Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > Session 5: Foot and Ankle Problems > Flashcards

Session 5: Foot and Ankle Problems Flashcards

1
Q

What is the most common mechanism of injury for an ankle fracture?

A

Inversion or eversion injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What co-morbidities are important to consider regarding ankle fractures, and why?

A

Diabetes Neuropathy Peripheral vascular disease Smoking These are important to consider because they are likely to affect the healing of the fracture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How are ankle fractures assessed?

A

Whether they are open or closed. Whether there is skin at risk of necrosis Whether there is swelling or blisters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common treatment of open ankle fractures and why?

A

They often require urgent surgery with extensive irrigation and debridement to reduce the risk of osteomyelitis which is an infection of the bone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Explain the ankle joint and the associated ligaments in the coronal plane.

A

It can be visualised in a ring consisting of:

Articular surfaces of the tibia and fibula by the inferior tibiofibular joint which has been joined by syndesmotic ligaments.

Medial side of the ring is formed by the medial (deltoid) ligament.

Inferior part of the ring is formed by the subtalar joint

The lateral side of the ring is formed by the lateral ligament complex of the ankle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does the lateral ligament complex consist of?

A

Anterior talofibular ligament (ATFL)

Talocalcaneal ligament

Posterior talofibular ligament (PTFL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the subtalar joint?

A

Joint between the talus and calcaneus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does the ring usually break during an ankle fracture?

A

In two places rendering the joint unstable. Think of it as a polo ring where it is hard to break the ring in just one place due to the rigidity of it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Explain what will commonly happen in an ankle injury resulting from forced eversion or external rotation of the foot.

A

It will push towards the lateral malleolus, potentially leading to an oblique fracture of the lateral malleolus and will pull on the medial ligaments leading to a ruptured deltoid ligament or a transverse fracture of the medial malleolus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Explain what will commonly happen in an ankle injury caused by forced inversion or adduction of the foot.

A

Can push the medial malleolus off the tibia and pull on the lateral structures, leading to a ruptured lateral ligament or a transverse fracture of the lateral malleolus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a talar shift?

A

When there is a disruption of any two of the syndesmosis, medial or lateral ligaments.

This causes the ankle mortise to become unstable and widen so that the talus can shift medially or laterally withing the ankle joint.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is a stable ankle fracture most commonly treated?

A

With an air cast boot or a fibreglass cast. These patients can weight-bear safely and do not need surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is an unstabled ankle fracture most commonly treated?

A

Usually needs surgical stabilisation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Surgical stabilisation of an unstable ankle fracture can be a high risk procedure. Why and in what cases?

A

In people with diabetes due to poor healing leading to necrosis and possible amputation.

In people with peripheral vascular disease leading to necrosis and possible amputation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is an ankle sprain?

A

A partial or complete tear of one or more ligaments of the ankle joint.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give factors that can contribute to an increased risk of ankle sprains.

A

Weak muscles and tendons that cross the ankle joint (especially at the peroneal muscles)

Weak or lax ankle ligaments

Inadequate joint proprioception

Slow neuromuscular response to an off-balance position

Runnning on uneven surfaces

Shoes with inadequate heel support

Wearing high-heeled shoes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do ankle sprains usually occur?

A

Through excessive strain on the ligaments of the ankle.

Caused by excessive external rotaion, inversion or eversion.

The most common mechanism of injury however is an inversion injury affecting a plantar-flexed weightbearing foot.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In inversion injury of ankle spraining what ligmanent is at the highest risk of spraining?

A

The anterior talofibular ligament.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In a severe psrain of the ankle, why is it not uncommon to find that the patient has an avulsion fracture of their fifht metatarsal tuberosity?

A

The fibularis brevis tendon is attached to a tubercle on the base of the fifth metatarsal. In an inversion injury it is under tension and can pull off a fragment of bone at its insertion site.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In children something can easily be confused with fifth metatarsal fracture. What?

A

In children aged 10-16 an unfused fifth metatarsal apophysis can be seen on x-rays and looks very similar to a fifth metatarsal fracture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In what group of people does a rupturing of the achilles tendon most commonly occur?

A

In men aged 30-50 which are not too well trained and occasionally perform recreational sports that require bursts of action, pivotin and running.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Give common mechanisms of injury of achilles tendon rupture.

A

Forceful push-off with extended knee

Fall with the foot outstretched in front and the ankle dorsiflexed.

Falling from a heigh, or abruptly stepping into a hole or off a kerb.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most common site of rupture? Why?

A

It is called vascular watershed which is about 6 cm proximal to the insertion of the achilles tendon.

This area has decreased vascularity and thickness which makes it more prone to tearing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is most common; partial or complete tear?

A

Complete tear.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are symptoms of achilles rupture?

A

Sudden severe pain at the back of the ankle or in calf

Sound of a loud pop or snap

Palpable gap or depression in the tendon

Initial pain and swelling followed by bruising

Inability to stand on tip toe or to push-off while walking.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the test called that is used to test if the achilles is ruptured?

A

Thompson’s test or sometimes called Simmond’s test.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Explain Thompson’s test also called Simmond’s test.

