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Medicine II: Orthopedics > Foot & Ankle > Flashcards

Foot & Ankle Flashcards

1
Q

Pes Planus

A

“Flat Feet”

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2
Q

Cause of Pes Planus

A

Due to loss of medial longitudinal arch

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3
Q

Pes Planus in Pediatrics

A

Pediatric- usually develop a normal arch after time of minimal flat arch

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4
Q

Pes Planus in Adults

A

Occurs in 20%. Can predispose to posterior tibialis tendonitits. Can be seen with posterior tibialis tendon rupture. Also seen with spring ligament complex injury.

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5
Q

Treatment of Pes Planus

A

Normal benign (if flexible) and rarely requires surgery

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6
Q

Foot Drop

A

A peroneal nerve injury is a peripheral nerve injury that affects a patient’s ability to lift the foot at the ankle. While foot drop injury is a neuromuscular disorder, it can also be a symptom of a more serious injury, such as a nerve compression or herniated disc.

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7
Q

Patient Presentation with Foot Drop

A

Steppage gait is usually seen w/ foot drop, secondary to peripheral motor unit disease. Drag feet or lift them high, with knees flexed, bring them down with slap onto floor. Cannot walk on heels, Tibialis anterior and toe extensors are weak

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8
Q

Causes of Foot Drop

A

Foot drop injury can be caused by an injury to the spinal cord or from other underlying diseases. Sometimes, drop foot is a complication from hip replacement surgery, or other injuries (e.g., knee or joint dislocation or fracture, herniated disc).

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9
Q

Treatment for Foot Drop

A

Orthotics, including braces or foot splints, which may be custom-built into the patient’s shoe. Physical therapy, including gait training

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10
Q

Hallux Valgus

A

Bunion, Lateral deviation of the Hallux (great toe) on the 1st metatarsal.

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11
Q

Who is most likely to develop Hallux Valgus?

A

More common in Females

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12
Q

What is a risk factor for Hallux Valgus?

A

FHx: Strong genetic predisposition

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13
Q

Treatment for Hallux Valgus

A

Wide, low heeled shoes; night splinting, orthoses, medial bunion pads or surgical referral.

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14
Q

Mallet Toe Deformity

A

Hyperflexion of DIP joint

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15
Q

Treatment for Mallet Toe Deformity

A

Footwear modification (wide toe box), dorsal foot pads, or referral for surgery.

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16
Q

Hammer Toe Deformity

A

Flexion of PIP with extension of DIP

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17
Q

What toe is usually affect with Hammer Toe Deformity

A

2nd toe

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18
Q

T/F: Mallet Toe Deformity is the most common deformity of the lesser toes.

A

False, Hammer Toe Deformity is

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19
Q

Treatment for Hammer Toe Deformity

A

Footwear modification (wide toe box), dorsal foot pads, or referral for surgery.

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20
Q

Cause or Achilles Tendon Rupture

A

Acute onset due to possible hx of Achilles tendonitis or a sudden extreme forced plantar flexion.

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21
Q

Physical Exam for Achilles Tendon Rupture

A

Tender to palpation on Achilles tendon with swelling and eccyhmosis. Pain with dorsiflexion and resisted plantar flexion. Palpate for defect or gap.

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22
Q

Special Tests for Achilles Tendon Rupture

A

Thompsons Test

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23
Q

Treatment for Achilles Tendon Rupture

A

Move toward conservative treatment. Short leg cast in equinous for 4 wks and then start walking boot. Consider operative treatment for younger/athletic patients.

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24
Q

Achilles Tendonitis

A

Describe me

25
Q

Cause of Achilles Tendonitis

A

Chronic onset due to overuse. May be due to specific injury.

26
Q

Physical Exam for Achilles Tendonitis

A

Tender to palpation on midpoint or insertion point of Achilles tendon. Pain with dorsiflexion and resisted plantar flexion.

27
Q

Treatment for Achilles Tendonitis

A

Walking boot with heel lifts, eccentric PT, iontophoresis, NTG patches

28
Q

Lower Leg Stress Fracture

A

Anatomy:
Tibia (high risk) or fibula (low risk)
History:
Chronic onset, “shin splints”, overuse, old shoes, localized pain, training errors

29
Q

Presentation of Lower Leg Stress Fractures

A

TTP on fx site with swelling and possible ecchymosis. NVI. Compression test

30
Q

Treatment for Lower Leg Stress Fractures

A

Non-wt bearing for at least 6w

31
Q

Weber classification

A

Weber A: Fracture below level of syndesmosis (Nondisplaced – SLWBC for 6 weeks)

Weber B: Fracture at level of syndesmosis (Nondisplaced – SLC NWB 4 weeks; SLC WBAT 4 weeks; Displaced – Surgery referral)

Weber C: Above level of syndesmosis (Surgery referral)

32
Q

Imaging for Lower Leg Stress Fractures

A

Xray is initially negative; Consider MRI if clinically suspected (bone scan? Eh..)

