Select Disorders of the Foot and Ankle--78 SLIDES--FOR FINAL Flashcards
Foot and Ankle
• Must provide support and shock absorption and
balance the weight of the entire body
– Dysfunction at FEET may therefore have consequences
throughout ENTIRE BODY!!
• As the most distal site of the body:
– Often affected by VASCULAR disorders
– NEUROLOGIC dysfunction as with Diabetes are often felt first distally at feet
– Vulnerable to TRAUMA and INFECTION
– Many problems often due to lack of support or
inappropriate ________
footwear
Foot and Ankle
1—Lateral Ankle Sprain
Extremely COMMON injuries in the athletic population
• MC injured ligament is: ________ talofibular ligament
• 2nd MC injury is a combination rupture of the ATFL and the calcaneofibular ligament
– Isolated calcaneofibular ligament sprain is rare
• MOI: _______ ___________ sprains
• High recurrence rate: has been reported to be as high as 80%
anterior
Plantarflexion inversion
Foot and Ankle
1—Lateral Ankle Sprain
Grade 1: (MILD) • No laxity • Stable • \_\_\_\_\_\_\_\_\_ tearing or stretching • Single ligament (ATF) • No hemorrhage • minimal swelling • point tenderness • (-) anterior drawer & tilt tests • 2-10 days
Grade 2 (MODERATE) • Mild to moderate laxity • Considered a stable injury • Large spectrum – \_\_\_\_\_\_\_\_\_ tearing of ATF – PARTIAL tearing of ATF and CF • Some hemorrhage • Some local swelling • (+) anterior drawer test • Difficulty with heal raises • 10-30 days
Grade 3 (SEVERE) • Unstable • At least 2 ligaments • Tearing of \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ ATF, CF • Early hemorrhage • Swelling both sides • (+) anterior drawer • (+) lateral stability test • Unable to bear weight • 1-3 month
Minimal
Complete
anterior capsule
Foot and Ankle
2—Medial Ankle Sprains
Isolated sprains of the medial ankle ligaments are unusual
–_________ ligament rupture can occur after pronation-eversion, internal rotation, forced plantarflexion, or forced dorsiflexion
• i.e. Stepping on uneven surface
• Chronic medial ligament instability is uncommon
Management • Uncomplicated Grade 1 and 2 sprains can be managed safely without X-rays • Standard approach: – RICE / MICE – Crutches for more serious sprains – Enable patient to bear weight ASAP • Management focus is now \_\_\_\_\_\_\_\_\_
Deltoid
prevention
Foot and Ankle——Fractures
3—Peroneal Tendon Subluxation
SNAPPING over _________ ankle
– Often with sense of WEAKNESS and PAIN
– Often confused with lateral ankle sprain
• History of ankle sprain (recurrent)
– Laxity/instability or ruptured retinaculum
Management:
• Trial of conservative treatment aimed at increasing stability
– Rocker board, strengthening
• If ineffective, surgery may be necessary
lateral
Foot and Ankle——Fractures
Distal Tibiofibular Syndesmotic Injury (DTSF)
4—______________ is made up of:
– Anterior-inferior tibiofibular ligament
– Posterior- inferior tibiofibular ligaments
– Inferior transverse tibiofibular ligament
– Interosseous ligament
• Stabilize the mortise
• Approximately 10% of total ankle sprains
– sometimes called high ankle sprains
• MOI: ________ rotation of foot / internal rotation of leg
– Foot is usually fixed to the ground
• Delayed recovery
– 2-4 months
Common mechanism of syndesmosis injury in football is a blow to the ________ leg of a player who is lying prone on the field, usually in a pile-up ——-Receiving a blow to the_________ leg, thigh, or anterior trunk, with the foot planted, commonly causes rotation of the body in the opposite direction and results in a tibiofibular syndesmosis sprain
Syndesmosis
External
lateral
lateral
Bursitis
1–________ ___________
• Swelling superficial to the Achilles tendon
