The Foot and Ankle Lecture Powerpoint

Question 1

Distal fibula makes up the ___ malleolus, distal tibia makes up the ___ malleolus

Answer 1

lateral, medial

Question 2

Anterior talofibular ligament function

Answer 2

Stabilizes the foot from moving forward

Question 3

Calcaneofibular ligament function

Answer 3

Stabilizes the foot from inverting, often injured in rolling of ankle

Question 4

Deltoid ligament of the ankle function

Answer 4

Multiple ligaments that support the medial malleolus and help limit how common pathology is seen here opposed to other parts

Question 5

Sprains grading (3)

Answer 5

I - stretching or partial tear, minimal to no functional loss, no laxity on stress test
II - incomplete tear, some loss of motion and function, some laxity at end points, some swelling and bruising
III - complete tear and loss of integrity, loss of function and motion (no weight bearing or ambulation), mechanical instability, complete laxity

Question 6

Anterior drawer test assesses this ligament’s integrity, talar tilt assesses these 2

Answer 6

• anterior talofibular ligament

- calcaneofibular ligament (inversion), deltoid ligament (eversion)

Question 7

High ankle sprain/syndesmosis injury

Answer 7

Injury of the interosseous ligament and associated ligaments between the tibia and fibula, most often mechanism of injury is dorsiflexion and external rotation, will see widening of the syndesmosis space on x ray

Question 8

Squeeze test

Answer 8

Test for syndesmosis injury that tests to see if pain is elicited upon sqeezing the calf together from the sides

Question 9

Syndesmosis injury treatment options (4)

Answer 9

• rule out associated fractures
• surgical repair if complete
• support/stabilization
• crutches, PT

Question 10

Achilles tendonitis

Answer 10

Overuse inflammation injury seeing pain and swelling along tendon or at heel,

Question 11

Achilles tendonitis treatment options (3)

Answer 11

• rest for months and NSAIDS
• avoid steroid injection
• stretching

Question 12

Achilles tendon rupture mech of action (3 and sequelae)

Answer 12

• Most often forceful plantarflexion while the knee is extended
• sudden unexpected dorsiflexion
• going from plantar to sudden dorsiflex position
• frequently describe popping sensation followed by pain, inability to bear weight, and inability to plantar flex the ankle

Question 13

Achilles tendon rupture treatment options

Answer 13

• surgery internal or external fixation in complete tear

- immobilization in plantarflexion for partial tear

Question 14

Bimalleolar fracture

Answer 14

Affects both the tibia and fibula (medial and lateral malleolus), causes loss of ankle mortise

Question 15

Trimalleolar fracture

Answer 15

Affects the distal fibula, distal tibia, and posterior tibia, recommended to be treated by ORIF in many cases

Question 16

Ankle mortise

Answer 16

Bony arch formed between the malleoli forming a rectangular socket in which the foot articulates with the leg

Question 17

Ankle fracture treatment options (2)

Answer 17

• casting in stable cases

- unstable need surgical ORIF

Question 18

Lisfranc injury

Answer 18

Injury of the 2nd metatarsal which is already in a lisfranc position (wedged between talar bones) pops dorsally upon a sudden axial load send thru the plantar flexed foot upward

Question 19

Lisfranc injury treatment options (3)

Answer 19

• immobilize
• nonweight bearing
• surgical repair

Question 20

Stress fractures diagnostic studies (3)

Answer 20

• initial radiographs not helpful!!!
• MRI
• Bone scan to see increased metabolic activity

Question 21

Jones fractures

Answer 21

Occurs distal to the tuberosity of the base of the 5th metatarsal (different from avulsion), due to poor blood flow requires long time for healing, can be casted or surgically repaired

Question 22

Dosriflexion eversion test

Answer 22

Used to reproduce symptoms of tarsal tunnel syndrome in a patient by dorsiflexing and everting the foot and watching for response

Question 23

Plantar fasciitis definition

Answer 23

Caused by collagen degeneration from repetitive microtears of the plantar fascias, often from overuse, pes lanus or cavus at increased risk, first steps of day tend to produce excruciating pain, treated with massage, stretching, strengthening

Question 24

Heel spur (osteophyte)

Answer 24

Extremely painful for some osteophyte formation from chronic overuse/inflammation

Question 25

Morton’s neuroma definition and diagnosis (2)

Answer 25

• inflamed nerve due to chronic trauma and repeptitve stress or tight fitting shoes, sees pain and paresthesias in distribution of the nerve involved, lateral compression often elicits symptoms
• Injection of anesthetic and MRI

Question 26

Callus vs corn

Answer 26

Callus is thickened skin that is not painful and has no central core, corn’s central core extends deep into skin and presses on nerve endings resulting in increased sensitivity and pain unlike calluses,

Question 27

Callus and corn treatment options (4)

Answer 27

• padding
• sharp debridement to reduce tissue
• changing shoes
• surgery in extreme cases to fix anatomic predisposition

Question 28

Ingrown toenails treatment

Answer 28

-administer digital anesthesia (1% lidocaine no epi), complete or partial nail avulsion or wedge resection

Question 29

Cellulitis treatment options (2)

Answer 29

• fluorquinolone

- non weight bearing, elevation, warm compress