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Ortho > Foot ankle > Flashcards

Foot ankle Flashcards

1
Q

What type of joint is ankle joint?

A

Mitre joint with hinge

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2
Q

Nerves that supply joint also supply ________

A

Nerves that supply joint also supply muscles that move the joint.

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3
Q

AITFL and PITFL are very strong. Hence tibiofibular joint is not ____, unlike the radioulnar joint

A

AITFL and PITFL are very strong – hence tibia and fibular joint is not very flexible like radioulnar joint.

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4
Q

High ankle sprain can come with ____ and _____ fractures

A

Can come with medial malleolus fracture or fibular head fracture

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5
Q

Why doesnt ACL heal well? How long do other ligaments take to heal (with examples)?

A

ACL is intra-articular. Other ligaments like MCL, PCL or syndesmotic ligaments can heal better, but still very long with 3-6 months to heal

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6
Q

What is Simmond’s test?

A

When u squeeze calf muscles the foot will plantarflex.
Test for Achilles’ tendon rupture. Rupture shows gap in the tendon - at the mid-substance point where it is most affected due to poor vascularization

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7
Q

What is Haglund’s deformity?

A

Bony growth on calcaneus at attachment point of Achilles

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8
Q

Flat foot is a spectrum, and can present with other deformities like ______

A

Its a spectrum and can present with things like high foot valgus or forefoot abduction.
Can be split into rigid or flexible flat foot.

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9
Q

Flat foot in children? Ohno how

A

Arch is not fully developed in children. Flat foot is common and normal.

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10
Q

Difference btw rigid and flexible flat foot?

A

When u tiptoe, arch reappears - flexible FF

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11
Q

Some causes of flat foot?

A

congenital vertical talus, a condition in which the foot bones are not aligned properly, or lateral subtalar dislocation, a condition in which feet that once had arches flatten over time due to a dislocation of the talus bone.

Others can be: trauma, idiopathic etc etc

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12
Q

Viewing options for imaging of foot?

A

Oblique, AP, lateral views
From true lateral view, 2nd toe head is the highest

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13
Q

What is hallux valgus?

A

Common forefoot deformity.
Proximal phalanx deviating laterally and the first metatarsal head deviating medially

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14
Q

Some causes of hallux valgus?

A

Gout, RA, psoriatic arthritis
Malunion post-fracture
Congenital, shoewear

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15
Q

One common manifestation of hallux valgus?

A

Medial Crossover of 2nd toe, pressing on big toe

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16
Q

5 orthopaedic emergencies?

A

Cauda Equina
Compartment Syndrome
Nec fasc
Septic arthritis
Open fracture

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17
Q

Tx of hallux valgus?

A

Conservative - foot spacers, lifestyle changes, activity modifications, podiatry etc
Surgical - 130 techniques, commonest is Scarf Osteotomy

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18
Q

Hammer toe shows as?

A

PIP extension, DIP flexion, MCP slight extension

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19
Q

Etiology of hammer toe?

A

Overpull of EDL
Plantar plate injury
Imbalance of intrinsics

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20
Q

Green classification of trigger finger?

A

Grade 1 = palm pain and tenderness at A1 pulley
2 = Catching of digit
3 = Locking of digit, passively correctable
4 = Fixed, locked digit

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21
Q

Physiology of Claw toe?

A

MTP hyperextension. Chronic MTP hyperextension leads to unopposed flexion of DIP and PIP by FDL.
Can be sec to neuro disorders like peripheral neuropathy

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22
Q

Pathophys of hammer toe, mallet toe, claw toe?

A
  • Imbalance btw intrinsic (lumbricals & interossei) and extrinsic (long flexors & extensors) muscles of lesser toes
  • Neurological = Peripheral neuropathy [CMT, DM], polio, stroke

Polio = LMN disease
Stroke, Multiple Sclerosis = UMN disease

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23
Q

PE of Hallux valgus and rigidus?

A

Valgus deviation of 1st MTPJ
Varus deviation of 1st metatarsal
Pronation of Hallux
Erythema of 1st MTPJ
Lesser toe deformities
Callosities and corns
Pes planus

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24
Q

4 stages of Pes Planus?

A

1 = Tenosynovitis, no deformity
2 = Flexible pes planus
3 = Rigid pes planus
4 = ankle arthritis

25
Q

Commonest cause of adults-acquired flat foot deformity?

A

Posterior tibial tendon dysfunction

26
Q

Causes of posterior tibial tendon dysfunction in adults?

A

Acute or chronic injury
Longstanding tendon degeneration

27
Q

Risk factors for post tibial tendon dysfunction in adults?

A

Women >50
Obesity, DM, HTN, RA, steroid use - poor blood supply

28
Q

Pathophysiology of Pes cavus (Cavovarus foot)?

A

Neurologic
Spinal tumour
Charcot-Marie-Tooth

29
Q

Presentation of Pes Cavus?

A

Midfoot cavus, Hindfoot heel varus
Plantarflexion of 1st ray and forefoot pronation and adduction, claw toes, callosities under metatarsal head
Swelling over lateral malleolus

30
Q

Why is there swelling over lateral malleolus in Pes Cavus?

A

Lateral ligaments are stretched out in pes cavus

31
Q

What test for Pes Cavus?

