The Ankle and Foot Flashcards

1
Q

What type of joint is the ankle?

A

Hinge-type

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2
Q

What are the ligaments of the ankle?

A

Lateral ligament - anterior talofibular, posterior talofibular, calcaenofibular

Medial ligament (deltoid): tibionavicular, tibiocalcaneal, anterior and posterior tibiotalar

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3
Q

Which muscles are responsible for dorsiflexion of the foot (4) and what are these innervated by?

A

TA
EDL
EHL
FT (slightly)

Innervated by deep fibular/peroneal nerve

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4
Q

Which muscles are responsible for plantarflexion (6) of the foot and what are these innervated by?

A
Gastrocnemius
Soleus
(Plantaris)
FHL
FDL
Tibialis posterior

Innervated by tibial nerve

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5
Q

What are the 3 major ligaments of the foot?

A

Plantar calcaneonavicular
Long plantar
Plantar calcaneocuboid

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6
Q

What is the medial longitudinal arch of the foot composed of?

A

Talus, calcaneus, navicular, 3x cuneiform, 3x metatarsals

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7
Q

What is the lateral longitudinal arch of the foot composed of?

A

Calcaneus, cuboid, lateral 2 metatarsals

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8
Q

What is the transverse arch of the foot composed of?

A

Cuboid, 3x cuneiforms

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9
Q

Which is weaker - the lateral or the medial ligaments of the ankle?

A

Lateral - more prone to sprain.

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10
Q

Which X-ray views of the ankle would you order if you suspect an ankle injury?

A
  1. AP
  2. Lateral
  3. Mortise - ankle at 15 degrees of internal rotation, which gives true view of ankle joint and shows a symmetric joint space with no talar tilt
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11
Q

What are the Ottawa Ankle Rules?

A

Guides use of X-ray in emergency for potential ankle injuries

X-rays are only required if:
Pain in the malleolar zone AND
bony tenderness over the posterior aspect of the medial or lateral malleolus

OR

inability to weight bear both immediately after injury and in the ER

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12
Q

In addition to an X-ray, what other investigation would be ordered in an ankle injury to better characterize fractures?

A

CT

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13
Q

What is the Danis-Weber classification of ankle fractures based on?

A

Level of fibular fracture relative to syndesmosis

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14
Q

Describe a Danis-Weber Type A (2). What is it caused by?

A

Infra-syndesmotic

Caused by a pure inversion injury -

  1. Avulsion of lateral malleolus OR torn calcaneofibular ligament
  2. +/- shear fracture of medial malleolus
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15
Q

How is a Danis-Weber Type A fracture managed?

A

Most Type A #s are stable/non-displaced - minimal splintage (firm bandage or stirrup brace applied mainly for comfort)

Occasionally displaced requires ORIF + post-operative removable splintage boot for 6 weeks

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16
Q

Describe a Danis-Weber Type B ankle fracture. (3) What is it caused by?

A

Trans-syndesmotic (can be intact/partially torn)

External rotation and eversion

  1. Spiral fracture at lateral malleolus
  2. Syndesmosis can be intact/partially torn
  3. +/- avulsion of medial malleolus OR rupture of deltoid ligament
17
Q

How is an undisplaced Danis-Weber Type B ankle fracture managed?

A

Undisplaced - if syndesmosis or mortise intact, below-knee cast applied with the ankle in neutral position, overboot is fitted after X-rays at 2 weeks to confirm that fracture remains undisplaced. Cast discarded after 6-8 weeks.

18
Q

How is a displaced Danis-Weber Type B ankle fracture managed? (2)

A

Closed reduction involving traction and internal rotation of foot. If successful, cast is applied, following the same routine for undisplaced fractures (overboot fitted at 2 weeks after X-ray confirms stabilisation, cast discarded after 6-8 weeks)

Failure of closed reduction of late redisplacement - internal fixation.

19
Q

Describe a Danis-Weber type C ankle fracture (3). What is it caused by?

A

Supra-syndesmotic.

Caused by pure external rotation injury

  1. Syndemosis usually torn.
  2. Avulsion of medial malleolus OR torn deltoid ligament
  3. +/- Posterior malleolus avulsion with posterior tibio-fibular ligament
20
Q

What is the Maisonneuve fracture?

A

Spiral fracture of proximal 1/3 of fibula; most commonly occurring alongside a Type C ankle fracture.

21
Q

Describe the management of Danis-Weber Type C fractures.

A

Both displaced and undisplaced fractures are bad and highly unstable. Therefore ORIF!

22
Q

Describe three clinical features of an Achilles tendon rupture.

A
  1. Ripping/popping sensation/sound often heard and felt
  2. Sensation of having been kicked in heel - looking around and no one’s there
  3. Positive Thompson’s test
23
Q

What is Thompson’s test?

A

Used to diagnose achilles tendon rupture.

Lying prone, or kneeling on chair - squeeze calf muscles

Normal - should cause passive plantar flexion

A positive test = nothing! No plantarfexion = rupture

24
Q

Where is the most common site of Achilles tendon rupture?

A

About 4 cm above tendon insertion - vascular watershed or where blood supply is poorest

25
Q

How is Achilles tendon rupture treated? (2)

A

Non-operatively: cast of foot in plantarflexion (tendon relaxed) for 8-12 weels

Operative - surgery, then cast as above

Early rehab and physiotherapy important!

26
Q

What is the cause of hallux valgus? What is it associated with?

A
  1. Valgus alignment on 1st MTP causes eccentric pull of extensor and intrinsic muscles - reactive exostosis forms with thickening of skin to create bunion
  2. Most often associated with poor-fitting footwear but can be hereditary; 10x more frequent in women
27
Q

How is halux valgus treated? (2)

A
  1. Non-operative: properly fitted shoes (low heel) and toe spacer
  2. Surgical: goal is to restore normal anatomy - osteotomy with realignment of 1st MTP joint or arthrodesis
28
Q

What is a Jones fracture?

A

Fracture of the midshaft 5th MT caused by a stress injury

29
Q

What is a March fracture and how is it treated?

A

Fracture of shaft 2nd, 3rd MT caused by a stress injury. Symptomatic

30
Q

What is a Lisfranc fracture and how is it treated?

A

Tarso - MT fracture - dislocation caused by fall onto plantar flexed foot or direct crush injury

ORIF

31
Q

List 3 complications of an Achilles tendon rupture

A
  1. Infection
  2. Sural nerve injury
  3. Re-rupture - surgical repair decreases likelihood of rerupture compared to nonoperative management