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Lecture Notes- Orthopaedics and Fractures > The foot and Ankle > Flashcards

The foot and Ankle Flashcards

1
Q

What structure runs from the tip of the medial malleolus distally to the talus, navicular and calcaneus in a fan shape

A

The deltoid ligament - broad structure

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2
Q

What does the lateral ligament complex consist of

A

3 bands
anterior talofibular ligament
calcaneofibular ligament and
posterior talofibular ligament

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3
Q

What ligament is most commonly affected by an ankle sprain

A

ATFL

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4
Q

Where is the subtler joint and what is its function

A

between the talus and the calcaneum

provides for inversion and eversion of the heel

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5
Q

What makes up Chopart’s joint

A

Talonavicular and calcaneocuboid joints

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6
Q

What structure suspends the head of the talus

A

The plantar calcaneonavicular ligament or the spring ligament

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7
Q

What structures contribute to maintaining the medial longitudinal arch of the foot

A

The plantar ligament and the plantar aponeurosis

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8
Q

What is an abnormally high arch

A

pes cavus

associated with an adducted forefoot

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9
Q

What structures help us to accommodate for walking on uneven terrain

A

intercuneiform and the tarsometatarsal joints

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10
Q

What is important in the push off movement of normal walking

A

dorsiflexion of the MTPJs

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11
Q

How are the subtalar movements tested

A

holding the heel and gliding it fem side to side on the talus

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12
Q

How are mid tarsal movements tested

A

Grasping the heel firmly to hold it still and rotating the midst around the hindfoot

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13
Q

What are the causes most cases of flat foot (pes planus) in children

A

Physiological

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14
Q

What does severe clawing of the toes often result in

A

dislocation of the MTPJs

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15
Q

What is Hallux valgus

A

A condition in which the first metatarsal deviates medially to a variable degree and the great toe deviates laterally and may be rotated into pronation

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16
Q

What conditions is commonly associated with Hallux valgus

A

Hammer toe (2nd toe)

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17
Q

Who is more likely to develop Hallux Valgus

A

Women

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18
Q

What is the treatment for Hallux Valgus

A

most are asymptomatic and need to be careful when selecting shoes

Surgery in some patients

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19
Q

What are the surgical options for Hallux Valgus

A

metatarsal osteotomy - Z shaped osteotomy which allows correction of the metatarsal deformity in 2 planes
Arthrodesis of the metatarsophalangeal joint

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20
Q

If a patient “goes over their ankle” what is likely to have been damaged

A

Anterior talofibular ligament - inversion and twisting

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21
Q

What are the clinical features of a ligament injury in the ankle

A

swlling
pain
restriction of movements
tenderness over the lateral ligament

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22
Q

What is the treatment for a ligament injury

A

strapping or a below the knee walking cast for 2-3 weeks if swelling is severe
MRI to rule out complete rupture of bilateral ligaments
Surgical reconstruction if recurrent

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23
Q

What is the prognosis for a medial ligament treated conservatively

A

very poor - needs operative repair

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24
Q

What is the classification system used for ankle fractures and dislocations

A

Weber classification and the Lauge-Hansen classification

25
Q

What is an important structure in maintaining ankle stability

A

the strong interosseous ligament between the lower ends of the tibia and fibula

26
Q

What is the main difference in treating an ankle fracture in a diabetic to an ankle fracture in a non-diabetic patient and why

A

Diabetic need to be immobilised for twice the normal period

They are prone to delayed union and skin break down

27
Q

What is the treatment for a uni-malleolar fracture

A

Bandage or light-weight malleolar splint - six weeks weight bearing immobilisation

28
Q

What is the treatment for bi-malleolar injuries

A

Internal fixation with a contoured plate and screws

29
Q

What is the treatment or a ruptured interosseous ligament

A

stabilisation of the joint with a horixontal screw orientated in the inter-malleolar plane

30
Q

Why must a screw be removed before weight bearing following an interosseous ligament rupture

A

The screw may break

31
Q

What is the treatment for a trip-malleolar fracture. What does this prevent

A

Open reduction and stabilisation with a plate and screw

Avoid backward subluxation of the talus

32
Q

How does a patient end up with a vertical compression fracture

A

fall on the foot from a height

33
Q

What are vertical compression fractures also known as

A

Pilon fracture

34
Q

What is the management for a Pilon fracture

A

external fixation

35
Q

What is a major complicating of a fractured talus

A

Avascular necrosis of the body of the talus due to interruption of the blood supply by the fracture

36
Q

What is the gold standard treatment for a talar neck fracture and dislocated taller body

A

Open reduction - very high risk of avascular necrosis

37
Q

How do fractures of the calcaneum arise

A

Falls from a height onto the heel - often bilateral

38
Q

What often occurs alongside a fractured calcaneum

A

lumbar spinal burst fracture

39
Q

What are the clinical features of a fractured calcaneum

A

grossly swollen and bruised
unable to weight bear
ankle movements may be reduced
subtalar movements are completely absent

40
Q

What are some complications of a fractured calcaneum

A

trapped peroneal tendons

41
Q

What is a Lisfranc injury

A

Injury to the tarsometatarsal joint usually as a result of rotation of the handoff about a fixed forefoot

42
Q

What is the treatment for a Lisfranc injury

A

reduction and stabilisation (open or closed) with screws or plates)

43
Q

What causes a basal fracture

A

inversion strain of the foot

44
Q

What is the treatment of a basal fracture

A

walking plaster cast or bandage for 3-6 weeks

45
Q

What causes a shaft fracture

A

crushing

46
Q

What is the treatment of a shaft fracture

A

elevation of the foot if swollen. followed by a below-knee cast for 6 weeks

47
Q

What might a fractured phalange interfere with

A

circulation necessitating amputation of the toe

48
Q

What is the treatment for a fractured phalange

A

Protective dressings,

Allow patient to continue walking

49
Q

What are the most common cause of infections in the ankle and foot

A

in relation to the toe nails which can become in growing

50
Q

What is the treatment for an in-growing toenail

A

antibiotics for severe acute epidodes

removal of the nail edge or whole nail

51
Q

What are the main clinical features of OA in the ankle

A

pain on weight bearing

diminished range of movement

52
Q

What are the treatment options for OA in the ankle

A

Arthrodesis - helps with pain

Arthroplasty - allow greater freedom of movement

53
Q

What is Hallux rigidus

A

OA of the 1st MTPJ

54
Q

What are the clinical features of Hallux rigidus

A

Progressivel more painful when walking especially during push-off

55
Q

What is the treatment for Hallux rigidus

A

Surgery - arthrodesis

56
Q

Describe the clinical presentation of RA in the ankle and foot

A

Diffuse porous followed by joint erosions and narrowing

Hallux valgus

57
Q

What is the characteristic sensation of the sole as the MPTJs dislocate

A

Walking on pebbles

58
Q

What are the treatment options for the ankle in RA

A

synovectomy
Fusion
Ankle joint replacement
Excision f proximal phalanges or interphalangeal fusions

59
Q

What are some neurological conditions which affect the foot and ankle

A

Hereditary motor sensory neuropathies e.g. Charcot-Marie-Tooth disease
Friedreich’s ataxia
Spina bifida
Poliomyelitis

Lecture Notes- Orthopaedics and Fractures (23 decks)

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