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Clinical Medicine PT-517 > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

1
Q

Common impairments at the ankle

A 
Swelling/effusion
Decreased ROM
Postural Abnormalities
Muscle Weakness
Joint Instability
Decreased Joint Compression Load Tolerance
Pain
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2
Q

Common Functional Limitations at the ankle

A 
Need for assistive devices to ambulate
Unable to don shoes
Abnormal gait
Limited standing/walking tolerance
Limited surface ambulation
Limited stair negotiation
Limited squatting, running, jumping
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3
Q

Rearfoot Bones

A

Talus and Calcaneus

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4
Q

Midfoot Bones

A

Cuneiforms
Cuboid
Navicular

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5
Q

Forefoot Bones

A

Metatarsals

Phalanges

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6
Q

Talipes Equinoverus

A

Clubfoot
Usually Rigid
Inversion of rearfoot
PF, Inversion, and adduction of forefoot

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7
Q

Talipes Equinoverus Causes

A 
Genetics
Fetal Position
Neuromuscular Dysfunction
2 per 1000 live births
Bilateral in 50%
Boys 2x as much
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8
Q

Talipes Equinoverus Treatment

A

Reduction of varus and later equinus component performed by gentle stretching
Splinting
77% good and fair results
Surgery required in recalcitrant cases

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9
Q

Convex Pes Valgus

A

Congentical vertical talus w/ dislocation of the navicular
Can occur in isolation or with CNS abnormalities
Valgus and Plantarflexed rearfoot
DF force causes convexity along the foot’s plantar aspect
Surgery correction

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10
Q

Tarsal Coalitions

A

Hereditary and Congenital
Incidence 6% general population
Complete or incomplete fusion of the mid and rearfoot
Most common is calcaneonavicular fusion, then talocalcaneal
Subtalar motion limited
Rigid pronated foot can develop, symptomatic between 8-12 years

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11
Q

Tarsal Coalition treatment

A 
Relative Rest, Short leg cast
Oral anti-inflammatories
Orthotics to control compensation
Surgical treatment
Subtalar fusion sometimes indicated
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12
Q

Talipes Calcaneovalgus

A

1/1000 births
Caused by malposition in uterus
Foot in dorsiflexion and eversion
Talus platarflexed and calcaneus everted

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13
Q

Metatarsus Adductus

A 
Most common causes of intoeing in children
1/1000-2000 live births
Greater in females
90% corrected by 3 yrs
4% severe deformity @7 years
10% moderate deformity
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14
Q

Metatarsus Adductus Causes

A

Intrauterine molding or overactive abductor hallucis in CP

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15
Q

Metatarsus Adductus Grade I

A

Reversibility beyond neutral, flexible

Treatment by stretching at each diaper

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16
Q

Metatarsus Adductus Grade II

A

Reversibility to neutral

Treatment by serial casting and possible hallucis release 6-18 months

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17
Q

Metatarsus Adductus Grade III

A

Not reversible to neutral, rigid

Treatment by serial casting then corrective surgery at 2-4 years

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18
Q

Metatarsus Adductus Bar protocol

A

Excellent results in early ages

More cost effective and less inconvenient than serial casting

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19
Q

Common Ankle Fractures

A

Injuries involving one or more of the 3 malleoli about the ankle joint
Bimalleolar
Trimalleolar

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20
Q

Classification systems of ankle fractures

A

Danis-Weber

Lauge Hansen

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21
Q

Weber A Fx

A

Fibular fracture distal to the plafond

Bimalleolar

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22
Q

Weber B Fx

A

Fibular fractures originate at the level of the plafond and often spiral proximally

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23
Q

Weber C Fx

A

Fibular fractures originate at a level proximal to the plafond and are associated with injury to the syndesmosis

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24
Q

Lauge-Hansen Classification of ankle fractures

A

Divides ankle fx into 4 categories based on the mechanism of injury
First part is the position of foot at time of injury
Second part refers to the direction of the force that caused the Fx
-Adducted, Abducted, Externally Rotated

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25
Q

Treatment of Ankle Fx

A

Non-operative treatment can occur if Fx is in stable, anatomic configuration
Displaced Fx require reduction with acceptable limits of displacement from 0-5 mm