A

Coleman block test - if hindfoot corrects in neutral alignment = flexible deformity

32
Q

Does flexible deformity = forefoot driven hindfoot varus?

A

Yes

33
Q

Triad of heel pain?

A

Plantar fasciitis
Post tibial tendon dysfunction
Tarsal tunnel syndrome

34
Q

What is achilles tendonitis = Plantar Fasciitis?

A

Tensile and compressive forces at calcaneal insertion.
Plantar fascia/aponeurosis degenerates and inflames over time

35
Q

Pathophysiology of Achilles tendonitis?

A

Chronic overuse -> microtears in origin of plantar fascia
Repetitive trauma -> recurrent inflamm + periostitis
Abductor hallucis, FDB and Quadratus Plantae share origin on medial calcaneal tubercle and may be inflamed too

36
Q

Risk factors for Plantar fasciitis?

A

Obesity
Tight calves
Flat feet
Excessive running mileage

37
Q

Conditions a/w Plantar Fasciitis?

A

Gout
Ankylosing spondylitis
Reiter’s disease

38
Q

Symptoms of Plantar Fasciitis?

A

Heel pain with first steps in morning, better with warm up. Recurs at night
Pain when getting up after prolonged sitting
Pain with prolonged sitting

39
Q

What is Pes Equinus? Also known as?

A

Dorsiflexion is limited. Also known as tight calf.

40
Q

Significance of Pes Equinus?

A

Commonly a/w primary diagnosis of Hallux Valgus and most commonly seen in Pes Cavus

41
Q

Presentation of Hallux Rigidus?

A

Pain and loss of motion of 1st MTPJ in adults due to degenerative arthritis.
- Worse with push-off phase of gait
- dorsal medial foot paraesthesia

Also a/w gout, RA

radiological hallmarks of OA seen e.g. narrowed joint space, osteophytes

42
Q

Neurovascular involvement in Hallux Rigidus?

A

Medial dorsal cutaneous nerve overlies 1st MTPJ.
Can be irritated by dorsal osteophytes

1st metatarsal is shortest and widest

43
Q

Coughlin and Shurnas classification for Hallux Rigidus?

Exam findings only in this card

Split into exam and radiographic findings

A

Grade 0 = Stiffness
1 = mild pain at extremes of motion
2 = Moderate pain with ROM
3 = Strong stiffness, pain at extreme ROM, no pain at mid-range
4 = Strong stiffness, pain at extreme ROM + pain at mid range

44
Q

Treatment for Hallux Rigidus?

A

Dorsal cheilectomy for Grade 1-2
MTPJ arthroplasty for 3-4

cheilectomy is removing bone spur so big toe has space to bend

45
Q

5 signs of Lisfranc injury?

A
  • 2nd MT and intermediate cuneiform misaligned (not straight)
  • Widening btw 1st and 2nd MT
  • Fleck sign
  • Misalignment btw 4th MT and cuboid on Oblique view
  • Dorsal subluxation of proximal base of 1st/2nd MT in Lateral view

Fleck sign = bony fragment in 1st interMT space

46
Q

What is Lisfranc ligament?

A

Disruption of Lisfranc LIG that runs btw medial cuneiform and base of 2nd MT

47
Q

How to injure Lisfranc?

A

Axial load on hyper-plantarflexed forefoot.
**Energy exerted on forefoot and transmitted to TMT articulation.

48
Q

Which 3 ligamentous complexes stabilize ankle?

A

Deltoid lig
Lateral lig complex
Syndesmosis

Deltoid Lig = Superficial, Deep
Lat Lig complex = ATFL, CFL, PTFL

49
Q

XR signs of syndesmotic injury?

A

Increased medial clear space or tibiofibular diastasis on stress view
Lambda sign on MRI

50
Q

Significance of Weber’s grading?

For syndesmotic injury

A

Type A = Stable, low risk of syndesmotic injury
B = Variable stability, 50% risk of syndesmotic injury
C = unstable, 100% chance of syndes injury

Type C cfm need ORIF

51
Q

What is Tillaux fracture?

A

Tibial frac where AITFL attaches at lateral distal tibia

Due to avulsion of AITFL attachment

52
Q

What is Le Fort Fracture?

A

Weber B frac with fibular avulsion where ATFL attaches at medial distal fibula

Due to avulsion of ATFL attachment

53
Q

Commonest mechanism of injury in ankle fracs?

A

External rotation and abduction of foot.

Adduction injury least common cause of ankle fracs

53
Q

What can be seen on XR of calcaneus in plantar fasciitis?

Lateral view

A

Bone spurs
Extends distally on undersurface of calcaneus

But not cause of pain

53
Q

Which part of foot most prone to stress fracs?

A

The second and third metatarsals of the foot, which are thinner (and often longer) than the adjacent first metatarsal

54
Q

2 theories of Charcot foot?

A

Neuro-traumatic = neuropathy and repeated micro-trauma produces joint destruction
Neurovascular theory = Higher peripheral blood flow results in osteolysis and demineralization

55
Q

Most common deformity a/w Charcot joint?

A

Rocker bottom deformity

56
Q

Common site for Charcot joint neuropathy?

A

Ankle.

Area under the most stress, weight-bearing

57
Q
A

Ortho (11 decks)

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