The foot and Ankle Flashcards
What structure runs from the tip of the medial malleolus distally to the talus, navicular and calcaneus in a fan shape
The deltoid ligament - broad structure
What does the lateral ligament complex consist of
3 bands
anterior talofibular ligament
calcaneofibular ligament and
posterior talofibular ligament
What ligament is most commonly affected by an ankle sprain
ATFL
Where is the subtler joint and what is its function
between the talus and the calcaneum
provides for inversion and eversion of the heel
What makes up Chopart’s joint
Talonavicular and calcaneocuboid joints
What structure suspends the head of the talus
The plantar calcaneonavicular ligament or the spring ligament
What structures contribute to maintaining the medial longitudinal arch of the foot
The plantar ligament and the plantar aponeurosis
What is an abnormally high arch
pes cavus
associated with an adducted forefoot
What structures help us to accommodate for walking on uneven terrain
intercuneiform and the tarsometatarsal joints
What is important in the push off movement of normal walking
dorsiflexion of the MTPJs
How are the subtalar movements tested
holding the heel and gliding it fem side to side on the talus
How are mid tarsal movements tested
Grasping the heel firmly to hold it still and rotating the midst around the hindfoot
What are the causes most cases of flat foot (pes planus) in children
Physiological
What does severe clawing of the toes often result in
dislocation of the MTPJs
What is Hallux valgus
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
What conditions is commonly associated with Hallux valgus
Hammer toe (2nd toe)
Who is more likely to develop Hallux Valgus
Women
What is the treatment for Hallux Valgus
most are asymptomatic and need to be careful when selecting shoes
Surgery in some patients
What are the surgical options for Hallux Valgus
metatarsal osteotomy - Z shaped osteotomy which allows correction of the metatarsal deformity in 2 planes
Arthrodesis of the metatarsophalangeal joint
If a patient “goes over their ankle” what is likely to have been damaged
Anterior talofibular ligament - inversion and twisting
What are the clinical features of a ligament injury in the ankle
swlling
pain
restriction of movements
tenderness over the lateral ligament
What is the treatment for a ligament injury
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
What is the prognosis for a medial ligament treated conservatively
very poor - needs operative repair
What is the classification system used for ankle fractures and dislocations
Weber classification and the Lauge-Hansen classification
What is an important structure in maintaining ankle stability
the strong interosseous ligament between the lower ends of the tibia and fibula
What is the main difference in treating an ankle fracture in a diabetic to an ankle fracture in a non-diabetic patient and why
Diabetic need to be immobilised for twice the normal period
They are prone to delayed union and skin break down
What is the treatment for a uni-malleolar fracture
Bandage or light-weight malleolar splint - six weeks weight bearing immobilisation
What is the treatment for bi-malleolar injuries
Internal fixation with a contoured plate and screws
What is the treatment or a ruptured interosseous ligament
stabilisation of the joint with a horixontal screw orientated in the inter-malleolar plane
Why must a screw be removed before weight bearing following an interosseous ligament rupture
The screw may break
What is the treatment for a trip-malleolar fracture. What does this prevent
Open reduction and stabilisation with a plate and screw
Avoid backward subluxation of the talus
How does a patient end up with a vertical compression fracture
fall on the foot from a height
What are vertical compression fractures also known as
Pilon fracture
What is the management for a Pilon fracture
external fixation
What is a major complicating of a fractured talus
Avascular necrosis of the body of the talus due to interruption of the blood supply by the fracture
What is the gold standard treatment for a talar neck fracture and dislocated taller body
Open reduction - very high risk of avascular necrosis
How do fractures of the calcaneum arise
Falls from a height onto the heel - often bilateral
What often occurs alongside a fractured calcaneum
lumbar spinal burst fracture
What are the clinical features of a fractured calcaneum
grossly swollen and bruised
unable to weight bear
ankle movements may be reduced
subtalar movements are completely absent
What are some complications of a fractured calcaneum
trapped peroneal tendons
What is a Lisfranc injury
Injury to the tarsometatarsal joint usually as a result of rotation of the handoff about a fixed forefoot
What is the treatment for a Lisfranc injury
reduction and stabilisation (open or closed) with screws or plates)
What causes a basal fracture
inversion strain of the foot
What is the treatment of a basal fracture
walking plaster cast or bandage for 3-6 weeks
What causes a shaft fracture
crushing
What is the treatment of a shaft fracture
elevation of the foot if swollen. followed by a below-knee cast for 6 weeks
What might a fractured phalange interfere with
circulation necessitating amputation of the toe
What is the treatment for a fractured phalange
Protective dressings,
Allow patient to continue walking
What are the most common cause of infections in the ankle and foot
in relation to the toe nails which can become in growing
What is the treatment for an in-growing toenail
antibiotics for severe acute epidodes
removal of the nail edge or whole nail
What are the main clinical features of OA in the ankle
pain on weight bearing
diminished range of movement
What are the treatment options for OA in the ankle
Arthrodesis - helps with pain
Arthroplasty - allow greater freedom of movement
What is Hallux rigidus
OA of the 1st MTPJ
What are the clinical features of Hallux rigidus
Progressivel more painful when walking especially during push-off
What is the treatment for Hallux rigidus
Surgery - arthrodesis
Describe the clinical presentation of RA in the ankle and foot
Diffuse porous followed by joint erosions and narrowing
Hallux valgus
What is the characteristic sensation of the sole as the MPTJs dislocate
Walking on pebbles
What are the treatment options for the ankle in RA
synovectomy
Fusion
Ankle joint replacement
Excision f proximal phalanges or interphalangeal fusions
What are some neurological conditions which affect the foot and ankle
Hereditary motor sensory neuropathies e.g. Charcot-Marie-Tooth disease
Friedreich’s ataxia
Spina bifida
Poliomyelitis
