Ankle and Foot Flashcards
(56 cards)
1
Q
What are the four main joints of the foot?
A
- ankle (tibotalar)
- subtalar (talocalcaneal)
- mid tarsal (chopart)
- mid foot (lisfranc)
2
Q
Why don’t we see amputations at the chopart or lisfranc joint?
A
equinovarus foot–> cannot put an artificial foot on
3
Q
Which ligament tears first?
A
ATF: anterior talofibular
4
Q
When do we see the too many toes sign?
A
pes planus
5
Q
Whats the difference between claw toes and hammer toes?
A
- claw toes- result of neuropathy
- hammer toes- result of neuropathy
6
Q
What is Hallus Valgus?
A
the toes angle laterally
7
Q
Why can you get knee pain with pes planus?
A
- Because the tibia rotates internally
* may cause lateral OA
8
Q
What’s another sign of pet planus?
A
-look at the achilles tendon–> If it curves out, signifies yes plants
9
Q
What is the bony landmark to palpate in plantar fasciitis?
A
-anteromedial calcaneus–> bottom of heel on medial side
10
Q
What are the Tom, Dick, and Harry tendons?
A
- Posterior tibial
- Flexor digitorum longus
- Flexor hallucis longus
11
Q
What is “pump bump” refer to?
A
-retrocalcaneal bursa
12
Q
What is the functional ROM?
A
- walking 10 DF, 20 PF
- running 20 DF, 25 PF
13
Q
How can you evaluate the ATF ligament (MC ligament injured in inversion ankle sprains)?
A
Anterior drawer test
- grab heel with one hand, stabilize tibia with other hand, pull heel anterior
- compare to opposite side
- positive test is 3-5mm increased translation
14
Q
What does the taller tilt test evaluate?
A
-ATFL and CFL (calcaneofibular ligament)
15
Q
How to perform talar tilt test?
A
- grab hell with one hand, stabilize the tibia with other hand
- inversion of foot with ankle plantar flexed evaluates ATFL
- inversion of foot dorsiflexed evaluates CFL
- positive test is 10-15 degrees increase in inversion compared to opposite side
16
Q
What test do you do to evaluate for morton’s neuroma?
A
- metatarsal squeeze test
- positive test is reproduction of pain and paresthesias
*remember, rarely, does a lumbar radic cause symptoms in 3rd and 4th toes
17
Q
What test do you do to evaluate achilles tendon?
A
- Thompson test
- patient lies prone
- examiner squeezes gastro muscle
- positive test is absence of ankle plantar flexion; indicated ruptured achilles tendon
18
Q
What is the peroneal subluxation test?
A
- evaluates for subluxation of peroneal tendons over lateral malleolus; may be a/w recurrent inversion ankle sprains
- have patient DF foot and evert the foot against resistance while palpating the peroneal tendons posterior to lateral malleolus
- positive test is pain, clicking, or feeling of instability
19
Q
How do you attempt to distinguish between MTSS (shin splints) and tibial stress fracture?
A
Hop test
- have patient single leg hop on affected leg ten times
- If negative, patient can return to activity (i.e. running)
20
Q
What type of ankle sprain is MC?
A
- inversion ankle sprain (70-85%) with injury to the lateral ligamentous complex
- ATFL is the MC, followed by CFL, then PTFL
21
Q
Deltoid ligament injury- common or rare?
A
- Isolated injury is rare
- high suspicion for associated injuries
22
Q
Exam of ankle sprain?
A
-swelling, anterior drawer test (ATFL), talar tilt test (ATFL, CFL)
23
Q
What do you ALWAYS need to palpate with inversion/eversion ankle sprains?
A
- Base of the 5th metatarsal with inversion sprains (tuberosity avulsion or Jone’s fracture)
- Proximal fibula with eversion sprains (Maisonneuve fracture)
24
Q
Jones fracture
A
- a/w inversion ankle sprain
- always palpate base of the 5th MT
- serious issue!
- can be acute or chronic
25
Which tendon can cause avulsion fracture with inversion ankle sprain?
-peroneous braves tendon can cause avulsion fracture at the base of the 5th MT
26
Ottawa Ankle Rules
- Used to determine if x-ray if indicated
- Sensitive, not specific
- X-ray indicated if:
- unable to take 4 steps after injury
- tenderness over distal 6cm of tibia and fibula
- tenderness over navicular (post tibias inserts) or base of the 5th MT
27
What is a Maisonneuve fracture?
- Medial malleolus fracture a/w fracture of the proximal fibular
- Occurs with eversion ankle sprain but with greater force
- eversion force is transmitted through syndesmosis to proximal fibula
28
What type of training can help prevent ankle sprains?
-proprioception training
29
What is a high ankle sprain?
- injury to the interosseous ligament complex between the tibia and fibula
- usual mechanism is hyperdorsiflexion and/or eversion
- long recovery (2-8 weeks)
30
What do you do on exam for high ankle sprain?
