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Flashcards in Ankle and foot Deck (76)
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Outline Weber's classification of ankle fractures

Classification of lateral malleolar fractures
Type A: fracture inferior to syndesmosis
Type B: fracture at level of syndesmosis
Type C: fracture above ankle joint


Describe the features of a Type A weber ankle fracture

Syndesmosis intact
May fracture medial malleolus
Usually stable


How is a Type A weber ankle fracture treated?

Reduction and cast if stable, may need ORIF
If stable: advise early weight bearing


Describe the features of a Type B weber ankle fracture

Syndesmosis intact or partially torn
Possible medial fracture or deltoid ligament damage
Stability variable


How is a Type B weber ankle fracture treated?

Reduction and cast if stable
May need ORIF if unstable
If stable: advise early weight bearing


Describe the features of a Type C weber ankle fracture

Syndosmosis damaged ➔ widened joint
Usually medial fracture or deltoid ligament injury
Unstable ➔ fracture-subluxation


How is a Type C weber ankle fracture treated?

ORIF required due to instability


What is a bunion?

Swelling over the medial side of the first metatarsal head


How do the heels normally appear when standing?

Heels are normally in slight valgus while standing


How do the heels normally appear when on tiptoes?

Heels are normally inverted when on tiptoes


Describe the phases of the walking cycle

1. Heel strike
2. Move into stance
3. Push-off
4. Swing-through


What is the cause of foot-drop?

Weak ankle dorsiflexors


What gait abnormality may be seen with foot-drop?

High-stepping gait


Name the 3 standard views of the ankle for imaging

Anteroposterior (AP)
Mortise: AP view with inversion 15-20 degrees

N.B. always image both ankles for comparison


Define Pes planovalgus

Flat-foot: flattened longitudinal arch, with the medial border in contact (or nearly in contact) with the ground.

Anterior flat-foot, if dropped metatarsal arch also


Define Pes cavus

Foot with excessive high longitudinal arch


Define Hallux valgus

Excessive lateral deviation of the big toe


Define Hammer toe

Flexion deformity of the PIPJ of one of the lesser toes, usually second or third. Hyperextension of DIPJ and MTPJ.


Define Claw-toes

Curled flexion of all the toes. MTP hyperextension with IP joint flexion.

Typically bilateral, and may severely restrict walking.
Seen with intrinsic muscle weakness.


Define Mallet toe

Flexion deformity of DIPJ of one of the lesser toes


Describe the presentation of idiopathic club-foot (congenital talipes equinovarus)

Ankle in equinus
Heel in varus
Forefoot adducted, flexed, and supinated
-adducted at talonavicular joint

Soles face posterior-medially
Heel usually small, deep creases posterior and medial
Skin and soft tissue of calf and medial side of foot are short and under-developed


Describe the epidemiology of club-foot

1-3 per 1000 births
Boys (2:1)
Bilateral 50%
FHx increases risk be 20-30x


What conditions must be examined for alongside club-foot?

Developmental dysplasia of the hip
Spina bifida


Describe the treatment of club-foot

Ponseti method: successive manipulation and casting on a weekly basis, typically for 6 casts.
-Requires strict follow-up regime of splintage in de-rotation boots until 3 years of age

If resistant:
-Open release of joint tethers
-Tendon elongation: achilles tendon
-Tendon transfer: anterior tibialis (medial cuneiform -> lateral cuneiform) to improve dorsiflexion


Differentiate metatarsus adductus and club-foot

Metatarsus adductus: adduction occurs at tarsometatarsal joints

Club-foot: adduction occurs at talonavicular joint


What is the prognosis and treatment of metatarsus adductus?

90% improve spontaneously or can be managed non-operatively using serial corrective casts followed by straight-last shoes.

Resistant: abductor hallucis muscle release


Describe the pathogenesis of rocker-bottom foot

Plantar dislocation of the head of talus from the navicular.
-cannot be passively corrected

Appears as a 'vertical' talus on lateral x-ray.


How can congenital vertical talus be differentiated from flexible forms of flat-foot?

Lateral x-ray whilst plantarflexed: Talus will not line up with the first metatarsal


How is congenital vertical talus treated?

Serial casting
Resistant: open surgery


How can flexible and rigid forms of flat-foot be differentiated in children/adolescents?

Jack toe raise test: dorsiflexion of the great toe whilst foot planted on ground

Flexible flat-foot: medial arch reappears
Rigid flat-foot: no change in medial arch appearance