Foot and Ankle Disorders

Question 1

By which movement is ankle fracture most common?

Answer 1

Inversion of the ankle

Question 2

What co-morbidities can affect ankle fracture healing?

Answer 2

• Diabetes mellitus
• neuropathy
• peripheral vascular disease
• smoking

Question 3

What is talar shift?

Answer 3

When there is disruption of any two syndesmosis causing the ankle mortise to become unstable and widen- the talus can shift medially or laterally within the ankle joint

Question 4

What is the standard treatment for a stable ankle fracture?

Answer 4

Aircast boot or fibroblast cast

Question 5

What is an ankle sprain?

Answer 5

Partial or complete tear of one or more ligaments of the ankle joint

Question 6

Name some of the factors that cause an increased risk of ankle sprain

Answer 6

• weak muscles/ tendons of the joint
• weak or lax ankle ligaments
• inadequate sense of joint position
• slow neuromuscular response to being in an off balance position
• running on uneven surfaces
• inadequate heel support from footwear
• wearing high heels

Question 7

What is the most common mechanism of injury for an ankle sprain?

Answer 7

Inversion injury on a plantar-flexed, weigh bearing foot

Question 8

Which ankle ligament is the most at risk of spraining?

Answer 8

Anterior talofibular ligament

Question 9

What is an avulsion fracture?

Answer 9

When the tendon or ligament is under tension (rather than tears) and pulls the bone off at the site on insertion

Question 10

Why does the 5th metatarsal undergo an avulsion fracture in an ankle sprain?

Answer 10

The peroneus (fibularis) bravis tendon is attached to a tubercle on the base of the 5th metatarsal.

Inversion injury can pull the bone off at its attachment site

Question 11

In what group is achilles tendon rupture most common in?

Answer 11

Men aged 30-50 years

Question 12

What is the most common site of rupture of the achilles tendon?

Answer 12

The ‘vascular watershed’ - 6 cm from the insertion onto the cancaneal tuberosity

An area of decreased vascularity and thickness

Question 13

Describe the test used to test for an Achilles tendon rupture

Answer 13

The Thompson’s test - squeeze the calf (gastronemus and soleus complex) when the patient is lying prone - if the foot undergoes plantar flexion the achilles tendon is intact

Question 14

What is Hallux Valgus?

Answer 14

When the distal part of the big toe is deviated laterally

It is the most common cause of a ‘bunion’

Question 15

What group is Hallux Valgus most common in?

Answer 15

Middle aged females

Question 16

What surgery is performed to correct Hallux Valgus?

Answer 16

Metatarsal osteomy - cutting through the metatarsal bone to realign the fragments

Question 17

What is Hallux rigidus?

Answer 17

Osteoarthritis of the 1st Metarsophalangeal joint causing stiffness

Causes pain on walking and toe dorsiflexion

Question 18

What is arthroplasty?

Answer 18

Joint replacement

Question 19

What is arthrodesis?

Answer 19

Joint fusion

Question 20

What is excision arthroplasty?

Answer 20

surgical removal of the joint with the tendon rolled up between the bone ends

Question 21

What is osteotomy?

Answer 21

Cutting of bone to allow realignment

Question 22

What is claw toe?

Answer 22

All 4 toes are hyperextended at the MTPJ and flexed at the DIP

Question 23

How might claw toe develop?

Answer 23

As a result of muscle imbalance from neurological damage that causes ligaments and tendons to become unnaturally tight

Types of injury:

• cerebral palsy
• diabetes
• stroke
• alcohol dependence

Question 24

What is hammer toe?

Answer 24

A deformity where the toe is flexed at the PIPJ

Can occur in any toe but mainly the 2nd toe

Question 25

What is mallet toe?

Answer 25

A deformity where the toe is flexed at the **DIPJ** Can occur in any toe but mainly the 2nd toe

Question 26

What is the most common cause of hammer and mallet toes?

Answer 26

**Ill- fitting shoes** putting pressure on the 2nd to from the adjacent hallux valgus

Question 27

What are curly toes?

Answer 27

Congenital curling of the toes, usually the 3rd and 5th digits bilaterally Thought to develop as tendons of FDL or FDB are **too tight**

Question 28

What is Achilles tendinopathy?

Answer 28

A degenerative condition of the Achilles’ tendon due to many years of over use

Question 29

What are some of the signs and symptoms of Achilles tendinopathy?

Answer 29

* pain and stiffness along the tendon in the morning * pain in tendon at the back of the heel that worsen with activity * severe pain 24hrs after exercise * tendon thickening * swelling present and worsens with activity * palpable bone spur

Question 30

What is pes planovalgus?

Answer 30

**Flat footedness** The medial arch of the foot has collapsed

Question 31

What is the difference between flexible flat feet and rigid flat feet?

Answer 31

**Flexible flat feet**= no medial arch but one appears when standing on **tip toes** **Rigid flat foot**= no arch appears when on tip- toes

Question 32

What causes rigid flat foot?

Answer 32

**Tarsal coalition** = failure of tarsal bones to separate in development

Question 33

What deformity in the ankle/foot can poorly controlled diabetes lead to?

Answer 33

**Charcot arthropathy** Progressive destruction of bones, joints and soft tissues of the ankle or foot (but can also affect the knee) In severe cases a **rocker bottom foot** may develop