The foot and Ankle

Question 1

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

Answer 1

The deltoid ligament - broad structure

Question 2

What does the lateral ligament complex consist of

Answer 2

3 bands
anterior talofibular ligament
calcaneofibular ligament and
posterior talofibular ligament

Question 3

What ligament is most commonly affected by an ankle sprain

Answer 3

ATFL

Question 4

Where is the subtler joint and what is its function

Answer 4

between the talus and the calcaneum

provides for inversion and eversion of the heel

Question 5

What makes up Chopart’s joint

Answer 5

Talonavicular and calcaneocuboid joints

Question 6

What structure suspends the head of the talus

Answer 6

The plantar calcaneonavicular ligament or the spring ligament

Question 7

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

Answer 7

The plantar ligament and the plantar aponeurosis

Question 8

What is an abnormally high arch

Answer 8

pes cavus

associated with an adducted forefoot

Question 9

What structures help us to accommodate for walking on uneven terrain

Answer 9

intercuneiform and the tarsometatarsal joints

Question 10

What is important in the push off movement of normal walking

Answer 10

dorsiflexion of the MTPJs

Question 11

How are the subtalar movements tested

Answer 11

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

Question 12

How are mid tarsal movements tested

Answer 12

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

Question 13

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

Answer 13

Physiological

Question 14

What does severe clawing of the toes often result in

Answer 14

dislocation of the MTPJs

Question 15

What is Hallux valgus

Answer 15

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

Question 16

What conditions is commonly associated with Hallux valgus

Answer 16

Hammer toe (2nd toe)

Question 17

Who is more likely to develop Hallux Valgus

Answer 17

Women

Question 18

What is the treatment for Hallux Valgus

Answer 18

most are asymptomatic and need to be careful when selecting shoes

Surgery in some patients

Question 19

What are the surgical options for Hallux Valgus

Answer 19

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

Question 20

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

Answer 20

Anterior talofibular ligament - inversion and twisting

Question 21

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

Answer 21

swlling
pain
restriction of movements
tenderness over the lateral ligament

Question 22

What is the treatment for a ligament injury

Answer 22

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

Question 23

What is the prognosis for a medial ligament treated conservatively

Answer 23

very poor - needs operative repair

Question 24

What is the classification system used for ankle fractures and dislocations

Answer 24

Weber classification and the Lauge-Hansen classification

Question 25

What is an important structure in maintaining ankle stability

Answer 25

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

Question 26

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

Answer 26

Diabetic need to be immobilised for twice the normal period | They are prone to delayed union and skin break down

Question 27

What is the treatment for a uni-malleolar fracture

Answer 27

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

Question 28

What is the treatment for bi-malleolar injuries

Answer 28

Internal fixation with a contoured plate and screws

Question 29

What is the treatment or a ruptured interosseous ligament

Answer 29

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

Question 30

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

Answer 30

The screw may break

Question 31

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

Answer 31

Open reduction and stabilisation with a plate and screw | Avoid backward subluxation of the talus

Question 32

How does a patient end up with a vertical compression fracture

Answer 32

fall on the foot from a height

Question 33

What are vertical compression fractures also known as

Answer 33

Pilon fracture

Question 34

What is the management for a Pilon fracture

Answer 34

external fixation

Question 35

What is a major complicating of a fractured talus

Answer 35

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

Question 36

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

Answer 36

Open reduction - very high risk of avascular necrosis

Question 37

How do fractures of the calcaneum arise

Answer 37

Falls from a height onto the heel - often bilateral

Question 38

What often occurs alongside a fractured calcaneum

Answer 38

lumbar spinal burst fracture

Question 39

What are the clinical features of a fractured calcaneum

Answer 39

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

Question 40

What are some complications of a fractured calcaneum

Answer 40

trapped peroneal tendons

Question 41

What is a Lisfranc injury

Answer 41

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

Question 42

What is the treatment for a Lisfranc injury

Answer 42

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

Question 43

What causes a basal fracture

Answer 43

inversion strain of the foot

Question 44

What is the treatment of a basal fracture

Answer 44

walking plaster cast or bandage for 3-6 weeks

Question 45

What causes a shaft fracture

Answer 45

crushing

Question 46

What is the treatment of a shaft fracture

Answer 46

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

Question 47

What might a fractured phalange interfere with

Answer 47

circulation necessitating amputation of the toe

Question 48

What is the treatment for a fractured phalange

Answer 48

Protective dressings, | Allow patient to continue walking

Question 49

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

Answer 49

in relation to the toe nails which can become in growing

Question 50

What is the treatment for an in-growing toenail

Answer 50

antibiotics for severe acute epidodes | removal of the nail edge or whole nail

Question 51

What are the main clinical features of OA in the ankle

Answer 51

pain on weight bearing | diminished range of movement

Question 52

What are the treatment options for OA in the ankle

Answer 52

Arthrodesis - helps with pain | Arthroplasty - allow greater freedom of movement

Question 53

What is Hallux rigidus

Answer 53

OA of the 1st MTPJ

Question 54

What are the clinical features of Hallux rigidus

Answer 54

Progressivel more painful when walking especially during push-off

Question 55

What is the treatment for Hallux rigidus

Answer 55

Surgery - arthrodesis

Question 56

Describe the clinical presentation of RA in the ankle and foot

Answer 56

Diffuse porous followed by joint erosions and narrowing | Hallux valgus

Question 57

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

Answer 57

Walking on pebbles

Question 58

What are the treatment options for the ankle in RA

Answer 58

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

Question 59

What are some neurological conditions which affect the foot and ankle

Answer 59

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