A

Squeeze the calf with the patient lying facing downwards (pronated).

If the tendon is intact the foot should plantarflex.

If the tendon is ruptured the foot will not move at all or reduced movement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Treatment of achilles tendon rupture.

A

Usually treated conservatively nowadays with the foot being held in the correct position in an aircast boot.

This is because surgery has a relatively high complication rate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is this?

A

Hallux valgus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is hallux valgus?

A

It’s in the name.

Hallux (big toe) valgus (distal part deviated laterally)

It involves varus deviation (medial) of the first metatarsal

Valgus deviation and or lateral rotation of the hallux

Prominence of the first metatarsal head with or without an overlying callus.

When hallux valgus starts to present the line of pull of the extrinsic tendons like extensor hallucis longus exacerbates the problem.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Who is most susceptible to hallux valgus?

What causes it?

A

Most common in middle-aged females.

Secondary to trauma, gout, rheumatoid arthritis, psoriatic arthritis, EDS, ligamentous laxity.

If you already have a starting hallux valgus high-heeled shoes and tight-fitting shoes can exacerbate the problem.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Clinical presentation of hallux valgus.

A

Cosmetically unattractive

Painful movement of 1st MTPJ and difficult with footwear

Most common cause of a bunion which is a bony deformity at the 1st MTPJ.

Varus deviation of 1st metatarsal

Valgus deviation and or lateral rotation of the hallux

Prominence of the first metatarsal head.

33
Q

Treatment of hallux valgus.

A

Surgery should not be carried out purely for cosmetic reasons. This is because this can lead to a painless foot becoming painful.

34
Q

What is hallux rigidus?

A

Osteoarthritis of the 1st MTPJ resulting in stiffness of this joint.

35
Q

Why is the 1st MTPJ so prone to OA?

A

The joint is normally under tremendous stress during walking. This is because with each step a force equivalent to twice the body weight passes through this very small joint.

36
Q

Secondary causes of hallux rigidus.

A

Gout and previous septic arthritis.

37
Q

Most common symptoms of hallux rigidus.

A

Pain in the MTPJ on walking and on attempted dorsiflexion of the toe.

Pain is usually not present at rest but can be in severe cases.

Patients usually tend to compensate by walking on the outside of their foot.

38
Q

Complications of hallux rigidus.

A

Range of dorsiflexion of the toe becomes severely restricted.

Dorsal bunion (osteophyte) can develop on top of the joint.

39
Q

What are the four surgical managements of osteoarthritis in any location?

A

Arhtroplasty

Arthrodesis

Excision arthroplasty

Osteotomy

40
Q

What is arthroplasty?

A

Joint replacement.

41
Q

What is arthrodesis?

A

Joint fusion

42
Q

What is excision arthroplasty?

A

Surgical removal of the joint with interposition of soft tissue.

43
Q

What is osteotomy?

A

Surgical cutting of a bone to allow realignment.

44
Q

Treatment of hallux rigidus.

A

Use the treatment ladder.

Initially treated with activity modification, analgesia, orthotics or aids and sometimes intra-articular steroid injections.

It is common to give a rigid sole orthotic which is a very stiff shoe that prevents motion at the 1st MTPJ.

If conservative management fails to control the symptoms sufficiently surgery can be done.

Surgery involves arthrodesis. Arthroplasty can also be done since there are protheses for 1st MTPJ.

45
Q

Causes of osteoarthritis of the ankle joint.

A

70-80% of cases occur due to previously suffered trauma also called post-traumatic arthritis. The initial injury may heal with full return of the ankle’s function but in some cases OA can develop.

12% of cases are secondary to inflammation of the ankle joint like RA and reactive arthritis.

Remainder of cases have no identifiable cause meaning they are termed primary OA of the ankle joint.

46
Q

Risk factors of OA of the ankle joint.

A

Obesity

Joint stress like footballers and ballet dancers.

47
Q

Treatment of OA of the ankle joint.

A

Most commonly arthrodesis surgery is done.

Arthroplasty is not performed as readily as it major complication may follow but it can be considered.

48
Q

Label

A
49
Q

What is this?

A

Claw toe of all small toes.

50
Q

What is claw toe?

A

Hyperextension at the MTPJ and flexion at the PIP joint most commonly of all four small toes.

The DIP joints can also be flexed curling under the foot.

51
Q

Causes of claw toe.

A

Result from a muscle imblance which causes the ligaments and tendons to become unnaturally tight.

This is usually due to neurological damage.

Can be secondary to conditions such as cerebral palsy, stroke, diabetes or alcohol dependence.

Trauma, inflammation and RA can also cause claw toes.

52
Q

What is this?

A

Hammer toe

53
Q

What is this?

A

Mallet toe

54
Q

What is the difference between hammer toe and mallet toe?

A

In hammer toe the toe is flexed at the PIPJ.

In mallet toe the toe is flexed at the DIPJ.

Both deformities can affect any toe but most common in second toe.

55
Q

Causes of hammer and mallet toe.

A

Ill-fitting pointed shoes and pressure on the second toe from an adjacent hallux valgus.

Tight shoes and too small shoes.

56
Q

What is this?

