Ankle + foot Flashcards
(21 cards)
How do you treat an ankle sprain?
RICE, crutches, anti-inflammatory medications
Phase II (weeks 2-4): ICE, strength
Phase III (4-6 weeks): more agility, proprioception, balance board
Surgical treatment not usually indicated in acute injury – chronic instability
Free ligament reconstruction
/+ ankle arthroscopy
How do you treat an unstable syndesmosis?
No instability = walking cast x 4 weeks + PT
Instability = fixation of syndesmosis
criteria for ankle fracture treatment
Criteria:
1) Dislocations + fractures reduced ASAP
- Splint with joint in most normal position possible
- Open = antibiotics and take to OR for irrigation + debridement
2) All joint surfaces must be restored
3) Fracture must be helped in reduced position during bony healing
4) Joint motion should begin asap
ankle fractures w/o separation tx
Fractures w/o separation = short leg cast w/ ankle in neutral position and immobilization is continued for 6-8 weeks
Cast 4-6 weeks
Cam walker
PT
ankle fractures w/ separation tx
Fractures w/ separation = reduced (check syndesmosis stability)
Isolated lateral fractures non-op
Bimalleolar + medial need surgery → ORIF
Immobilize for 6 weeks then slow advancement with weight bearing
PT for ROM, strength
ankle arthritis treatment
Non-surgical = NSAIDs, intra-articular injection, mechanical unloading (cane), bracing (arizona AFO)
Surgical = osteophyte excision, distraction arthroplasty, ankle arthrodesis, ankle arthroplasty
achilles tendonitis tx
Non-surgical =
NSAIDs
immobilization (boot/cast)
heel lift
achilles sleeve
PT (stretching, eccentric strengthening)
avoid steroids
extracorporeal shockwave therapy
achilles rupture tx
Ice to area, analgesics, rest
Bracing, casting with gradual dorsiflexion towards neutral
Usually non operative – REFER
Non-weight bearing 6-8 weeks
Walking boot 2-4 weeks
Surgery in those who fail conservative or in athletes
Jones fracture
peroneal tendonitis tx
Immobilization, NSAIDs, therapy
Continued pain → MRI
How do you treat plantar fasciitis
PT - formal therapy more effective
NSAIDs
Night splints
Inserts
Heel pad
Injection - only 1 cortisone injection
how do you treat calcaneus fracture
ORIF
Closed reduction percutaneous fixation
ORIF w/ primary fusion
Consider:
Timing
Soft tissue swelling
Must wait
+ wrinkle sign
Fracture blisters
Be aware of peroneals
Dislocation
What’s good post op care for calcaneus fracture
Post-op care:
– casting + non-weight bearing 6-10 weeks
– ROM exercises after 6 weeks
– wean from boot to shoe at 10-12 weeks
→ PT to gait training, ROM, strengthening
lisfranc treatment
Unstable - surgical management
Screw fixation, bridge plate fixation, tightrope fixation, primary fusion
How do you treat metatarsalgia
Transfer weight AWAY from affected heads
Low heeled shoes w/ sufficient room
Metatarsal bar placed on shoe
how do you treat a march fracture
RICE
Pain management
Surgery not common
How do you treat hammer toe
●Conservative
Analgesics
Proper footwear
Toe dividers
● Surgical - Rare
Arthroplasty
Pin
Tendon reconstruction
how do you treat morton’s neuroma
Local injection of steroid or lidocaine may give temporary relief
Surgical resection often necessary
how do you treat hallux valgus?
Shoewear modifications
Bunion pads
Toe spacers
Shoes, pads
In juveniles wait until done growing to consider surgery
Surgery is contraindicated in high-performance athletes + dancers until no longer able to perform
how do you treat charcot foot
Ortho consult
– limit destruction + preserve stable plantigrade foot to protect soft tissue + prevent ulceration → off loading
Surgery/”rocker-bottom shoe”
How do you treat a diabetic foot
Abscess or osteo → emergency surgery for drainage of infection, wound left open, dressing changes, closure at later date or amputation
Gangrene toes/forefoot → amputation
Entire foot → amputation
Surgery to remove any bony prominences and cause pressure to skin and increase risk of developing an ulcer
