Foot and Ankle Fractures, Tendinopathies, DM implications

Question 1

How many bones in the foot

Answer 1

26 + tibia

Question 2

What is the first question when presented with a foot or ankle fracture

Answer 2

Does the fx need sx?

• how displaced
• how mis-aligned
• is a joint surface involved?

Question 3

How to heal fx that do no require sx?

Answer 3

• some fx heal better with slight movement some better with rigid immobilization

Question 4

Low energy fractures

• usually dt what?
• classification name?

Answer 4

• rotational forces about the ankle

- Lauge-Hansen classification: based on position of foot at time of injury and force applied during injury

Question 5

Fracture of foot/ankle

- clinical eval

Answer 5

• swelling
• bruising
• deformity

Question 6

Fracture of foot/ankle

- radiographic eval

Answer 6

• alignment
• displacement
• comminution
• Articular involvement

Question 7

Fracture of foot/ankle

- conservative tx

Answer 7

• limited weightbearing

- limitation in motion of fx

Question 8

Fracture of foot/ankle

- sx tx

Answer 8

• reduction of fx
• maintenance of reduction (hardware)
• compression

Question 9

Arthritis of foot and ankle

- define

Answer 9

• inflammation in a joint arising from loss or degeneration of hyaline cartilage
• 33 potential articulations in foot/ankle

Question 10

Arthritis of foot and ankle

- types

Answer 10

• primary
• inflammatory (RA for ex)
• post-traumatic
• septic

Question 11

what causes the pain in arthritis?

Answer 11

• bone and inflammation

- NOT the cartilage (no nerve)

Question 12

Arthritis of foot and ankle

- clinical presentation

Answer 12

• swelling
• limited/irregular ROM
• pain

Question 13

Arthritis of foot and ankle

- radiographic eval

Answer 13

• joint space narrowing
• osteophyte formation
• subchondral sclerosis and irregularity (bright right under joint space on xray)

Question 14

Arthritis of foot and ankle

- conservative tx

Answer 14

• immobilization
• anti-inflammatory meds
• injections (caution in DM dt hyperglycemic effects)

Question 15

Arthritis of foot and ankle

- sx tx

Answer 15

• debridement (remove bone spurs, buys time)
• arthrodesis (hallmark of arthritis tx in foot/ankle)
• arthroplasty

Question 16

What is the gold standard sx tx for most ankle/foot arthritis

Answer 16

fusion (arthrodesis)

Question 17

Plantar fasciitis

- cause

Answer 17

• secondary to contracture of the plantar fascia ligament
• results in repetitive micro trauma to the ligament (heals with scar tissue which causes more contracture = vicious cycle)

Question 18

Plantar fasciitis

- clinical presentation

Answer 18

• am pain
• pain after rest
• tenderness over plantar hind foot
• limitation in ankle ROM

Question 19

Plantar fasciitis

- radiographic eval

Answer 19

• usually not helpful

- possible plantar osteophyte (indication previous inflammation of plantar fascia)

Question 20

Plantar fasciitis

- what causes pain

Answer 20

• the ligament not the bone!

Question 21

Plantar fasciitis

- tx

Answer 21

• stretching protocols**
• massage
• NSAIDs
• night splinting
• injections (very common)
• conservative tx for 4-6 months before more aggressive
• conservative tx successful 99% of the time

Question 22

Achilles tendinopathy

- describe

Answer 22

• inflammation of tendon OR
• degenerative change of the tendon
• insertional or non-insertional

Question 23

Achilles tendinopathy

- clinical presentation

Answer 23

• swelling
• pain
• limited ROM

Question 24

Achilles tendinopathy

- radiographic eval

Answer 24

• increased diameter of tendon

- osteophyte formation or calcification of the tendon

Question 25

Cause of insertional Achilles tendinopathy

Answer 25

- usually overuse | - 80-90% of achilles tendinopathy

Question 26

cause of non-insertional Achilles tendinopathy

Answer 26

- degeneration usually - seen in younger people - seen in middle of tendon

Question 27

Achilles tendinopathy | - conservative tx

Answer 27

- stretching/PT - immobilization - NSAIDs (topical is great)

Question 28

Achilles tendinopathy | - sx tx

Answer 28

only after fail conservative for a few months

Question 29

Posterior tibial tendinopathy | - desribe

Answer 29

- inflammation - imbalance across hind foot - degenerative (MC) or traumatic - can lead to arthritic changes to the hind foot

Question 30

Posterior tibial tendinopathy | - clinical exam findings

Answer 30

- swelling - WB pain - hindfoot deformity

Question 31

Posterior tibial tendinopathy | - radiographic exam findings

Answer 31

- collapse of longitudinal arch | - abduction of the forefoot

Question 32

Posterior tibial tendinopathy | - conservative treatment

Answer 32

- bracing/orthotics - PT - NSAIDs

Question 33

Posterior tibial tendinopathy | - sx treatment

Answer 33

- reconstruction | - fusion

Question 34

Diabetic implications of the foot and ankle | - dt what

Answer 34

- poor glycemic control = - impaired sensory fn - impaired vascular fn - micro and macro vascular disease

Question 35

What are two common diabetic foot problems

Answer 35

- ulcers | - charcot arthropathy

Question 36

Diabetic foot ulcers

Answer 36

- often dt neuropathy | - impaired vasculature delays wound healing

Question 37

Charcot arthropathy | - describe

Answer 37

- hallmarks: bony destruction and collapse of foot bones - large scale deformity - unique to neuropathy, not just DM

Question 38

Charcot arthropathy often confused with what?

Answer 38

infection bc warm, swollen foot

Question 39

Charcot arthropathy | - conservative treatment

Answer 39

- bracing - orthotics - *tx like aggressive fx treatment - limit weight bearing - bone is crumbly like butter (gross). Crutches or wheelchair if necessary

Question 40

Charcot arthropathy | - sx tx

Answer 40

- fusion | - amputation