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phase iii orthopaedics > foot and ankle > Flashcards

foot and ankle Flashcards

(57 cards)

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1
Q

typical signs of congenital talipes equino varus

A

CAVE

  • C: Midfoot cavus (tight intrinsics, FHL, FDL)
  • A: Metatarsus adductus (tight tibialis posterior)
  • V: Hindfoot in varus (tight tendoachilles, tibialis posterior and anterior)
  • E: Heel in equinus (tight tendoachilles)
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2
Q

management of talipes equino varus

A
  • rule out associated disorders (DDH, spinal bifida, arthrogryphosis)

1) conservative (within 1/2 days of birth)
- ponsetti method of manipulation & serial casting (toe to groin plaster of paris)
- followed by foot abduction orthosis: dennis browne boots for infants; moulded ankle foot orthosis for older children

2) surgical (seldom)
- posteromedial soft tissue release & tendon lengthening
- corrective osteotomy

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3
Q

signs elicited in pes planus

A
  • too many toes sign (N: only 4th and 5th toe seen)
  • tip toe/dorsiflex: flexible flat foot if medial arch restored and heels invert
  • jack’s test: great toe passive extension restores arch as plantar fascia tightens
  • beighton’s score: >4
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4
Q

management of infantile flat foot (congenital vertical talus)

A

operation before 2 years

- no passive correction as tendons and ligaments on dorsolateral side of foot usually shortened)

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5
Q

signs of congenital vertical talus

A
  • rocker bottom foot

- foot in valgus

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6
Q

causes of flexible flat foot in children/adolescents

A

1) general ligamentous laxity
2) tight tendoachilles (2ndary to growth spurt > muscle imbalance)
3) collagen tissue disorders

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7
Q

management for flexible flat foot in children/adolescents

A

conservative:
- stretching
- shoes with medial arch support

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8
Q

causes of rigid flat foot/spasmodic flat foot in children/adolescents

A

1) tarsal coalition +/- peroneal spasm
2) inflammatory joint condition
3) neuromuscular disorder (e.g. CP)
4) ligament (e.g. marfan’s, ehler danlos)
5) idiopathic

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9
Q

management of rigid flat foot in children/adolescents

A

operation + muscle rebalancing

  • remove bony irregularity
  • triple arthrodesis if pain intolerable
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10
Q

causes of flat foot in adults

A

1) constitutional flat feet
2) recent onset
- underlying disorder: RA/general muscular weakness
- tibialis posterior tendon dysfunction

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11
Q

management for flat foot in adults

A

1) painful rigid flatfoot: foot wear + arch support
2) underlying disorder: treat disorder
3) tibialis posterior tendon dysfunction: operative repair/tendon replacement

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12
Q

commonest foot deformity

A

halux valgus

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13
Q

risk factors for hallux valgus

A
  • idiopathic
  • hereditary
  • ra
  • loss of muscle tone
  • wearing enclosed foot wear
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14
Q

deformities a/w hallux valgus

A
  • inflamed bunion
  • hammer toe
  • metatarsalgia
  • secondary OA of 1st MTPJ
  • callosities
  • pes planus
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15
Q

signs on XR of hallux valgus

A

weight bearing XR

  • degree of metatarsal & hallux angulation (N: intermetatarsal angle 9deg; hallux valgus angle 10deg)
  • presence of OA of 1st MTPJ
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16
Q

management of hallux valgus

A

1) conservative
- foot wear modifiaiton
- physiotherapy

2) operative
- corrective osteotomy + ST rebalancing around 1st MTPJ

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17
Q

2nd commonest deformity of 1st MTPJ

A

hallux rigidus

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18
Q

XR complications of achilles tendonitis

A

1) haglund’s deformity
2) bony spurs
3) intratendineal calcification

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19
Q

management of achilles tendonitis

A

conservative:

  • rest, gentle stretching of tendon, nsaids
  • proper foot wear (arch support) +/- orthotics

DO NOT inject steroids > achilles tendon prone to rupture

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20
Q

risk factors for rupture of achilles tendon

A

LT use of steroids

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21
Q

sign of ruptured achilles tendon

A

simmond’s test: lack of plantarflexion on squeezing calf

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22
Q

management of ruptured achilles tendon

A

1) conservative
- cast heel in equinus to approximate tendon ends
- shoes with raised heel

2) surgical (more reliable)
- tendon repair > cast

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23
Q

signs of posterior tibial tendon rupture

Study These Flashcards
A
  • hindfoot: valgus during weight bearing
  • midfoot: pes planus
  • tenderness around medial malleolus
  • active inversion of ankle painful + weak
24
Q

management of posterior tibial tendon rupture

Study These Flashcards
A

1) conservative: poorly mobile patients
- splintage

2) surgical: physically active patients
- operative repair or tendon transfer with FDL

