Flashcards in Ankle and Foo Deck (91):
What is Talipes Equinovarus?
What is the position of the calcaneus with clubfoot?
What is the forefoot position in clubfoot?
What is the position of the midtarsal in clubfoot?
What happens to the joint capsule in clubfoot?
Who gets clubfoot more often?
How many cases of clubfoot are bilateral?
What is the management of eqinovarus?
weekly casting (6 wks)
splints (8 wks)
AFO or corrective boot (until walking)
Night splint (1 more year)
Straight lace shoes (2 years)
What % of those with equinovarus respond in the first 3-4 months?
What % of those with equinovarus need soft tissue surgery?
60%, usually a muscle release
If the pt is not treated for equinovarus by 5 years what will they need?
arthrodesis, usually wait until they are > 10 years old
What is pes cavus?
Structural high medial and lateral arch resulting in a rigid foot
What can pes cavus be associated with?
May be associated with a neurological disorder
Is pes cavus familial?
What is an associated pathology with pes cavus?
What is the Rx for pes cavus?
specialized arch supports
What is pes planus?
flat feet, congenital or acquired. If you dont have adequate dorsiflexion you will pronate prematurely.
A congenital pes planus is more or less common? more or less rigid?
less common. More rigid
How is pes planus acquired?
compensation for other bony abnormalities, weakness or neuromuscular problems
What is Hallux limitys?
1st MTP restriction usually due to OA or Jt capsule.
How much MTP extension do you need for push off?
What is the Rx for Hallux limitus?
adaptive shoues (rocker sole shoes), joint mobs (if capsular)
What is Hallux rigidus?
complete bony ankylosis, may require resection arthroplasty
What is hallux (abducto)valgus?
1st toe laterally angulated at MTP joint associated with bunion formation
Who gets hallux (abducto)valgus more?
Females>males, usually assocated with poorly fit shoes
What is a Keller operation?
Resection of proximal half of the proximal phalanx and excision of prominent medial portion of met head
What is a hammer toe?
MTP extended, PIP flexed,
How are hammer toes caused?
Intrinsic weakness or imbalances
fallen transverse arch
poor shoe fit
What is a claw toe?
MTP extended, PIP flexed, DIP extended
What is a mallet toe?
Flexed DIP, usually due to poor shoes
What is a mortons toe?
Long 2nd metatarsal or short 1st metatarsal elading to excessive pressure under 2nd met head
What do you see sometimes with a mortons toe?
What is Mortons neuroma?
Nerve inflammation usually between 3rd and 4th metatarsals
Who gets mortons neuroma more?
What are the symptoms of mortons Neuroma?
burning pain, toe numbness
What is the Rx for Mortons neuroma?
Roomier shoes (limit heels)
Excision if conservative failure
What are the most common type of ankle sprain?
Lateral (inversion sprain)
What is a medial sprain?
What is a high ankle sprain?
syndesmotic sprain. excessive ankle dorsi-flexion and external rotation of the shin
What are the signs/sxs of an ankle sprain
tender to palpation
What is a grade 1 sprain?
mild-stable. single ligament stretch or minor tear, usually ATFL
What is a grade 2 sprain?
moderate, some instability. Full ATFL tear or partial of ATFL and CFL
What is a grade 3 sprain?
Severe, unstable. Complete tear of ATFL, CFL and ant. capsule. may need operative repair
1st degree high ankle sprain?
only a few ligament fibers are damaged within the interosseous membrane
2nd degree high ankle sprian?
more extensive damage to the interosseous membrane with some widening of the T-F joint
3rd degree high ankle sprain?
complete rupture of the interosseous ligament with gross widening of the T-F joint and possible joint dislocation
PT considerations post ankle sprain?
protect from eversion/inversion
restore active motion painfree
restore timing and coordination and strength
What is the mechanism of an Achilles tendon rupture?
violent contraction of gastroc, usually 1-2 inches above insertion into calcaneus (if complete)
What are the signs/sxs of an Achilles tendon rupture?
Edema, ecchymosis, PF grossly impaired
+ thompson test
What is the Rx of a total Achilles rupture?
surgical repair then casted in PF for 4-6 weeks (LLC 2 wks then SLC for 3-6 wks)
What is Achilles tendinitis usually 2ndary to?
Rx for Achilles tendinitis?
RICE, heel lift, check for abnormal foot position, length of muscle
What is Retrocalcaneal Bursitis? What is it assocaiated with?
Inflammation of bursa anterior to gastroc tendon but posterior to talus and calcaneus. excessive pronation, poor shoe fit or padding in heel area
What is plantar fascitis?
inflammation of plantar apeneurosis
How do you get plantar fascitis?
repetitive mecrotrauma associated with rigid or excessively mobile foot AND/OR excessive pronation
What is associated with plantar fascitis?
May have heel spur at medial calcaneal tubercle
What are the signs/sxs of plantar fascitis?
plantar foot pain on arising in AM or after sitting for a while
may have crepitus in soft tissues of the facia
What is the Rx for plantar fascitis?
treat inflammation, night splints in DF, foot orthosis to correct biomechanical faults
What is MTSS?
Medial tibial stress syndrome. Periosteal irritation or stress reaction of medial border of tibia along post. Tib or Soleus origin
What can cause MTSS?
excessive pronation, tight muscles
What are the signs/sxs of MTSS?
painful gait, tender along medial/posteriomedial shin
What do you need to differentiate MTSS from?
tibial stress fx via bone scan
What are some sxs of Tibial stress fx?
Specific spot pain
Sensitive to US
What causes a Tibila stress fx?
Overuse injury often with poor mechanics
Acute Compartment syndrome cause?
Acute Compartment syndrome length of symptoms?
hours to days
Acute Compartment syndrome area of involvement?
any muscle group
Acute Compartment syndrome method of diagnosis?
clinical symptoms or compartmental pressures
Acute Compartment syndrome treatment?
Chronic Compartment syndrome type of injury?
usually no trauma
Chronic Compartment syndrome length of symptoms?
weeks to months
Chronic Compartment syndrome area of involvement?
usually anterior or lateral compartment of lower leg
Chronic Compartment syndrome method of diagnosis?
compartmental pressures or stress thallium testing
Chronic Compartment syndrome treatment?
RICE or possible elective fasciotomy if no response to conservative therapy
What muscle is usually the culprit in anterior compartment syndrome?
Anterior tib, 2ndary irritation and swelling of muscle causing ischemia and compression of neurovascular strutures
What is the timeframe for return for a fasciotomy?
return to exercise after 3 weeks
What is tarsal tunnel syndrome?
A compression of the tarsal tunnel in the foot
What are the symptoms of tarssal tunnel?
pain burning, paresthesiae to medial and plantar surface of foot
How is tarsal tunnel aggravated?
eversion, DF and excessive pronation
What is a distal Tib-Fib fx usually secondary to?
Why does the lower 1/3 shaft of a the distal fib heals slower?
How is a distal Tib-fib fx treated?
Closed reduction if stable; ORIF with intramedullary nail if unstable
What is a type A ankle fx on the Denis-Weber Classification scale?
fx below the ankle joint
What is a Type B ankle fx on the Denis-Weber Classification scale?
Fx at the level of the joint, with tib-fib ligaments usually intact
What is a Type C ankle fx on the Denis-Weber Classification scale?
Fx above the joint level which tears the anterior and posterior syndesmotic ligaments
How would you fx the medial malleolus?`
adduction (inversion) injury. With or without lateral ligaments
How would you fx the lateral malleolus?
Abduction and ER (with or without medial ligaments)
What is a tibial pilon Fx?
Verticle compression fx of distal tibia
How would you treat a severe Tibial pilon fx?
ORIF or arthrodesis
What are talar injuries usually 2ndary to?