T&O: Ankle and foot

Question 1

Where do injuries to the Talus most often occur / how do they occur?

Answer 1

50 % occur in the neck (can occur in head, neck, lateral body)

Neck fractures: high energy fracture causing ++ dorsiflexion. Talus pushed agaisnt Tibia. Blood supply disturbed - avascular necrosis

Body fractures : jumping from height

Question 2

How do calcaneal fractures often occur?

What type of fracture is common?

What are some long term complications of calcaneus fracture?

Answer 2

Occur due to axial loading e.g. falling from a height like a ladder

Comminuted fracture is common. Xray - calcaneus shorter and wider

Can lead to arthritis in sub-talar joint. Inversion and eversion are painful making walking on unever ground painful.

Question 3

What type of joint is the ankle joint?

What 2 movements does this allow and which is more stable?

Answer 3

Hinge joint

Dorsiflexion and Plantarflexion of the foot

Dorsiflexion is more stable as the anterior part of talus is wider and is held in the mortise (In plantarflexion the narrower posterior part is)

Question 4

At the ankle joint the Tibia and Fibia are held together by ____(1)____

This results in a bracket shaped socket called ____(2)_____ which the _____(3)_____bone fits snugly into

Answer 4

(1) Tibiofibular ligaments
(2) Mortise
(3) Talus

Question 5

What is the most important thing to notice in ankle fractures?

Answer 5

Talar shift

Question 6

What is talar shift?

Answer 6

The talus usually sits in the mortiste, if moved from here, talar shift- unequal joint space around the talus

Question 7

Explain the anatomy of the ankle joint

Answer 7

Tibia- medial, Fibula- laterally, syndamosis joining the two bones. Medial malleolus at the base of the tibia with the deltoid ligaments and lateral malleolus at the base of the fibula and lateral ligaments.

Question 8

What types of fractures can occur at the ankle?

Answer 8

Lateral malleolus ( most common), medial malleolus, bimalleolar, trimalleolar

Question 9

What are the mechanism of injuries of lateral and medial malleolus fractures?

Answer 9

Lateral- inversion of foot
Medial- eversion of foot

Question 10

What is the weber classification?

Answer 10

For lateral malleolar fractures.
A- below the syndamosis
B- at the syndamosis
C- Above the syndamosis

Question 11

When would you use conservative management for malleolar fractures?

Answer 11

Weber A, weber B without talar shift
Non-displaced medial malleolus fractures

Question 12

When would you use surgical management for malleolar fractures?

Answer 12

Weber B with talar shift, weber C, bimallerolar or trimalleolar fractures and open fractures

Question 13

What is a pilon fracture?

Answer 13

Usually high impact, talus drives into distal tibia

Question 14

What are risk factors for plantar fasciitis

Answer 14

Running, obesity, prolonged standing

Question 15

Which area of the leg does the saphenous nerve provide sensation to?

Answer 15

Medial aspect of lower leg and foot§

Question 16

Where does the tibial nerve provide sensation?

Answer 16

Posterolateral side of the leg, lateral side of the foot and the sole.

Question 17

What is hallux valgus?

Answer 17

Characterised by the medial deviation of the first metatarsal and the lateral deviation of the hallux +/- rotation of the hallux with associated joint sublaxation

Question 18

How does hallux valgus present ?

Answer 18

painful medial prominence
aggravated by walking, weight bearing activities and narrow fitting shoes

Question 19

What are the risk factors for hallux valgus?

Answer 19

female
Hyper-mobility conditions
Connective tissue disorders
flat feet

Question 20

What should you assess on examination for a patient that presents with hallux valgus

Answer 20

Position and lateral deviation of hallux
Check for inflammation and skin breakdown over the prominence at the base of the hallux
Check for worsening prominence when weight bearing
Check for active and passive range of movement. Check for crepitus and pain associated with crepitus

Question 21

Why do we Xray in hallux valgus?

Answer 21

• To assess the degree of lateral deviation and joint subluxation
• Measure the angle between the first metatarsal and the first proximal phalanx- greater than 15 degrees, indicative of hallux valgus

Question 22

What makes up the syndesmosis between the tibia and fibula?

Answer 22

Anterior inferior tibiofibular ligament, Posterior inferior tibiofibular ligament and the intra-osseous membrane.

Question 23

What part of the ankle anatomy is involved in a trimalleolar ankle fracture?

Answer 23

medial malleolus fracture, lateral malleolus fracture and posterior malleolar fracture

Question 24

How do you manage an ankle fracture?

Answer 24

Immediate fracture reduction to realign the fracture. Place ankle in a ‘below knee back slab’. Repeat NV examination after reduction. Management after this can be conservative or surgical depending on type of fracture sustained.

Question 25

What is the main complication after an ankle fracture?

Answer 25

Post traumatic arthritis. This is rare with appropriate reduction and fixation.

Question 26

In a Weber’s fracture, what other features may be present?

Answer 26

Talar shift and shortening.

Question 27

Ottawa ankle rules?

Answer 27

Ankle x-ray is required only if there is pain in the malleolar zone and any of:

Bone tenderness at the posterior edge or tip of the lateral malleolus
Bone tenderness at the posterior edge or tip of the medial malleolus
Inability to bear weight both immediately and in emergency department for four steps.

Foot x-ray is only required if there is midfoot zone pain and any of the below:

Bone tenderness at base of the fifth metatarsal.
Bone tenderness at navicular bone.
Inability to bear weight both immediately and in emergency department for four steps.