A

Curly toes

57
Q

Causes of curly toes.

A

Congenital and usually involve the 3rd and 5th digis. Usually bilateral and are more common in those with a family history.

Thought to develop because the tendons of the FDL and FDB are too tight.

58
Q

Treatment of curly toes.

A

Usually conservative with passive extension of the toes and stretching of the flexor tendons.

Surgery is rarely needed.

59
Q

What is achilles tendinopathy?

A

A degenerative process which usually leaves the tendon thickened and degenerated.

60
Q

There are two types of achilles tendinopathy.

Which?

A

Insertional tendinopathy

Non-insertional tendinopathy

61
Q

Explain both insertional and non-insertional tendinopathy.

A

Insertional: Degeneration at the point of insertion of the achilles tendon into the calcaneum

Non-insertional: Degeneration at the vascular watershed area within the achilles tendon.

62
Q

Causes of achilles tendinopathy.

A

Usually a consequence of many years overuse of the tendon like in long-distance runners and sprinters.

It can also occur in people who are inactive, there are risk factors such as obesity and diabetes.

63
Q

Symptoms and signs of achilles tendinopathy.

A

Pain and stiffness along the Achilles tendon in the morning

Pain in the tendon or at the back of the heel that worsens with activity

Severe pain 24 hours after exercising

Thickening of the tendon

Swelling that is present all of the time but worsens during activity

A palpable bone spur in insertional tendonitis.

64
Q

Treatment of achilles tendinopathy.

A

Physiotherapy especially eccentric stretching exercises to try and improve the vascularity of the tendon and promote healing.

65
Q

What is Pes planovalgus?

A

Flat foot.

66
Q

Explain flat foot (pes planovalgus)

A

A condition that is normal in children. It is due to a medial arch which has collapsed (or in children it hasn’t developed yet).

This means that the medial border of the foot touches or almost touches the ground. There is also a valgus angulation of the hindfoot.

This is completely normal in children and it is only if the flat foot persists into adolescence it is considered abnormal.

67
Q

There are two types of flat foot. Which?

A

Flexible flat foot and rigid flat foot.

68
Q

What is the difference between rigid flat foot and flexible flat foot?

A

Flexible: When the patient stands on tip-toes a normal medial arch appears and there is no valgus deviation of the hind-foot.

Rigid: The flat foot persists on tip-toe and the valgus deviation does as well. Rigid flat foot are usually symptomatic and require treatment.

69
Q

Cause of rigid flat foot.

A

Develop as a result of tarsal coalition. Failure of tarsal coalition meaning the tarsal bones do not separate during embryonic development.

70
Q

Causes of acquired flexible adult foot.

A

Dysfunction of the tibialis posterior tendon. Tibialis posterior tendon usually support the medial longitudinal arch of the foot while walking. This also leads to stretching of the spring ligmanet also called plantar calcaneonavicular ligament and also the plantar aponeurosis.

Talar head becomes displaced inferomedially, flattening the medial longitudinal arch and producing lateral deviation of the hindfoot.

71
Q

Risk factors of adult acquired flatfoot.

Symptoms.

A

Obesity, hypertension and diabetes.

It can also occur temporarily during pregnancy due to increased laxity of the ligament.

Usually pain described beind the medial malleolus, collapsed medial arch and valgus deviation of the hind-foot.

72
Q

Treatment of adult acquired flexible flat foot.

A

Use of orthotics (insoles) to support the medial arch and physiotherapy to improve muscle strength.

Some patients will require surgical reconstruction or if secondary to OA arthrodesis.

73
Q

How can diabetes mellitus lead to foot disease?

A

Ischaemia due to peripheral arterial disease and microvascular disease + immunosuppression due to poor glycaemic control can lead to foot ulcers and severe infections of the foot.

This is exacerbated by peripheral neuropathy meaning there will be less sensation of the feet. This means that the patient might not feel that they have ulcers and wounds on their feet so they continue to walk on their ulcer making it even worse.

Peripheral arterial disease also means that wound healing will not be as good.

74
Q

How is diabetes foot prevented?

A

Regular diabetic foot clinics for screening. Screening for any corns, callouses, cracks and dry skin. Sensation and perfusion of the feet are assessed as well as their shoes.

Tigh glycaemic control as well to maintain healthy immune response.

75
Q

What can poorly controlled diabetes lead to?

A

Charcot arthropathy.

76
Q

What is Charcot’s arthropathy?

A

Progressive destruction of the bones, joints and soft tissues of the foot and ankle.

Can also affect the knee joint.

Combination of neuropathy, abnormal loading of the foot, repeated microtrauma and metabolic abnormalities leads to inflammation causing osteolysis, fractures, dislocation and deformity.

77
Q

Treatment of Charcot arthropathy.

A

Optimisation of glycaemic control and reduction of the load placed on the affected joints like losing weight.

78
Q

What happens if there is injury to the common peroneal nerve?

A

Common peroneal everts and dorsiflexes the foot. This means that damage to it causes foot drop.

79
Q

What happens if there is damage to the tibial nerve?

A

Tibial nerve inverts and plantar flexes. (TIP)

This means you can’t walk on tip-toes.

MSK (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions