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Musculoskeletal 2 > Foot and Ankle Fractures, Tendinopathies, DM implications > Flashcards

Foot and Ankle Fractures, Tendinopathies, DM implications Flashcards

1
Q

How many bones in the foot

A

26 + tibia

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2
Q

What is the first question when presented with a foot or ankle fracture

A

Does the fx need sx?

  • how displaced
  • how mis-aligned
  • is a joint surface involved?
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3
Q

How to heal fx that do no require sx?

A
  • some fx heal better with slight movement some better with rigid immobilization
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4
Q

Low energy fractures

  • usually dt what?
  • classification name?
A
  • rotational forces about the ankle

- Lauge-Hansen classification: based on position of foot at time of injury and force applied during injury

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5
Q

Fracture of foot/ankle

- clinical eval

A
  • swelling
  • bruising
  • deformity
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6
Q

Fracture of foot/ankle

- radiographic eval

A
  • alignment
  • displacement
  • comminution
  • Articular involvement
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7
Q

Fracture of foot/ankle

- conservative tx

A
  • limited weightbearing

- limitation in motion of fx

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8
Q

Fracture of foot/ankle

- sx tx

A
  • reduction of fx
  • maintenance of reduction (hardware)
  • compression
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9
Q

Arthritis of foot and ankle

- define

A
  • inflammation in a joint arising from loss or degeneration of hyaline cartilage
  • 33 potential articulations in foot/ankle
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10
Q

Arthritis of foot and ankle

- types

A
  • primary
  • inflammatory (RA for ex)
  • post-traumatic
  • septic
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11
Q

what causes the pain in arthritis?

A
  • bone and inflammation

- NOT the cartilage (no nerve)

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12
Q

Arthritis of foot and ankle

- clinical presentation

A
  • swelling
  • limited/irregular ROM
  • pain
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13
Q

Arthritis of foot and ankle

- radiographic eval

A
  • joint space narrowing
  • osteophyte formation
  • subchondral sclerosis and irregularity (bright right under joint space on xray)
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14
Q

Arthritis of foot and ankle

- conservative tx

A
  • immobilization
  • anti-inflammatory meds
  • injections (caution in DM dt hyperglycemic effects)
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15
Q

Arthritis of foot and ankle

- sx tx

A
  • debridement (remove bone spurs, buys time)
  • arthrodesis (hallmark of arthritis tx in foot/ankle)
  • arthroplasty
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16
Q

What is the gold standard sx tx for most ankle/foot arthritis

A

fusion (arthrodesis)

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17
Q

Plantar fasciitis

- cause

A
  • secondary to contracture of the plantar fascia ligament
  • results in repetitive micro trauma to the ligament (heals with scar tissue which causes more contracture = vicious cycle)
18
Q

Plantar fasciitis

- clinical presentation

A
  • am pain
  • pain after rest
  • tenderness over plantar hind foot
  • limitation in ankle ROM
19
Q

Plantar fasciitis

- radiographic eval

A
  • usually not helpful

- possible plantar osteophyte (indication previous inflammation of plantar fascia)

20
Q

Plantar fasciitis

- what causes pain

A
  • the ligament not the bone!
21
Q

Plantar fasciitis

- tx

A
  • stretching protocols**
  • massage
  • NSAIDs
  • night splinting
  • injections (very common)
  • conservative tx for 4-6 months before more aggressive
  • conservative tx successful 99% of the time
22
Q

Achilles tendinopathy

- describe

A
  • inflammation of tendon OR
  • degenerative change of the tendon
  • insertional or non-insertional
23
Q

Achilles tendinopathy

- clinical presentation

A
  • swelling
  • pain
  • limited ROM
24
Q

Achilles tendinopathy

- radiographic eval

A
  • increased diameter of tendon

- osteophyte formation or calcification of the tendon

25
Q

Cause of insertional Achilles tendinopathy

A
  • usually overuse

- 80-90% of achilles tendinopathy

26
Q

cause of non-insertional Achilles tendinopathy

A
  • degeneration usually
  • seen in younger people
  • seen in middle of tendon
27
Q

Achilles tendinopathy

- conservative tx

A
  • stretching/PT
  • immobilization
  • NSAIDs (topical is great)
28
Q

Achilles tendinopathy

- sx tx

A

only after fail conservative for a few months

29
Q

Posterior tibial tendinopathy

- desribe

A
  • inflammation
  • imbalance across hind foot
  • degenerative (MC) or traumatic
  • can lead to arthritic changes to the hind foot
30
Q

Posterior tibial tendinopathy

- clinical exam findings

A
  • swelling
  • WB pain
  • hindfoot deformity
31
Q

Posterior tibial tendinopathy

- radiographic exam findings

A
  • collapse of longitudinal arch

- abduction of the forefoot

32
Q

Posterior tibial tendinopathy

- conservative treatment

A
  • bracing/orthotics
  • PT
  • NSAIDs
33
Q

Posterior tibial tendinopathy

- sx treatment

A
  • reconstruction

- fusion

34
Q

Diabetic implications of the foot and ankle

- dt what

A
  • poor glycemic control =
  • impaired sensory fn
  • impaired vascular fn
  • micro and macro vascular disease
35
Q

What are two common diabetic foot problems

A
  • ulcers

- charcot arthropathy

36
Q

Diabetic foot ulcers

A
  • often dt neuropathy

- impaired vasculature delays wound healing

37
Q

Charcot arthropathy

- describe

A
  • hallmarks: bony destruction and collapse of foot bones
  • large scale deformity
  • unique to neuropathy, not just DM
38
Q

Charcot arthropathy often confused with what?

A

infection bc warm, swollen foot

39
Q

Charcot arthropathy

- conservative treatment

A
  • bracing
  • orthotics
  • *tx like aggressive fx treatment
  • limit weight bearing - bone is crumbly like butter (gross). Crutches or wheelchair if necessary
40
Q

Charcot arthropathy

- sx tx

A
  • fusion

- amputation

Musculoskeletal 2 (14 decks)

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