relaxed knees flexed
    * Check maximal DF & PF
  4. Muscle testing
    * Strength & pain
  5. Pulses
    Dorsalis Pedis, Tib. Post
  6. Sensation
  7. Generalised ligamentous laxity
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10
Q

ankle clinical instability test

A

ANTERIOR DRAWER TEST
* 20 ̊ plantar flexion
* Tibia stabilised & foot pulled forward

TALAR TILT TEST
* Tilting of hindfoot (varus/inversion)
* ?suction sign
* Palpate talar neck (ankle vs. subtalar jt.)

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11
Q

ankle clinical radiography

A
  • stress radiographs (indication abnormal clinical stress tests (chronic))
  • Arthrograms
  • CT
  • MRI
  • Ultrasound
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12
Q

ankle management - phases of healing

A
  • Inflammatory:
    PRICE protocol
    (Up to 10 days)
  • Proliferative:
    motion and strength, improve co-ordination & proprioception
    (Up to week 4-8)
  • Remodelling:
    endurance training, sport- specific drills, & training to
    improve balance
    (Up to 1 year)
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13
Q

ankle management - initial / inflammatory phase

A
  1. Protection
    * Casts/ moonboots
    * Small advantage with lace up braces
  2. Rest
  3. Ice
    early cold therapy (within 36 hours)
  4. Compression
    * Elasti cbandage, casting, splinting, pneumatic orthoses
  5. Elevation

Prolonged immobilisation is not recommended

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14
Q

acute ankle management

A
  • Cast immobilisation
  • Early mobilisation
  • Surgical repair
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15
Q

acute ankle management - functional method of rx

A
  • Sufficient recovery / Early mobilisation
  • Avoids immobilisation
  • Flexibility & strengthening
  • Closed chain activities (endurance & balance)
  • Aerobic fitness is maintained with cross-training activities such as water running & cycling.
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16
Q

acute ankle management - surgery

A

Indications
* Open injuries
* Large avulsion #
* Frank dislocation
* High demand athlete (with recurrence/chronicity)

17
Q

acute ankle management - lateral ligament reconstruction

A
  • safe and effective treatment for acute severe ruptures
  • providing a stable ankle
  • return in approx. 10 weeks
18
Q

acute ankle mx - functional rx ineffective, still pain & swelling =

A
  • Recurrent instability
  • Peroneal tendon injury
  • Osteochondral injury
19
Q

chronic ankle management - conservative

A
  1. Functional ankle bracing
  2. Rehab + decrease activity levels
    * Peroneal motor strengthening
    * Proprioception
    * Co-ordination
    * Effective in 50%
20
Q

chronic ankle management - surgery

A

indications:
* Failed rehabilitation
* X-ray
- Talar tilt >15 ̊(>10 ̊ of other side)
- Anterior translation >5mm (>3mm of other side)

21
Q

conclusion rx for acute & chronic

A

acute
- functional method of rx
- acute repair for sportsmen

chronic
- surgery
- anatomical repair

22
Q

plantar fasciitis

A
  • Principle static and dynamic stabiliser longitudinal arch
  • Shock absorber (sole of foot)
  • Chronic inflammation
  • Bony traction spur
23
Q

plantar fasciitis - clinical symptoms

A
  • 30 – 60 years
  • Pain, swelling, difficulty walking
  • 1st Step after inactivity worst
  • Antalgic gait
  • Point tenderness over medial calcaneal tuberosity
  • Pain exaccerbated on tip toes/ hallux stretch
24
Q

plantar fasciitis - diagnosis

A
  • Mainly clinical
  • Ultrasound
  • Bone scan
  • MRI
25
Q

plantar fasciitis - DDx heel pain

A
  • Calcaneal bone lesions
  • Stress fractures
  • Insertional Achilles
  • Tib post tendonitis
  • Heel pad atrophy
    • Painful fat pad
  • Nerve entrapment
    • Calcaneal branch posterior tibial nerve
    • Between deep fascia abductor hallucis and quadratus plantae muscle
    • Tarsal tunnel syndrome
26
Q

plantar fasciitis - aetiology / cause

A
  • Mechanical overload – obesity, tight TA, excessive pronation
  • Repetitive micro tears – chronic inflammation
  • Calcaneal spur not causative
27
Q

plantar fasciitis - conservative mx

A
  • Rest
  • NSAID’s
  • Stretching-Achilles and PF
  • Heel cushions
  • Orthotics
  • rigid night splints, dorsiflexion
  • Ice/Heat
  • Taping – reduces load transmission
  • Hydrocortisone injection
  • Extra corporeal shock wave therapy
  • Radiotherapy
  • Botulinum toxin
28
Q

plantar fasciitis - surgical mx

A
  • Emphasis on partial release
  • Open release
  • Percutaneous release
  • Endoscopic fasciectomy
  • Radiofrequency lesioning
  • Complete release
  • Loss of windlass mechanism
  • Increased bony stress reaction of calcaneus * Increased strain on plantar CCJ capsule
  • Increased stress long plantar ligament
  • Increased stress 2nd MT head

med n surg S2 (18 decks)

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