Ankle and foot module 1

Question 1

what are some potential foot and ankle pathologies?

Answer 1

fractures, achilles tendon rupture, DVT, muscle and tendon injuries, plantar fasciitis, ligament injuries, ankle stability and movement coordination impairments, congenital foot conditions/deformities, osteochondral injuries, OA, capsular restrictions, peripheral nerve injuries, and diabetic foot

Question 2

in what population are most stress fractures seen?

Answer 2

running population approx 10%

Question 3

what activities do stress fractures occur from?

Answer 3

high impact activities like gymnastics and marching

Question 4

where can stress fractures occur?

Answer 4

in any bone, with greatest percentage of fractures in the metatarsals and fibula (lateral malleolus)

Question 5

what are some key signs of stress fractures?

Answer 5

swelling, tenderness, gait change, reproduction of cc by performing activity

Question 6

what is a cause of stress fractures?

Answer 6

increased load on the bone after fatigue of supporting structures (ligaments/tendons)

Question 7

what is the pathology of stress fractures?

Answer 7

hypovascularity of certain areas of bone will create non-healing

Question 8

T/F: xrays will immediately show a stress fracture?

Answer 8

false they may not be positive for several weeks

Question 9

What is the gold standard test for a stress fracture?

Answer 9

a bone scan. it will be positive at one week

Question 10

what are some differential diagnosis for stress fractures?

Answer 10

malignancy, osteomyelitis, osteoid osteoma

Question 11

what is a common site for foot fractures?

Answer 11

5th metatarsal (jones fracture)
stress fractures of metatarsals (march fracture)
calcaneus

Question 12

which fracture is the one to be most worried about with fractures and why?

Answer 12

Jones fractures because there is longer prolonged healing times due to lack of blood supply

Question 13

should reproduction of pain be felt when healing stress fractures?

Answer 13

no pain reproduction or chief complaint should be avoided during healing

Question 14

what are some treatments of stress fractures?

Answer 14

may require immobilization with walking boot, may require partial weight bearing

Question 15

how are healing times determined for stress fractures?

Answer 15

usually based on chronicity of overload and symptoms as well as its location.

Question 16

what is the average healing time for stress fractures?

Answer 16

6-8 weeks

Question 17

what may traumatic fractures result in at the tarsometatarsal joint (lisfranc) ?

Answer 17

in complicated fracture dislocations in the foot

Question 18

what are some mechanisms of injury for tarsometatarsal injuries?

Answer 18

direct force dropping heavy weight on foot
jumping down onto a plantarflexed foot
force up through the toes of a PF positioned foot
pronation of the RF on a fixed positioned foot
supination of the RF on a fixed forefoot
violent abduction or plantarflexion of the forefoot

Question 19

what are some signs and symptoms of a tarsometatarsal injury?

Answer 19

severe pain in the forefoot
possibly paresthesias
inability to bear weight on the foot
swelling and deformity
tenderness, pain with passive motion of the forefoot
diagnosed through radiographs

Question 20

what are common mechanism of injuries for calcaneal injuries?

Answer 20

usually when a person lands on their feet following a fall from a height
motor vehicle collision

Question 21

what are some red flags foot and ankle pathologies?

Answer 21

fractures
achilles tendon rupture
DVT

Question 22

what are some sign and symptoms of calcaneal injuries?

Answer 22

severe pain in the rearfoot, possibly paaresthias
inability to bear weight on the foot; severe limp
deformity of the heel
bruising in heel and arch
diagnosed through radiographs

Question 23

what are some common ankle fractures?

Answer 23

bimalleolar fractures
trimalleolar fractures

Question 24

what is the 2 classification systems for ankle fractures?

Answer 24

danis-weber (fibular location)
lauge-hansen (foot position and force application)

Question 25

what is the danis weber classification?

Answer 25

a classification to describe the level of fibular fracture relative to the syndesmosis level a: below syndesmosis level b: level of syndesmosis level c: above level of syndesmosis

Question 26

which weber classification level is the worst?

Answer 26

B because it is not only bone but also joint and ligamentous damage

Question 27

what is the surgical treatment for ankle fractures?

Answer 27

indicated for unstable fractures, open fractures and multiple injuries acceptable limits of displacement ranging from 0-5mm theoretical advantages to ORIF are shorter acute recovery time, and better maintenance of reduction decreasing chance of osteoarthritis

Question 28

what is the conservative treatment for ankle fractures?

Answer 28

long leg cast with knee flexed at 30º NWB radiographs can be taken on a weekly basis to confirm maintenance of reduction at 4 weeks change to short leg walking cast after 4 additional weeks, radiographs are then taken- if bony union has been achieved, cast is removed and unprotected weight-bearing begun

Question 29

what is the purpose of the ottawa foot and ankle rules?

Answer 29

to determine which patients who have experienced trauma may need radiographs

Question 30

what are the benefits of the ottawa foot and ankle rules?

Answer 30

this may help to decrease unnecessary exposure to radiation and reduce costs

Question 31

what are some limits of the ottawa foot and ankle rules?

Answer 31

can only be used in skeletally mature patients and only if within 10 days of traumatic event

Question 32

are the ottawa foot and ankle rules sensitive or specific?

Answer 32

nearly perfect sensitivity and higher specificity

Question 33

when is an x-ray required for the ankle according to the ottawa foot and ankle rules?

Answer 33

pain in malleolar region: anterior aspect of medial or lateral malleoli and anterior talar dome area bone tenderness: distal 6cm of posterior medial malleolus or posterior lateral malleolus inability to bear weight on limb

Question 34

when is an x-ray required for the foot according to the ottawa foot and ankle rules?

Answer 34

pain in metatarsal region: dorsal medial and lateral aspect of the mid-foot bone tenderness: base of the 5th metatarsal or navicular inability to bear weight on limb

Question 35

what is the mechanism of injury for an achilles tendon rupture?

Answer 35

trauma, often when jumping or landing, prolonged steroid or history of certain antibiotic use

Question 36

what are the symptoms of an achilles tendon rupture?

Answer 36

"hit" in back of ankle, report hearing a loud "pop"

Question 37

what is the typical age and sex for an achilles tendon rupture?

Answer 37

males >40 years old

Question 38

what activity is common for an achilles tenon rupture?

Answer 38

"weekend warriors", explosive activities

Question 39

how can we determine if there is an achilles tendon rupture?

Answer 39

palpable defect, severe loss of function

Question 40

what medications put some one at higher risk for an achilles tendon rupture?

Answer 40

fluoroquinolones (antibiotics), systemic corticosteroids

Question 41

what is the percent risk of re rupture with non surgical repair for an achilles tendon rupture?

Answer 41

8-10%

Question 42

what is the percent risk of re rupture with surgical repair for an achilles tendon rupture?

Answer 42

approx 2%

Question 43

what is the protocol for a non surgical repair of an achilles tendon rupture?

Answer 43

immobilized in 20º PF for at least 4 weeks and progressive WB as tolerated

Question 44

what is the protocol for a surgical repair of an achilles tendon rupture?

Answer 44

initial NWBing status and casted 4-6 weeks slowly increase WBing status, in controlled ankle motion (CAM) boot so that AROM can be started early accelerated program may progress DF ROM to neutral 2 weeks earlier, and allow earlier WBing progression

Question 45

what is DVT of the distal lower extremity?

Answer 45

thrombus (blood clot) in the deep veins causing leg pain or swelling but also can occur with no symptoms

Question 46

what is an embolism?

Answer 46

when the blood clot breaks loose and travels through your bloodstream.... can travel to your lungs and cause a PE (pulmonary embolism