33
Q

Plantar Fasciitis

A

Irritation of plantar fascia at medial calcaneal tuberosity.

34
Q

Symptoms of Plantar Fasciitis

A

80% of patients complain of plantar heel pain. Can occur with heel spurs but they are NOT the cause. Worst with “first step in the morning”.

35
Q

Treatment of Plantar Fasciitis

A

Heel cord stretching, shoe inserts, posterior night splints, deep frictional massage.

36
Q

Why do we tend not to use steroids for treatment of Plantar Fasciitis?

A

Concern for fat pad atrophy with steroid injections

37
Q

Mortons Neuroma

A

Compressive neuropathy of interdigital nerve.

38
Q

Most common incidences of Mortons Neuroma

A

Most common in between 3rd and 4th space. Second most common between 2nd and 3rd space.

39
Q

Symptoms of Mortons Neuroma

A

Burning and tingling interspace of involved toes. Worse with high heeled shoe with narrow toe box. TTP in intermetatarsal webspaces. Palpable click (Mulder’s Sign) with compression.

40
Q

Special Tests for Mortons Neuroma

A

Palpable click (Mulder’s Sign) with compression.

41
Q

Treatment of Mortons Neuroma

A

Footwear modifications, injections, surgical referral

42
Q

Jones Fracture

A

Fracture of metaphyseal-diaphyseal junction

43
Q

Symptoms of Jones Fracture

A

Weight bearing is almost impossible

44
Q

Treatment for Jones Fracture

A

Short leg, non-weight bearing cast for 6-10 wks vs. screw fixation.

45
Q

What is the most common distal fifth metatarsal fracture?

A

Avulsion fracture, a/w inversion/plantar flexion lateral ankle sprains.

46
Q

Lisfranc Fracture

A

Disruption between medial cuneiform and base of 2nd metatarsal. Disruption of tarsal-metatarsal joint complex.

47
Q

Cause of Lisfranc Fracture

A

Usually due to MVA, falls, trauma, athletic injury

48
Q

Physical Exam for Lisfranc Fracture

A

TTP over Lisfranc joint, with both plantar and dorsal ecchymosis, in ability to bear weight, and pain with instability testing.

49
Q

Treatment for Lisfranc Fracture

A

Surgical vs conservative management. MAKE NWB INITIALLY.

50
Q

Cause of Diabetic Ulcers

A

15% develop foot ulcers and substantially increases the risk of LEA (lower extremity amputations). Peripheral neuropathy, specifically sensory, deprives the pt from warning signs of pain and pressure from footwear, inadequate soft tissue padding or from infection. “STOCKING GLOVE”. PVD and decrease WBC allow wounds to become infected

51
Q

Clinical Presntation of Diabetic Foot Ulcers

A

Burning or searing pain with swelling and warmth

52
Q

Patient Presentation and Physcial Exam for Diabetic Foot Ulcers

A

All ulcers have drainage, usually bloody or watery. Redness, swelling, pain and if pus → infection (discharge will be thick and white). Risk for developing Charcot joint (midfoot collapse in pts w/peripheral neuropathy). It is red, hot, swollen, and is often mistaken for infection. If caught late, then will present as a completely flattened arch “rocker-bottom” foot

53
Q

Diagnostic Tests for Diabetic Ulcers

A

Culture to find out which bacteria to treat for. Wt bearing AP/Lat/oblique XRay. Will help assess for charcot joint (severe destruction and erosion). MRI for Charcots joint will show subluxations and help differentiate b/w osteomyelitis. CT scan for Charcots joint too. 3-phase bone scan diff b/w Charcot’s, osteomyelitis, and cellulitis. Negative bone scan r/o pathology.

54
Q

Treatment for Diabetic Ulcers

A

Refer to Orthopaedist: for total contact casting (no ulcer, just charcots), debridement and wound care, and/or vascular eval. Usually b/c of progressive deformities, infection, fx, and intractable pain.

55
Q

Charcots Foot

A

Neuropathic, neurotrophis, or neuroarthropathic joint. Destruction of joint surfaces, fx often accompanied by dislocation of one or more joints in pt with inappropriate pain response.

56
Q

Cause of Charcots Foot

A

Diabetes is by far the leading cause of Charcot joints.

57
Q

Eichenholtz classification of Charcot phases:

A
  1. Fragmentation (acute charcot): periarticular fx and joint dislocation → unstable, deformed foot.
  2. Coalescence: resorption of bone fragments.
  3. Consolidation: restabilization of foot with fusion of involved fragments → stable but deformed foot.

(1) inflammatory phase, (2) healing, less swelling, warmth, bone formation, (3) consolidation and resolution of inflammation.

58
Q

Treatment of Charcots Foot

A

Limit joint destruction and preserve stable plantigrade foot that protects soft tissue and prevents ulceration.

(1) TX: immobilization, elevation, check skin for breakdown.
(2) TX: removal of prominence, fusion of joints, exostectomy. Goal is a stable and plantigrade foot.

Medicine II: Orthopedics (9 decks)

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