- tenderness over distal tibia/fibula syndesmosis
- squeeze test: pain with compression of proximal calf
- external rotation test: pain with passive DF and external rotation of foot
- fibular drawer test: patient laying on side, anterior and posterior forces applied to fibula; positive test with increased translation and/or pain
31
What 3 ligaments are injured in a high ankle sprain?
- posterior inferior tibiofibular
- anterior inferior tibiofibular
- interosseous membrane
32
What is tarsal tunnel syndrome?
-Compression syndrome of tibial nerve as it passes through tarsal tunnel
33
What symptoms do patient's report with tarsal tunnel syndrome?
- burning/electrical like pain on base of foot/heel and paresthesias radiating to toes
- symptoms exacerbated by activity, relieved by rest
- exam: +tinel's sung over tarsal tunnel
34
What is hallux rigidus?
- OA of the 1st MTP joint
- a/w pronated feet, unstable arches, and hyper mobile 1st MT
- interferes with push off phase of gait
35
What is the exam finding of hallux rigidus?
-tenderness over 1st MTP joint with LOSS of passive MTP extension/great toe DF
36
What is turf toe?
- HyperDF injury to 1st MTP joint leads to stretching or tearing of soft tissue restraints on plantar aspect
- a/w soft shoe wear and hard playing surfaces
- may eventually lead to hallux rigidus
37
Exam of turf toe?
-swelling, ecchymosis, and tenderness over 1st MTP joint, limited ROM of 1st MTP
38
What is Lisfranc injury?
- midfoot sprain/fracture/dislocation
- usually traumatic etiology (MVC, fall, sports)
- exam: swelling/tenderness over tarsal/MT area, inability to bear weight or stand on toes, pain with passive abduction and pronation while hind foot is stabilized
39
What is the Lisfranc joint?
tarsal-metatarsal joint
40
What is plantar fasciitis?
- overuse/inflammatory condition of plantar fascia
- MCC of heel pain
- hx: pain with first few steps in the morning
41
What to do have on exam with plantar fasciitis?
-tenderness on plantar aspect over anterior medial calcaneus
42
What is Freiberg's infraction?
- AVN of metaphysics of 2nd/3rd MT heads
- more common in younger women who wear heels
- present with forefoot pain
43
Tendonitis
- Multiple area of tendonitis possible in foot/ankle
- posterior heel pain: achilles tendonitis
- medial ankle pain- Tom, Dick, and Harry
- lateral ankle pain: peroneus braves/longus
Exam: pain with resisted contraction of involved muscle, pain with passive stretching of the muscle
44
What is retrocalcaneal bursitis?
- 2 bursa near achilles tendons insertion
- due to repetitive trauma/overuse, may be related to poorly fitted shoes
- may be a/w with inflammatory arthritis, gout, spondyloarthropathy, etc.
- hx: posterior heel pain worse with pressure or wearing tight shoes
45
What is Haglund's deformity?
- prominence of posterior superior aspect of calcaneus
| - causes mechanical irritation of retrocalcaneal bursa with DF
46
Exam for retrocalcaneal bursitis?
-warmth/swelling over posterior heel, pain with passive DF and active PF
47
What is a stress fracture?
- failure of wolf's law that bone will adapt to loads to which it is subjected to due to remodeling
- hx of increase in training
48
MC sites for stress fracture?
-tibia (49%) followed by metatarsals
49
Exam for stress fracture?
-point tenderness over bone, + hop test, pain with vibratory stimulus, focal edema sometimes
50
Treatment of stress fractures?
-Low and high risk --> conservative rest vs. surgery
51
What is a march fracture?
- 5th metatarsal fracture
- high risk of nonunion and considered a "high risk" site
- exam: point tenderness over proximal 5th MT, positive hop test, may have focal area of edema
- treatment is surgical
52
Tarsal navicular stress fractures (pointy bone on inside of foot)
- common in track and field athletes
- point tenderness over posterior navicular, + hop test, pain with toes raises
- conservative tx: NWB 4-6 weeks
53
MTSS (medial tibial stress syndrome)
- "shin splints"
- overuse injury
- hx: pain at start of activity, improves over time
- exam: tenderness on medial border of tibia
54
Bone scan in MTSS vs. stress fracture
- diffuse uptake= shin splints
| - treaded black line= final stress fracture
55
Exertion compartment syndrome
- exercise induced pain, often a/w paresthesias and weakness, localized to a neuromuscular compartment
- pathophys not well understood
- hx: symptoms occur in a predictable time after onset of activity (i.e. 10-20 minutes), diminished with rest
56
Exam and dx of exertion compartment syndrome?
- Exam: pain with active contraction/passive stretching of muscles in compartment during episode; muscle herniation in 20-60% of patients
- lack of boney tenderness
- usually with normal pulses and neurological exam
- dx: compartment pressures; test at rest and exercise until symptomatic
