Ankle and Foot

Question 1

What are the Ottawa ankle rules?

Answer 1

• If there is pain in malleolar zone

AND

• Bone pain in the posterior edge or tip of the medial or lateral malleolus
• Can’t weight bear immediately in clinic

Question 2

What are the Ottawa foot rules?

Answer 2

• Pain in midfoot

AND

• Bone pain in base of 5th MT or navicular
• Can’t weight bear immediately or in clinic

Question 3

What is the 1 - 2 intermetatarsal angle?

Answer 3

• Bisection of 1st and 2nd MT

Question 4

What is the Hallux Valgus angle?

Answer 4

• Bisection of 1st MT and proximal phalanx

Question 5

What is mild, moderate, and severe 1-2 intermetarsal angle?

Answer 5

Mild: < 11 degrees
Mod: < 15 degrees
Sev: 15 < degrees

Question 6

What is a mild, moderate, and severe hallux valgus angle?

Answer 6

Mild: < 20 degrees
Mod: 20 - 40 degrees
Sev: 40 < degrees

Question 7

What is the WB lateral view of the foot used to measure?

Answer 7

Longitudinal arch measurements

Question 8

What is the NWB lateral view of the foot used to assess?

Answer 8

Trauma

Question 9

What is the Boehler angle? What does is its use? What is normal?

Answer 9

• Calcaneal fractures
• Line joining anterior and posterior calcaneal facets
• Line through posterior facet and superior posterior process

Normal: 25 - 40 degrees

Question 10

What is the Talometatarsal angle? What is its use? What is normal?

Answer 10

Assesses flat foot

• Line bisecting the (long-axis) of 1st MT
• Line bisecting the (long-axis) of the talus

Normal: 0 - 10 degrees

Question 11

What is Calcaneal Inclination? What is its use? What is normal?

Answer 11

Assesses flat foot

• Line joining inferior limit of distal calcaneal facet and inferior distal tuberosity
• Plane of support
• Normal 20 - 30 degrees

Question 12

What is measured in an inversion or stress view? What is considered abnormal?

Answer 12

• Inversion or eversion applied manually

- > 10 degree for either is considered abnormal

Question 13

What is assessed in a sesamoid view?

Answer 13

• Position of the sesamoids in the groove

Question 14

What is a unimalleolar fracture?

Answer 14

• Medial or lateral malleolus is fractured

Question 15

What is a bimalleolar fracture?

Answer 15

• Medial and lateral are fractured

Question 16

What is a trimalleolar fracture?

Answer 16

• Medial and lateral malleoli are fractured

- Posterior tibial rim is fractured

Question 17

What is the second most fractured bone in the foot?

Answer 17

The talus.

Question 18

Which aspect of the talus is fractured most commonly?

Answer 18

• The neck

Question 19

What is there a high incidence of with respect to talar fractures?

Answer 19

• AVN

- Subtalar and ankle DJD

Question 20

What can help prevent the incidence of AVN in talar fractures?

Answer 20

• Open reduction

- Internal fixation

Question 21

What age and gender are most susceptible to adult acquired flatfoot?

Answer 21

• Women, 45 - 65 y/o

Question 22

What are 4 lifestyle factors that can contribute to adult acquired flatfoot?

Answer 22

• Diabetes
• Seroneg Arthropathies
• Overweight
• Smoking

Question 23

What soft tissue dysfunction is associated with adult acquired flatfoot?

Answer 23

• Posterior tivialis tendonitis/ rupture

Question 24

What is the process of adult acquired flatfoot in relation to posterior tibial dysfunction?

Answer 24

• Loss of dynamic control of medial longitudinal arch

- Stretches static stabilizers

Question 25

During what phases of gait is supination lacking with PTT?

Answer 25

- TSt | - PSw

Question 26

Where will pain be felt with PTT?

Answer 26

- Medial malleolus

Question 27

Which stages of adult acquired flatfoot may be recovered from?

Answer 27

Stage I and II

Question 28

What is stage I of adult acquired flat foot?

Answer 28

- Painful synovitis of PTT, tender to palpation | - Tendon length and function maintained, strength may be 5/5`

Question 29

What is stage II of adult acquired flatfoot?

Answer 29

- Progressive tendon dysfunction - Weakness and tendon lengthening - Flexible flatfoot develops

Question 30

What is stage III of adult acquired flatfoot?

Answer 30

- Deformity becomes rigid | - Stiff/ arthrosis

Question 31

What is stage IV of adult acquired flatfoot?

Answer 31

- Tibiotalar valgus | - Arthritic changes progress

Question 32

What is conservative treatment for stage I and II AAFF?

Answer 32

- Orthosis - Inflammation reduction - Stretching - High repetition plantar flexor training

Question 33

What are 4 surgical options to treat flatfoot?

Answer 33

- Transfer FDL to navicula - Implant plug to limit subtalar eversion (subtalar arthroereisis) - Calcaneal osteotomy (Reposition 2 halves of calcaneus so that plantar flexors invert during late stance phase - Arthrodesis (drill joint, and fuse it)

Question 34

What 3 joints may recieve arthrodesis?

Answer 34

- Talonavicular - Calcaneal cuboid - Subtalar

Question 35

What are 3 indications for arthrodesis?

Answer 35

- Correct hyperpronantion/ painful flexible flatfoot - Severe subtalar DJD - Trauma

Question 36

What imaging technique is good for assessing stress fractures?

Answer 36

Bone scan

Question 37

How is a bone scan assessed for a stress fracture?

Answer 37

- Look for hot spots where radioisotopes are taken up, indicating high metabolic activity - Compare bilaterally as growth plates also show up as hot spots