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26
Q

Non-operative Ankle Fx

A

Long leg cast with knee flexed at 30 degrees, non-weight bearing
Radiographs weekly
Short leg walking cast at 4 weeks
After 8 weeks, cast removed and unprotected WB begins

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27
Q

Surgical vs Non-surgical Ankle Fx

A

Theoretical advantage to ORIF are shorter acute recovery time, better maintenence of reduction decreasing chance of OA
Surgery indicated for unstable fx and open fx

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28
Q

Fx dislocation of the tarsometatarsal joint

A

Lisfranc

  • Lisfranc ligament usually causes avulsion fx on base of 2nd met, permitting lateral dislocation of lateral mets
  • Dislocation almost always dorsal
  • Dorsalis Pedis artery at risk for injury
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29
Q

Type A Lisfranc

A

Total incongruity

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30
Q

Type B Lisfranc

A

Partial inconcgruity
Lateral dislocation
Medial dislocation if 1st met

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31
Q

Type C Lisfranc

A

Divergent
Partial displacement
Total displacement

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32
Q

MOI responsible for Tarsometatarsal fracture dislocation

A
  • Direct force- dropping heavy weight on foot
  • Force up through toes of PF foot
  • Pronation/Supination of RF on fixed forefoot
  • Violent abduction or plantarflexion of the forefoot
33
Q

Signs and symptoms of Tarsometatarsal injury

A 
Severe pain in forefoot
Inability to WB
Swelling and deformity
Tenderness, pain w/ passive motion
Diagnosed through radiographs
34
Q

Treatment of Tarsometatarsal Injury

A
  • Manual closed reduction of subluxation attempted
  • Percutaneous pin used if reduction is not stable
  • Immobilization, NWB up to 3 months
  • ORIF may be necessary. NWB 8 weeks WBAT 4 weeks
  • Post-traumatic arthritis and ankylosis common
35
Q

Stress Fractures Incidence

A
  • Most occur in running population or high impact activity
  • Can occur in any bone.
  • Mostly in 1st, 2nd, 3rd met or lateral malleolus
36
Q

Stress Fracture Cause

A

Increased load after fatigue of supporting structures
Muscle forces acting across and on the bone
Hypovascularity of certain bony areas

37
Q

Signs and symptoms of stress Fx

A

Swelling, tenderness
Possible gait change
Causation of pain by inciting activity

38
Q

Diagnosing Stress Fx

A

US and tuning fork
X-ray- not positive for several weeks
Bone scan positive at one week
Differential diagnosis includes malignancy, osteomyelitis, osteoid osteoma

39
Q

Treatment of “at risk” stress fx

A

Aggressive operative and non-operative treatment

  • navicular
  • proximal second metatarsal
  • any intra-articular fx
  • medial and lateral great toe sesamoid bones
40
Q

Treatment of less critical stress fx

A

Pain free activity
May require immobilization
May require PWB
Healing times based on chronicity of overload

41
Q

Major mechanisms of ankle ligamentous injuries

A

Inversion/Supination

Eversion/Pronation

42
Q

Inversion/Supination

A 
Ankle in PF
-ATFL first
-CFL next
CFL tears with greater varus moment in neutral or DF
Subtalar tears can be present
Anterior Deltoid ligament often torn
43
Q

Instability

A

10% of acute lateral ankle injuries
Half Mechanical instability
Half Functional instability

44
Q

Mechanically unstable lateral ankle injuries

A

Positive anterior draw

Positive Talar Tilt

45
Q

Functionally unstable lateral ankle injuries

A

Peroneal weakness

Proprioceptive loss

46
Q

Pronation/Eversion Injuries

A

Deltoid ligament injured in 10% of inversion injuries

MOI is abduction, eversion or external rotation

47
Q

Syndesmosis Injuries

A

Isolated injuries occur with and ER or hyperDF MOI
May often go unrecognized
Longer recovery times
May cause greater disabling symptoms than lateral ankle injuries

48
Q

Signs and symptoms of ankle sprains

A 
Localized tenderness
Swelling, increased temp, ecchymosis
Pain with tension
Acute painful WB
Stress radiograph reliability questionable
49
Q