25
differential diganosis for posterior heel pain
1) haglund's deformity 2) traction apophysitis 3) retrocalcaneal bursitis
26
commonest cause of heel pain
plantar fasciitis
27
attachment of plantar fascia
medial calcaneal tuberosity to heads of MT
28
risk factors for plantar fasciitis
1) men aged 30-65yo 2) runners, jumpers, ballet dancers, obese 3) a/w systemic disease (DM, enthesiopathies - seroneg + seropositive arthritis)
29
management of plantar fasciitis
1) conservative (90% resolve) - rest - stretching exercises (roll ball on heel) - foot wear modification: supportive shoes with heel cup - corticosteroid injections - nsaids 2) surgical - plantar fascia release
30
common site of stress fractures in foot
2nd and 3rd metatarsal bones
31
common sites of stress fractures
``` head of femur distal end of femur tibia vertebrae 2nd and 3rd metatarsal bones ```
32
management of stress fracture of foot
rest
33
ligaments which make up the lateral ligament complex of ankle
1) ATFL 2) PTFL 3) CFL
34
frequency of injury of each lateral ligament in relation to one another
ATFL > CFL > PTFL
35
mechanism of injury of lateral ligament complex
inversion while ankle in plantarflexion
36
signs of ATFL injury
1) tenderness max just distal and anterior to lateral malleolus 2) pain on passive inversion of ankle 3) anterior drawer for grade III ATFL injury 4) talar tilt
37
investigations for ATFL injury
XR: AP + lateral + mortise
38
are mortise stress XR always required?
NO | - only to demonstrate instability if operative repair considered
39
ligaments which make up the medial ligament complex (deltoid ligament)
1) anterior tibiotalar 2) posterior tibiotalar 3) tibionavicular 4) tibiocalcaneal
40
management for ATFL injury
1) conservative - muscle strengthening to prevent recurrent sprains: peroneus longus and brevis) - taping: prevents excessive movement - change foot wear - proprioception exercises 2) surgical - brostrum procedure: ligament repair
41
grading of ankle ligamentous injuries
grade I: microscopic tear of collagen fibres - mimimal tenderness and swelling - pain but no give grade II: macroscopic tear of collagen fibres - moderate tenderness and swelling - less painful than grade I (pain on motion) - solid end point to give grade III: complete tear of collagen fibres - significant tenderness and swelling - little to no pain - no end point - talar tilt
42
management of ankle ligamentous injuries
grade I and II: 1) conservative - RICE - bandage/brace > begin physiotherapy immediately> protective weight bearing with crutches > stop when patient can walk grade III: 1) convservative - brace with hinged knee orthosis + crutches > physiotherapy note: past - BK cast immobilisation from knee to toes with foot plantar grade 2) surgery: athletes
43
most common joint for ankle dislocation
subtalar joint
44
commonest mechanism of injury of ankle malleoli
abduction +/- lateral rotation of ankle - lateral malleoli shears off at oblique angle - rupture of deltoid ligament/transverse avulsion fracture of medial malleolus
45
classification of ankle fractures
1) lauge hansen classification | 2) danis weber classificaiton
46
management of ankle fractures
1) reduce swelling - elevate leg +/- foot pump 2) reduce fracture - undisplaced: non weight bearing below knee cast - displaced: reduce ASAP (type A and B: CRIF, type C ORIF)
47
types of pilon fractures
I: undisplaced II: minimally displaced III: markedly displaced
48
injuries a/w pilon fracture
1) compartment syndrome 2) compression fracture of vertebral column (esp L1) 3) contralateral fracture of - calcaneum - tibial plateau - pelvis - acetabulum (vertical shear) 4) vascular injuries
49
management of pilon fracture
1) conservative - pain relief - antibiotics prophylaxis - elevation - splint
50
management of pilon fracture
1) conservative - pain relief - antibiotics prophylaxis - elevation - splint 2) surgical - primary stabilisation: calcaneal traction/external fixator +/- fibular fracture fixation - definitive surgery (after ST optimised): percutaneous pinning
51
indications for ORIF for ankle fractures
1) fracture dislocation 2) type C fractures 3) trimalleolar fractures 4) talar shift/tilt 5) failure to achieve or maintain closed reduction
52
complications of ankle fracture
1) early - vascular injury in severe fracture subluxation - wound breakdown and infection (esp DM) 2) late - incomplete reduction (common) > secondary OA - non union of medial malleolus due to flap of periosteum > prevent ORIF - joint stiffness > prevent with mobility - complex regional pain syndrome (swelling and diffuse tenderness, trophic changes and OP) - high incidence of post traumatic OA from malunion/incomplete reduction
53
indications for surgery for pilon fracture
1) open fracture 2) displaced fracture 3) vascular compromise 4) compartment syndrome
54
management of ankle fractures in children
1) SH 1 or 2 (extraarticular): conservative - closed reduction under GA - full length cast > below knee walking cast 2) SH 3 or 4 (intraarticular) - undisplaced: CR under GA - displaced: ORIF with screws
55
complications of ankle fractures in children
1) malunion if reduction imperfect > valgus deformity - children < 10: accommodated by growth and remodelling - children > 10: osteotomy 2) asymmetrical growth - fusion of physis (usually medial half) > distal tibia veers into varus (if bridge small> excise + replace with fat pad; if not supramalleolar osteotomy) 3) limb shortening - proximal tibial epiphysiodesis in opp limb of young child
56
injuries a/w fracture of calceneus
- spine - pelvis - hip (femoral neck) - tibial plateau - knee ligamentous injuries
57
management of calcaneal fracture
1) extraarticular - RICE - conservative: bandage > exercise 2) intraarticular - RICE - undisplaced (conservative as above) - displaced: ORIF (interfragmentary screws) - severe: primary arthrodesis

phase iii orthopaedics (6 decks)

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