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PHTH 7212 Pathophysiology > ankle/ foot patho- Dr Davies > Flashcards

ankle/ foot patho- Dr Davies Flashcards

1
Q

Ottawa Ankle Rules

about it

A

Ankle radiographs account for 2% for all radiographs taken (2nd to c-spine)
When used, any fractured missed should be minor and unlikely to lead to increased morbidly

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2
Q

Ottawa Ankle Rules

the rules

A

Where to palate:

  • palpate distal, posterior tip and the posterior 6 cm of the lateral malleoli (Pots fracture) and the medial malleoli
  • fifth metatarsal (Jone’s Fracture)
  • navicular bone- the whole bone
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3
Q

______ ankle sprains/ day

A

25,000

*one of the most common musclosketelar injuries that occur

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4
Q

how often is the AFTL the ligament involved in the injury?

A

85% of the time

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5
Q

AFTL is involved in what type of injuries?

A

plantar flexion, inversion injuries

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6
Q

What is the order of the ligaments that are injured?

A

ATFL
CF
PTFL

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7
Q

grade 1 sprain in ankle

A

interstitial injury, but not a lot of laxity

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8
Q

grade 2 sprain ankle

A

partial tearing; pain, swelling; increased laxity in the ligament (no 2+ or 1+ in the grade 2 for the ankle)

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9
Q

grade 3 sprain ankle

A

completely torn

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10
Q

High ankle sprain

A

one of the few ankle injuries that will need surgery
if someone has a high ankle sprain, it will involve the tib-fib jt, which is connected by syndesmosis.
High ankle sprain will be a syndesmotic injury= diastasis; this is an unstable joint, this can lead to OA
Need to do an ORIF

From http://www.wheelessonline.com/ortho/syndesmotic_sprain

  • Discussion:
    • if only syndesmotic ligaments are divided (w/ fibula & collateral ligaments intact) there will be no widening of mortise or lateral displacement of talus;
    • compressing the fibula and tibia above the ankle elicits tenderness at the syndesmosis, implies injury to the syndesmosis;

From http://www.wheelessonline.com/ortho/syndesmotic_injuries_of_the_ankle
- Anatomy:
- syndesmosis is made up of anterior-inferior tibiofibular ligament, interosseous ligament, and posterior-inferior fibular ligaments,
inferior transverse tibiofibular ligament, and interosseous ligament;
- these stabilize the mortise by opposing the fibula in the fibular notch (incisura fibularis tibiae);

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11
Q

imaging

A

radiograph
stress radiograph- plantar flex and invert the ankle to her the talar tilt measurement
*bone contusion, OCD lesions, etc

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12
Q

Talar Tilt measurement

A

line though the top of the malleolus and then a line on top of the talus; compare bilaterally

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13
Q

Salter’s Harris

A

when there is a stress to the growth plate but can not be seen because of the growth plate

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14
Q

Casting

A

for the fibula- do not need to cast the knee, but ankle (short leg cast)
for the tibia- need to have the cast cross the ankle and knee (long leg cast)
long leg cylinder cast does not imm the ankle

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15
Q

Shin Pain

progression of

A 
"shin splints"
Myositis
Tendonitis/ osus
Periostis
Medial Tibial Stress Syndrome
Stress Fracture
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16
Q

Myositis, tendonitis, periostitis for shin pain

A

Criacs muscle tendon sequence to see if it is the muscles involved
Palpating to see if it is more muscle belly or more bone
If it is the Criac- more tendon
If it is more on bone- periostits
If it is more on muscle- myostis

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17
Q

Lateral shin pain

A

most likely myositis of the anterior tibial muscle

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18
Q

Medial Tibial Stress Syndrome

A

The in between the inflammation of the bone and the stress fracture
Pain, inflammation (of muscle, tendon, and bone) involving the shin area

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19
Q

medial shin pain

A

posterior tibialis (muscle or tendon)

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20
Q

When imaging to use for stress fracture?

