Flashcards in foot/ankle Deck (54):
what major muscle is responsible for foot eversion?
what major muscle is responsible for plantarflexion?
what major muscle is responsible for dorsiflexion?
what major muscle is responsible for foot inversion?
this is what distal connection of the tibia to the fibula
syndesmosis joint (made up of AITFL, PITFL, and transverse ligament)
nerve responsible for hip flexion
nerve responsible for medial hamstring reflex
Nerve responsible for cremasteric and Babinski reflexes
positive anterior drawer sign of the ankle means what?
ATF sprain (anterior talofibular ligament)
positive findings on the talar tilt test indicate what?
calcaneofibular ligament tear (lateral....pain with inversion)
In the _______ test, the patient is prone with feet dangling over the edge of the bed. Provider squeezes the gastroc and looks for the foot to ________. If this does not happen, it may indicate rupture of the ___________
Thompson test, plantarflex (normal), absence = Achilles tendon rupture
during this test, the patient will experience reproduction of pain at a point away from the site of pain and suggests a fracture of syndesmotic injury
This view of the ankle in plain film is taken at 15 degrees internal rotation
This view allows us to see tib/fib/talar joint
What tendon is exclusively lateral ankle?
whenever you suspect an ankle sprain/inversion injury and there's ttp of the peroneal nerve, what must you ALWAYS do?
palpate the insertion at the 5th metatarsal for avulsion/fx
How do you tx ankle sprain? (medial or lateral)
1) walking boot
which ankle ligament is strongly a/w the medial malleolus?
If you suspect a medial ankle sprain/eversion injury and there's ttp to the deltoid ligament, what must you ALWAYS do?
palpate the proximal fibula for avulsion/fx
Your patient has pain with dorsiflexion and resisted plantar flexion. There is ttp over the Achilles tendon. How will you treat?
Achilles tendonitis, tx with
1) walking boot with heel lift,
3) NTG patch
How do you know if it's Achilles tendonitis vs Achilles rupture?
1) acute onset
3) THOMPSON TEST
What is the tx for an Achilles rupture?
short leg cast x 4 weeks, then walking boot.
sx for young athletes
What tests should you do if you suspect a low leg stress fx?
compression test, xrays usually negative, do MRI
What is common in the history of pts with stress fx?
what is the tx for stress fx?
No wt bearing x 6 weeks
Your young patient felt a "pop" when he twisted his ankle playing soccer. You detect ttp on the lateral retinaculum (tendon sheath). When you evert the foot you can feel subluxation.
subluxating peroneal tendon
what kind of imaging will you order for the subluxating peroneal tendon?
xray to r/u avulsion
how will you tx a subluxating peroneal tendon?
SLC x 6 weeks for older, Surgical fixation of sheath in young
What are the 3 types of distal fibula tx?
1) Weber A, below syndesmosis
2) Weber B, at level of syndesmosis
3) Above syndesmosis
How will you tx the Weber levels?
A--SLWBC x 6 wks
B--non-displaced: SLC x 4 wks, WB x 4 wks
This is a common foot fx, typically resulting from avulsion s/p inversion sprain (peroneus tendon)
proximal 5th metatarsal fx
Where is the 5th metatarsal most likely to fx?
What do most pt's say when they have a 5th metatarsal fx?
that they have sprained their ankles
How do you treat a 5th metatarsal fx?
firm soled shoe or WB
What is the term for a fx of the metaphyseal/diaphyseal junction of the 5th metatarsal, which makes wt bearing nearly impossible?
How do you tx a Jone's fx?
SLC x 6-10 wks or screw fixation
This injury usually occurs in young athletes due to repetitive stress on lateral foot (bball, running). Characterized by gradual increase of pain. Poor healing w/out tx.
stress fx of 5th metaphyseal diaphysis.
how would you tx the pseudo Jones fx (stress fx)?
SLC x 20 weeks or screw fixation
Your patient is c/o terrible heel pain, especially bad in the morning. PE reveals ttp of the medial calcaneal tuberosity. How will you tx this patient?
Dx: plantar fasciitis, tx will heel cord stretching, inserts, overnight splints
What is a history question you should be asking for any patient with plantar fasciitis?
Are they getting steroid injections, which cause atrophy of the fat pads
What joint connects metatarsals to tarsals?
A Lisfranc injury typically occurs as a result of trauma/MVA/fall and will have a physical exam with significant ttp over the _______ joint causing pain/swelling on ___________ and ______ of the foot. Typically they have an inability to bear wt.
Lisfranc, plantar and dorsal
How do you treat a Lisfranc Injury?
start with a non-walking boot, escalate to sx PRN
Toe abnormality, commonly 2nd toe, that presents with flexion of PIP and exention of DIP
How will you tx hammer toe and other "lesser toe" abnormalities?
footwear with wide toe, dorsal foot pad
or RFL to sx
This toe abnormality presents with flexion of the DIP
This problem is genetic, commonly affects females, and involves the lateral deviation of the big toe
hallux valgus aka bunion
How will you tx hallux valgus?
wide low shoes, orthotics, night splint, sx
This condition results from the loss of the medial longitudinal arch of the foot. It is common in kids and typically resolves
pes planus (aka flat feet)
When would pes planus necessitate sx?
If the foot looses flexibility
Pes planus places you at higher risk for developing __________
This condition causes burning and tingling between interspaces of involved toes (2nd-4th most common)
Morton's Neuroma compresses interdigital nerve
The _______ sign is positive for patients with Morton's neuroma, and is characterized by palpable clicks and ttp in the intermetatarsal web space