Foot And Ankle Problems Flashcards
Ankle fractures cause, description, things to consider, treatment
Inversion/eversion injury
Breaks in two places normally (in association with ligament damage), if disruption any two (syndesmosis, medial or lateral ligaments) the ankle mortise unstable and widens -> talus can shift medically/laterally within joint (Talar shift)
Need to consider co-morbidities affecting healing time, fracture blisters common surgery delayed, necrotic skin,
Stable fractures non-operative aircast boot/ fibreglass cast✅ unstable surgical stabilisation- high risk surgery if diabetic/ peripheral vascular disease ✅ Open fractures urgent surgery, debridement and irrigation reduce risk of osteomyelitis
Ring for ankle joint and associated ligaments
Proximal- articulate surfaces tibia and fibula, united syndesmotic ligaments
Medial- medial deltoid ligament
Inferior- subtalar joint
Lateral- lateral ligament complex (anterior talofibular, talocalcaneal, posterior talofibular)
Usually breaks in two parts
Sprained ankle definition and risks
Sprain = partial/ complete tear 1+ ligament
Increased risks: weak muscles/tendons, weak ankle ligaments, inadequate joint proprioception, slow neuromuscular response, running uneven, shoes invade heel support, 👠,
Ankle sprains cause and complications
Excessive strain on ligaments - XS external rotation/ inversion/ eversion. Most common inversion injury affecting plantar-flexed/ weight bearing foot -> anterior talofibular ligament
Severe sprain -> avulsion fracture 5th metatarsal tuberosity. Peroneus brevis tendon attached tubercle, inversion injury under tension pull off fragment bone. Caution: children 10-16 unfused apophysis
Achilles tendon rupture who and cause
Men 30-50 weekend warriors bursts jumping/pivoting/ running
Forceful push off extended knee, fall outstretched foot/ ankle dorsiflexed, fall from height/ stepping into hole
Achilles’ tendon rupture symptoms, tests and treatment
Site often ‘vascular watershed area’ proximal Achilles’ tendon into calcanea, tuberosity - decreased vascularity and thickness
❌ sudden severe pain back of ankle, sound loud pop/snap, palpable gap or depression, swelling, bruising, inability plantarflexed/ push off while walking
Test: simmond’s/ Thompson’s test (same) squeeze gastrocnemius and foot should plantar flex . MRI and ultrasound.
two ends frayed surgical reconstruction difficult ✅ conservative treatment aircast boot
Hallux valgus what, who, cause, symptoms, treatment
Varus deviation first metatarsal, valgus deviation hallux (big toe), prominence first metatarsal head (bunion) (May have callus)
Middle-aged females, FH
Painful movement and difficulty with footwear
Trauma, arthritic conditions (rheumatoid/ psoriatic A), metabolic conditions (gout), CT disorder ligamentous laxity (Ehlers-Danlos syndrome), 👠/ tight exacerbate
Surgery metatarsal osteotomy & realigning fragments, may needed proximal phalanx hallux ✅ (only if painful)
Hallux rigidus what, cause, symptoms, treatment
Osteoarthritis 1st metatarsophalangeal joint -> stiffness
Under stress (walking), gout, previous septic arthritis
Pain on walking/ dorsiflexion (severe at rest) ->tend to invert foot walking, dorsal bunion (osteophyte) May develop rub on shoes
✅activity modification/analgesia/ orthotics or aids (rigid sole prevents motion) / intra-articulate steroid -> arthrodesis (fusion) excised then stabilised with screws to heal OR arthroplasty (replacement)
Osteoarthritis of ankle cause, risks, treatment
Nearly all secondary e.g. post-traumatic, inflammation (rheumatoid arthritis/ reactive arthritis), joint stress & obesity. 7% idiopathic = primary (older, less pain, more motion)
✅ arthrodesis (fusion) OR arthroplasty (replacement) more risky
Claw toe what, cause
Often all 4 lateral toes, hyperextended MTPJ, flexed at PIP joint (sometimes also DIP), May get corns Dorsum of toe.
Muscle imbalance -> ligaments/ tendons tight (neurological damage), secondary cerebral palsy/ stroke/ diabetes/ alcohol dependency. Also trauma/ rheumatoid A/ inflammation.
hammer toe and mallet toe what, cause
Hammer toe toe flexed PIP joint
Mallet toe flexed DIP joint
Most common 2nd toe
Adjacent hallux valgus -> pressure, Tight shoes cause toe stay flexed for too long (muscles contract & shorten)
Curly toes where, cause, symptoms, treatment
3rd-5th digits, usually bilateral
Tendons flexor digitorum longs/ brevis too tight. Congenital FH
Children mostly asymptomatic
Passive extension of toes and stretching of tendons. Surgery only >6 pain on activity. ✅
Achilles tendinopathy where, cause, symptoms, treatment
May be point of insertion of tendon in calcaneum (insertional) OR at vascular watershed are within tendon (non-insertional)
DEGENERATIVE, Years overuse especially poor training regimens, obesity, diabetes
Pain and stiffness in morning, pain tendon or back heel worse activity, severe pain after exercising (24hrs), thickening of tendon, swelling worse activity, palpable bony spur (insertional)
✅physiotherapy (eccentric stretching exercises) improve vascularity
Flat foot (pes planovalgus) what, who, types
Medial arch collapsed, valgus angulation of hindfoot. Children appear as arches not developed and large fat pad.
Flexible flat feet- no medial arch when standing, plantarflexion appears no valgus deviation
Rigid flat feet- always abnormal, result tarsal coalition (failure separate). Often symptomatic.
Adult acquired flat foot what, cause, symptoms, treatment
Acquired flexible - dysfunction tibialis posterior tendon (normally supports medial longitudinal arch)
history change foot shape, pain behind medial malleolus, valgus deviation hind foot, medial arch collapsed
middle-aged females, obesity, hypertension, diabetes, temporarily during pregnancy
Stretching spring ligament and plantar aponeurosis -> talar head displaced inferomedially, medial longitudinal arch flattened -> lateral deviation hindfoot
✅orthotics (insoles), physiotherapy or surgical reconstruction, if secondary OA arthrodesis