A

MRs, rarely radiographs at first (takes 3-4 weeks for calcification to occur), bone scan (know something is going on, but don’t know what)

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21
Q

Most common areas for stress fractures in the LE

A

metatarsal
tibia
proximal femur

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22
Q

another name for a tibial stress fracture

A

the dreaded black line; tibia is a weight bearing bone. very bad to get a stress fracture here

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23
Q

chronic compartment syndrome

how this works

A

the muscles in these compartment response when exercising; more blood will flow to the muscles, increasing the fluid in the area. this increases the intra compartmental pressure in the area

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24
Q

which compartment is most likely involved in Chronic compartment syndrome (order)

A

lateral
anterior
deep
superficial

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25
Q

Wick Catheter

A

tells the amount of pressure in the compartment;

record the resting pressure then have the patient exercise to see the increase pressure change

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26
Q

How do define the Chronic Compartment with the Wick Catheter’s Chart? (3)

A
  • resting is higher
  • exercise increases faster
  • takes longer to get back to the pre exercise pressure
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27
Q

treatment for Chronic compartment syndorme

A

don’t exercise to the point of pain or fasciotomy

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28
Q

Fasciotomy

A

Problem is that it will scar down again

small insicion to tear the fascia apart so that the pressure will not build up

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29
Q

End result if acute compartmental syndrome is not found in time

A

amputation!

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30
Q

description of acute compartmental syndrome

A 
foot drop
swollen, red, glossy looking
"woody feel"
distal pulses- diminished 
neurological symptoms
31
Q

What are the 6 P’s for acute compartment syndrome?

A 
Pain (out of proportion to clinical exam)
Pressure (tense swelling)
Pain (with passive stretch)
Paralysis (muscle weakness)
Pulses (diminished/ absent)
Paresthesia (sensory deficits)
*palpation- woody feeling
32
Q

what do you do for acute compartment syndrome?

A

get them to the ER as fast as possible

33
Q

High Ankle Sprian- what does it effect

A

distal tib fib ligament; the swelling/ bruising will be laterally (more proximal to the normal ankle sprain)

34
Q

Surgery for the High ankle sprain

A

screw fixation for about 12 weeks to fixate the joint

Will take out the screw to help regain dorsiflexion (cant do DF with the screw)

35
Q

ankle arthroscopy

A

Number one reason to preform is anterior impingement syndrome (arthroscopy debrement)
Number two- OCD; where the talus hits the tibia (can do a microfracture as well)
Can do an arthroscopy diagnostically
For an accessory bone

36
Q

Os Trigonum

A

an accessory bone on the back of the talus; hurts in plantar flexion causing impingement (artho or open surgery

37
Q

Tarsal Tunnel Release

A

release the retinaculum to release the pressure on the nerve (hopefully the doctor will address the cause- pronation)

38
Q

CAI- chronic ankle instability (what may be involved)

A
  • capsules/ ligaments are loose
  • muscles cant provide dynamic stability
  • no or low proprioception
39
Q

Lateral Ankle Reconstruction

classification

A
  • Anatomic repair
  • Non anatomic repair
  • Dynamic reconstruction
40
Q

Anatomic repair of the ligaments

A

ligament is torn, you repair it; direct primary repair of the torn ligaments; usually ATFL and CFL
*Brostrom

41
Q

Non anatomic repair

A

changing the anatomy

*Brostrom with Gould modification

42
Q

Dynamic reconstruction

A

using the muscle tendon to reconstruct the ankle

*Watson Jones ligament reconstruction

43
Q

Brostrom with Gould modification

A

Start with the anatomic repair and then take the extensor reticulum and tighten the ankle

44
Q

Watson Jones ligament reconstruction

A

take the peroneus brevis tendon; leave it attached distally; bring it back up through the lateral malleolus (drill holes); will tighten up the lateral side of the ankle

45
Q

Achilles tendonitis/osus

A

-itis, -osus (will have degenerative changes when you have osus); eccentric exercises is the most effective for regenerating/ decreasing pain in the long run

46
Q

Description of Achille’s tendonitis (how it looks)

A

thicken type of tendon compared to the other side

47
Q

order for Achilles…

A

Achilles tendon-it is, -osus, rupture (can be a traumatic rapture too)

48
Q

Subjective for Achilles

A

“ive been shot”
hear a pop
30-50 age category

49
Q

Objective for Achilles

A

Swelling; bruising
finger tip test and Thompson/simmons test
*can have a radiograph if you think there may be an avulsion; MRI will show the rupture)

50
Q

Treatment for Achilles

A

Closed reduction or surgically repaired

Surgery: end to end approximation; may take the plantaris tendon to support it. Will debree the ends and sow the two ends together.

