Ankle and foot orthopaedics and trauma Flashcards Preview

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Flashcards in Ankle and foot orthopaedics and trauma Deck (52):
1

What is the most common cause of acquired flatfoot deformity in adults?

Tibialis posterior dysfunction

2

Which patients tend to be affected by tibialis posterior dysfunction?

Obese

Female

Increasing age - usually middle aged

Hypertension

Diabetes

History of steroid injections

Seronegative arthropathies

 

3

What is the cause of the laxity here?

Q image thumb

Left foot pes planus caused by tibialis posterior dysfunction

Arch has flattened so the foot everts

4

What are the signs and symtpoms of tibialis posterior dysfunction?

Pain and/or swelling posterior to medial malleolus – very specific
Change in foot shape

Diminished walking ability/balance
Dislike of uneven surfaces
More noticeable hallux valgus
Lateral wall “impingement” pain
 

A image thumb
5

How can a flexible pes planus be distinguished from a non-flexible pes planus?

Arch is still formed in flexible pes planus when standing on toes

6

What are the treatment options for tibialis posterior dysfunction?

Physiotherapy
Insole to support medial longitudinal arch

Orthoses to accommodate foot shape
Bespoke footwear
Surgery
 

7

Which treatment should not be given for tibialis posterior dysfunction?

Steroid injections

8

Which classification is used to describe ankle fractures?

Weber's classification

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9

Which kind of ankle fractures are stable?

Distal fibula fracture with no medial malleolus fracture or deltoid ligament rupture

10

Which ankle fractures are unstable?

Distal fibula fracture with medial malleolus fracture or deltoid ligament rupture

11

What is the treatment of a stable ankle fracture?

Cast or splint for around 6 weeks

12

When is rupture of the deltoid ligament suspected?

Bruising and tenderness medially

13

What is the usual treatment of unstable ankle fractures?

Open reduction internal fixation

14

What is the treatment of an unstable ankle fracture if there is any talar shift or talar tilt, and why?

Anatomical reduction and rigid internal fixation

Used to minimise the risk of development of OA

 

15

What is a pilon fracture?

A fracture of the distal tibia involving its articular surface

16

What is a Jones fracture?

A fracture of the proximal end of the 5th metatarsal bone

17

Why can a Jones fracture be problematic?

Higher risk of non-union (around 25%) due to poor blood supply

18

How do fractures to the base of the 5th metatarsal tend to occur?

Inversion injury with an avulsion fracture at the insertion of the peroneus brevis tendon

19

How do calcaneal fractures occur, and what other injuries should be looked for?

Fall from height onto heel

Therefore, also look for spinal injuries

20

What is at risk of developing following a calcaneal fracture?

Compartment syndrome of the foot

21

What is the prognosis of a calcaneal fracture dependant on?

Degree of involvement of subtalar joint

Degree of communition

22

When is subtalar arthodesis a treatment option following a calcaneal fracture?

Development of chronic pain from subtalar joint damage

Osteoarthrtitis

23

How do fractures of the talus tend to occur?

Forced dorsiflexion from rapid deceleration

e.g. RTA, aircraft crash

24

What is at risk of developing following a talar fracture-dislocation or subluxation?

AVN of the talus

25

What is a Lisfranc fracture?

A fracture of the base of the 2nd metatarsal is associated with dislocation of the base of the 2nd metatarsal with or without dislocation of the other metatarsals at the tarso‐metatarsal joints

26

What is the usual presentation of a Lisfranc fracture?

Grossly swollen and bruised foot

Unable to weight bear

May have normal Xray - CT scan if in doubt

27

What is the treatment for a Lisfranc fracture?

Closed or open reduction with screw fixation

28

What is the treatment for multiple displaced fractures of the metatarsals?

Stabilisation with K wires

29

How does plantar fasciitis present?

Heel pain

Fullness or swelling medially to heel

Can be worse after exercise or starting up after rest

 

30

What would indicate plantar fasciitis on examination?

Positive tinel's test for Baxters nerve

Swelling medially to heel

31

What are the causes of plantar fasciitis?

Repetitive stress
Seronegative arthropathies

Diabetes

Obesity

Frequent walking on hard floors

Improper footwear

32

What is the treatment for plantar fasciitis?

Rest

Achilles and plantar fascia stretching exercises

Gel filled heel pad

NSAIDs

Corticosteroid injections

Usually self-limiting

33

What is hallux valgus?

Medial deviation of the 1st metatarsal causing deformity of the big toe

34

What are some of the problems caused by hallux valgus?

Transfer metatarsalgia
Lesser toe impingement
Pain, deformity, cosmesis
Shoe difficulties

Formation of bunions and ulcers
 

35

What is the surgery for hallux valgus?

Multiple osteotomies to realign the bones

Soft tissue procedures to tighten slack tissues and release tight tissues

36

What is hallux rigidus?

OA of the 1st MTPj

37

What are some of the conservative treatment options for hallux rigidus?

Wearing of stiff soled shoe to limit motion at the MTPJ

Removal of osteophytes

38

What is the gold standard surgical treatment for hallux rigidus?

Arthrodesis

39

What is pes cavus?

Abnormally high arch of the foot often related to neuromuscular conditions

40

What is Morton's neuroma?

Degenerative fibrosis of common digital nerve near it’s bifurcation
 

41

How does Morton's neuroma present?

Pain in forefoot

Burning and tingling of toes

42

Which patients are most commonly affected by Morton's neuroma?

Women aged 45-50

43

What examination findings would implicate a Morton's neuroma?

Loss of sensation in affected web space

Medio‐lateral compression of the metatarsal heads (exerted by squeezing the forefoot with your hand) may reproduce symptoms or produce a characteristic "click"; this is Mulder's click test

44

What is the conservative management for Morton's neuroma?

Metatarsal pad or offloading insole

Steroid or anaesthetic injections

45

What is the surgical treatment for Morton's neuroma?

Excision of neuroma

46

What can be used to diagnose a Morton's neuroma?

Ultrasound - can see an inflamed nerve

47

What are the causes of Achilles tendonitis?

Repetitive strain

Rheumatoid arthritis

Quinolone antibiotics

Gout

48

What is the treatment for Achilles tendonitis?

Rest

Physiotherapy

Heel raise

Splint or boot

Tendon decompression

 

49

Which patients tend to suffer from Achilles rupture?

Middle aged or older patients due to degenerative changes

50

What signs on examinaton would indicate an Achilles rupture?

Unable to bear weight
Weak plantar flexion
Palpable painful gap
Positive calf squeeze (Simmonds) test
 

51

What is the conservative management of Achilles rupture?

Cast for up to 8 weeks in the equinous position - plantarflexed foot with toes pointing downwards to close gap between ruptured tendon sides

52

Why do claw or hammer toes occur?

Imbalance of flexor and extensor mechanisms