Orthopaedics & Rheumatology / Lowerleg, Foot, And Ankle Injuries Flashcards
What is the most common type of ankle sprain, characterized by pain anterior and inferior to the lateral malleolus?
Lateral sprain from an inversion injury, anterior talofibular ligament (ATFL) > posterior talofibular ligament (PTFL) > calcaneofibular
What additional injury do you need to worry about with a grade 3 ankle sprain?
Lateral malleolus fracture
Improper use of crutches can result in what injuries?
- Axillary artery or venous thrombosis
- radial nerve compression neuropathy
What are the guidelines for fitting crutches to a patient?
- Length of crutch should be 75% of the patient’s height
- position crutch 4-6 inches (10 cm) anterior and lateral to little toe
- place handgrips even with the hips so arm is 30° flexed
- tops of crutches should be 2 in (5 cm) below the armpits
What are the Ottawa ankle rules for when to order an ankle radiograph?
- Order AP, PA, and mortise view x-ray
- if pain is near the malleoli plus either inability to bear weight for immediately or in the emergency department (ED) for four steps
- or tenderness at or within 6 cm above either malleolus
What are the Ottawa guidelines for when a radiograph is needed for a foot injury?
- Pain in the mid-foot and either inability to bear weight for four steps or bone tenderness at navicular or base of fifth metatarsal
In what cases can you not use the Ottawa rules to guide your decision to obtain radiographs of an injured extremity?
- Children below 18
- pregnancy
- multiple painful injuries
- injury or intoxication that prevents examination
Mostly likerly injury
Football player plants his foot just as another player hits his heel forcing further dorsiflexion, and he notices tenderness and swelling when moving his MTP joint
Turf toe (1st MTP sprain)
Likely injury…
Middle-aged weekend warrior hears audible pop while jogging, absent plantar flexion in response to Thompson test (with the patient prone, squeeze the gastrocnemius), can’t toe stand
Achilles tendon rupture
Likely injury…
35-year-old male, training for marathon, with pain in proximal-medial aspect of calf, with swelling, ecchymosis, and tenderness, can’t stand on toes
- Gastrocnemius tear
Likely injury …
Fracture to the proximal diaphysis near the base of the fifth metatarsal
Jones fracture
Likely injury ….
Pain with activity, abnormal stress with normal bone, commonly in individuals in sports and military recruits
- Stress fracture: metatarsals (50%)
- calcaneous (25%)
- tibia (20%)
- tarsal navicular (<5%, especially in basketball players)
What is the name for postero-medial tibial pain, brought on by activity, and improved by rest?
- Medial tibial stress syndrome (MTSS)
- often referred to as “shin splints”
What are the risk factors for the development of (Medial Tibial Stress Syndrome) MTSS?
- Pes planus (flat feet)
- rapid growth
- hyperpronation
A 35-year-old female complains of pain on the surface of her heel and inside of her foot, which is worse after sitting or when she begins to walk in the morning. She does high-impact aerobics three times a week, and does not remember when she got her last pair of gym shoes. On examination, her pain increases with passive dorsiflexion. What is the most likely diagnosis?
Plantar Fasciitis