51
Q

rehab for Achiiles

A

will do non weighing for 4-6 weeks; then you will go into the CAM walker

52
Q

CAM (stands for)

A

control ankle motion

53
Q

PTTD- posterior tibial tendon dysfunction

A

will see this commonly in older adults

not helping your medial longitudinal arch; should have a nice arch, but instead there will be a excessive pronation

54
Q

TAA- total ankle replacement

A

if the ankle is too messed up- total ankle

rare

55
Q

IRMT

A

inflammatory reaction to microtrauma

56
Q

IRMT (what is it)

A

overuse syndrome
*running
abnormal stresses (shear, compression, tension)

57
Q

Rule of 3 with running

A

range of motion
angular of velocity
forces on the joints
*as in- increases stresses on the body

58
Q

microtraumatc injuries in runners

A

excessive compensatory prolonged pronation
excessive pronation
increase supination

59
Q

Causes of injuries for runners

A

Training programs
Training surfaces
Footwear

60
Q

Training programs (causes of injury)

A

60% of running injury due to improper training:
Frequency
Duration
Intensity

61
Q

Training surfaces (causes of injury)

A 
too hard
too soft
wet/icy
crowned surface (IT band syndrome)
down hill (increase knee strain
62
Q

Foot wear (causes of injury)

A

number of miles on shoes (300)
shoe construction
wear pattern

63
Q

Sesamoiditis

A

inflammation of sesamoid bones; may need to surgically remove, orthotics
*he said this was not important

64
Q

Turf Toe

A

Sprain of the 1st MTP jt; common in football players
have to use the 1st MTP so this is a big deal (will lead to OA problems)
Taping, maybe an orthotic

65
Q

Bunionectomy

A

One of the most common surgeries in the foot
Have a thick Hallux Valus; no longer pushing off the foot correcting

*will do an osteotomy of the 1st ray

66
Q

Metatarslagia

A

pain in the forefoot area

  • shoes that have a small toe box, etc
  • sorbathane, etc can help, orthotics
67
Q

Morton’s Neuroma

A

plantar nerves will bifurcate into digital nerves; where this occurs is where a Morton’s neuroma can occur; can occur between any of the metatarsal, but is most common between 3 and 4
*Molder’s Sign to confirm
orthotics to help with a protective pad, an injection, surgery to remove

68
Q

Stress fractures**** (how to determine)

A

MOI- excessive increased activity
Pain on palpation of a long bone
Pain increases with weight bearing activity

69
Q

Cuboid Syndrome

A

Occurs in the midfoot
Could be overuse syndrome or from traumatic ankle sprain
Do palpations, Do Ap mobility, do distraction, cuboid whip (follow up with tape to prevent subluxation)

70
Q

Chopart injury

A

in the tarsal (between the tarsal)

need ORIF

71
Q

Lisfarc injury

A

between the metatarsal and tarsals
can be a subluxation/ dislocation or fracture

need ORIF

72
Q

Planter Fascitis

about

A

inflammation of plantar fascia

Can occur in supinated foot due to decreased shock absorbion

73
Q

Plantar Fascitis

s/s

A

pain along medial tubercle of calcaneus (may have osteophytes
worsens with first steps in morning

74
Q

Plantar Fascitis

treatment

A 
rest, modalities, anti-inflammatories
limit excessive pronation
increase flexibility
night time splints/ heel cups 
*taping, plantar fasciotomy

PHTH 7212 Pathophysiology (12 decks)

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