• Often follows “Pump Bump” aka Haglunds Deformity
– wearing shoes that are TOO TIGHT can cause a bone spur on the back of the heel
(seen often in women who wear high heels)
2–____________
• Swelling deep to the Achilles tendon
• Pain with pressure applied behind the tendon (pinch)
• May be associated with GOUT
Superficial Achilles
Retrocalcaneal
Achilles Tendinitis
Common in runners, cyclists and aerobics • Inflammation of tendon • Pain at posterior ankle • Worse with passive \_\_\_\_\_\_\_\_ and active \_\_\_\_\_\_\_\_\_\_\_ • Squeezing tendon is painful
dorsiflexion
plantarflexion
Peritendinitis of the Extensor Tendons of the Foot and Toes
• Inflammation of the tendon sheath (tenosynovitis)
• Pain over the ______ aspect of the ankle
– Swelling, tenderness and redness may be present
• Pain intensified with active dorsiflexion and toe extension
• Check lacing on shoes to see if too tight a fit
anterior
Tibialis Posterior Tendinitis
1–Pain occurs over the medial midfoot with radiation
to the medial malleolus and posteromedial border of
the distal tibia
– SWELLING may obliterate the posterior concavity of the ___________ malleolus
2—• Palpation of the tendon causes pain
3—• Resisted plantar flexion and
inversion or passive dorsiflexion and eversion intensifies
– Often occurs in overweight, middle aged women and
men as a result of degenerative changes
medial
Peroneal Peritendinitis
• Gradual onset of pain and swelling below the lateral malleolus
• _________ is major cause
– Fracture, inversion injury, direct trauma
– Overuse
• Tenderness over the tendon at the inferior peroneal retinaculum
• Walking barefoot on irregular ground may increase symptoms
• Subtalar motion is often decreased
Trauma
Foot Conditions
Forefoot • 1st metetarsal • 2nd metetarsal • 5th metatarsal • Metatarsals
Midfoot
• Arch
• Tarsal injury
Hindfoot
• Heel
• Achilles(refer to ankle notes)
KNOW ALL
Foot Conditions———– Forefoot
1st Metatarsal
________ _____
• Hyperextension injury spraining the plantar
capsule of the MTP joint (sudden or chronic)
• Pain on dorsiflexion of toe
• Management
– taping the toe to prevent extension
– Ice, rest
– US in water, stiff soled shoe
• If non-responsive, casting may be necessary to decrease
patient activity and immobilize joint to allow for recovery
______ _______
• Beach activities – toe into plantarflexion
• Sprain of dorsal capsule
• Pain in plantarflexion
Turf toe
Sand Toe
Foot Conditions———– Forefoot
1st Metatarsal
______________-
• Pain at the bottom of the 1st toe
• Direct trauma or tension from flexor hallicus
brevis may be cause of irritation
• Onset often follows pushing-off w/ toe or forced dorsiflex’n
• Hallux valgus, flexible footwear and running or
walking on hard surfaces may predispose
• Medial sesamoid is most often involved
• NOTE: These bones may be affected by any
of the bone diseases or other processes:
– RA, Gout, DJD, Fx, Stress Fx, bursitis
Sesamoiditis
Treatment:
• Tape toe to prevent dorsiflexion
• Doughnut shaped padding to relieve pressure
and if halux valgus – tape toe into neutral
– Surgical procedures exist but are rarely needed
Prevention:
• Less flexible shoes
• Reduce time spent on hard surfaces
Foot Conditions———– Forefoot
Hallux Valgus
Lateral deviation (ABduction) of proximal phalanx, 1st toe • Deformity and pain on \_\_\_\_\_\_\_\_\_\_ side of toe • MC in middle aged women • Strong heredity component • Localized bursitis and bunion formation • Abnormal, bony bump Conservative Treatment • Aimed at SLOWING the deviation – Taping toe in neutral with padding over bunion – Keep joint mobile – Big toe box – No high heel • R/O: RA, Gout
medial
