Foot and ankle Flashcards
What deformities might you observe in the ankle and foot when a patient is standing?
Possible deformities observed of the ankles and feet when a patient is standing:
a. Bony – eg, fracture
b. Joints – subluxation or dislocation, hallux valgus (bunion), mallet toe
c. Arch poor or not at all = pes planus; high arch = pes cavus (is it fixed or mobile?)
d. Tendons position and thickening particularly Achilles’
e. Presence of talipes equines or talipes equino varus (club foot)
f. Any calf muscle wasting or swelling
g. Scars from previous ankle/feet operations or trauma, and skin changes from malignant lesions/infection
Using the VITAMIND acronym, what conditions can present with a swelling in the ankle joint or region?
V - heart failure, liver or renal failure (oedema), venous congestion, bruising, thrombophlebitis, lymphoedema
I - infection or inflammation of local structures e.g septic arthritis, tendinopathy, bursitis, tenosynovitis
T - fracture, dislocation, subluxation, sprains, bruising
A - RA, SLE, and other AIDs
M – gout, pseudogout, haemochromatosis
I – post-op joint problem
N - bony or soft tissue neoplasm
D – Calcium channel blockers
What may it mean if a person’s shoes are unevenly worn at the heels?
Uneven wear of the heels of a patient’s shoes may be unilateral or bilateral and could indicate a gait abnormality,
overpronation or over supination, uneven leg length. Note it is normal for slight wear more on the posterolateral aspect
of the heel.
What are the names of the tendons that run across the ankle (from medial to lateral)?
Anterior ankle tendons from medical to lateral are: tibialis anterior, extensor hallucis longus and extensor digitorum
longus
What muscles are involved in ankle dorsiflexion and plantar flexion?
Dorsiflexion – tibialis anterior and extensor digitorum longus muscles
Plantarflexion – gastrocnemius and soleus muscles
What is the range of ankle inversion and eversion in degrees?
Subtalar joint
Inversion is 30 degrees (heel into varus)
Eversion is 20 degrees (heel into valgus)
What muscles and nerves are used for ankle inversion and eversion?
Ankle joint
Inversion – tibialis anterior muscle (peroneal nerve) and tibialis posterior muscle (tibial nerve)
Eversion – peroneus longus and brevis muscles (peroneal nerve)
What is hallux valgus?
Hallux valgus or ‘bunion’ is seen as valgus angulation at the first metatarso-phalangeal joint and/or rotation of the hallux,
with or without medial soft-tissue enlargement adjacent to the first metatarsal head. This condition can lead to painful
motion of the joint or difficulty with footwear
What does excessive ‘drawer’ movement in the ankle joint indicate?
An increase in anterior movement, particularly compared to the other side, suggests a tear of the ATFL ligament.
However, consider hypermobility syndromes if laxity is seen in other joints
What does Thompsons’s test show when a patient has a complete rupture of the Achilles’ tendon?
In complete rupture of the Achilles’ tendon, there will be no plantar-flexion of the ankle when the gastrocnemius muscle
is squeezed