Treatment of ankle sprains

A

75-100% have good to excellent outcomes
most can be treated non-operatively
Short period of protection, early ROM and WB
Grade III ruptures casting or removable boot
Return to play 2-8 weeks
If functionally unstable, surgery indicated

50
Q

Osteochondral Lesions of the Talus and Medial Malleolus

A

Associated with trauma
Condition resulting from loss of blood supply to a bone
Can be congenital

51
Q

Treatment of osteochondral injuries

A

If early, immobilization
Osteochondral drilling
Chrondrocyte Implementation
Mosaicplasty

52
Q

OATS Procedure

A

Osteoarticular Transfer System
Damage only 6-20 mm in size
Young Patients

53
Q

Post Op OATS

A

CPM 8 hours to 6 Weeks
Non-WB 6-8 weeks with WBAT up to 12 weeks
Return to running 8-18 months

54
Q

Treatment Options for severe ankle/foot OA

A

Ankle fusion
Subtalar fusion
Midfoot fusion

55
Q

Post Op foot fusion

A

8-12 weeks NWB

Shoe modification

56
Q

Non Insertional Achilles tendonitis

A

2-6 cm proximal to insertion

Avascular zone

57
Q

Insertional Achilles tendonities

A

Involves tendon bone interface

58
Q

Haglund Deformity

A

Highly prominent posterosuperior calcaneal tuberosity
Retrocalcaneal bursitis
Bony impingement produces chemical attrition and mechanical abrasion of the Achilles

59
Q

Peritendinitis

A

Inflammation limited to the peritendon

60
Q

Peritendinitis with tendinosis

A

Tendon is involved

Thickening of tendon may be palpated

61
Q

Tendinosis

A

Diagnosis made at time of rupture

Microscopic degenerative changes without symptoms

62
Q

Signs and symptoms of plantar fascitis

A

Localized tenderness
Pain with contraction or passive stretch
Pain and stiffness in the morning or after prolonged sitting
Worsens with activity duration or intensity

63
Q

Treatment of tendinitis/plantar fascitis

A 
Relative rest/assistive devices
Foot orthotics
Immbilization
NSAIDS
Cortisone Injection Rarely
Rehab
64
Q

Operative Treatment for insertional achilles tendinitis

A

Haglund deformity, retrocalcaneal bursa resected
Inflamed tissue resected
Post op mobilization starting at 1 month

65
Q

Treatment of achilles tendon rupture

A

Operative or Non-Operative

66
Q

Hammer Toe

A

DIP extended
PIP flexed
MTP extended

67
Q

Claw Toe

A

DIP neutral
PIP flexed
MTP extended

68
Q

Mallet Toe

A

DIP flexed
PIP neutral
MTP extended

69
Q

Treatment of Hallux deformities

A

Orthotics

Surgical realignment

70
Q

Commonly Effected nerves for entrapment

A

Fibular
Sural
Long Saphenous
Posterior Tibial

71
Q

Tarsal Tunnel Syndrome

A

Posterior TIbial Nerve
Medial Heel/Foot pain
Paraesthesias

72
Q

Anterior Tarsal Tunnel Syndrome

A

Deep Fibular Nerve

Dorsal Foot pain/1st Web space

73
Q

Anterolateral Compartment Syndrome

A

Superficial Fibular Nerve

Pain on outer border of distal calf, dorsum of foot and ankle

74
Q

Sural Nerve entrapment

A

Pain on outer border of distal calf and lateral heel/foot

75
Q

Interdigital Neuroma

A

Pain affected web space and toes

Toe painful extension

76
Q

Differential Diagnosis of nerve entrapments

A 
Clear lumbar spine
Pain with palpation
Tinel's sign
Tension nerve
Quality of pain
77
Q

Diabetic Foot

A

Concurrent neurologic and circulatory involvement
Sensory loss
Motor weakness
Fat pads migrate and no longer protect the met heads

78
Q

Reiter’s syndrome

A

Arthritis, urethritis, conjuctivitis, dysentary of bowel

79
Q

Ankylosing Spondylosis

A

Ossification of periarticular structures

Clinical Medicine PT-517 (10 decks)

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