MSK - Ankle, Feet, and Toes

Tx of toe fx?

- buddy tape prn

- ice, elevation

- hard soled shoes

- referral to podiatry if comminuted/displaced

What are the torg classifications of 5th metatarsal fx?

- zone 1: pseduo jones avulsion fx

- zone 2: jones fx

- zone 3: proximal diaphyseal stress fx

What is the most common 5th metatarsal fx?

90% are zone 1

Tx of 5th metatarsal fx?

- zone 1: WBAT stiff soled shoe, CAM boot

- zone 2: NWB

- zone 3: NWB

___ is caused by excessive tightness of the gastrocsoleus complex which pulls on the achilles tendon causing microtears and pain

Plantar fasciitis

Tx of plantar fasciitis?

- correct mechanism of injury (stretching, proper footwear)

- symptomatic tx: NSAIDs, splints, ice, stretching, heel pad inserts

___ is a interdigital neuroma causing compressive neuropathy of the interdigital n. leading to plantar forefoot pain

Morton's neuroma

Dx/Tx of Morton's neuroma?

- clinical dx, TTP over plantar aspect of involved webspace

- tx: wear better shoes, metatarsal pad, injections, surgery

Most ankle sprains are ___ injuries

inversion

3 multiple choice options

Which ankle ligament is most often injured in a sprain? Which is 2nd?

Anterior talofibular ligament m/c, calcaneofibular 2nd m/c

PE shows drawer laxity in dorsiflexed position, which ligament is likely injured?

Calcaneofibular ligament

What are the indications for ankle X-ray after injury?

- pain in the malleolar zone

- bone tenderness along distal 6cm of posterior edge of fibula or tip of lateral malleolus

- bone tenderness along distal 6cm of posterior edge of tibia or tip of medial malleolus

- inability to bear weight for 4 steps

What are the indications for foot X-ray after injury?

- pain in midfoot region

- bony TTP at base of 5th MT

- bony TTP at navicular

- inability to WB

Tx of ankle sprains?

- RICE

- short immobilization w/ CAM boot/stirrup splint

- early mobilization facilitates healing

- PT

- surgery if chronically unstable

Which X-ray view is important for visualization of ankle injuries?

Mortis

What Weber classifications correspond to Lauge Hansen classifications?

Weber A = supination adduction

Weber B = supination external rotation

Weber C = pronation external rotation

What is a maisonneuve fx?

- complete spiral fx of distal fibula

- rupture of anterior inferior talofibular ligament

Tx of ankle fractures?

- dependent on joint stability, soft tissue swelling

- ORIF: unstable, NWB/TTWB x 6-8wks, 12 wks for syndesmotic

- Cast/CAM boot: stable, NWB/TTWB x 6-8wks

___ is an axial compression fracture of the tibial plafond due to high impact forces

Pilon fx

Tx of pilon fx?

- ORIF: must be delayed for soft tissue swelling management

- splint/ex-fix in mean time

- NWB x 12wks

___ is a tarsometatarsal fx dislocation or disruption between the articulation of the medial cuneiform and base of 2nd MT

Lisfranc fx

What are potential MOI of lisfranc fx?

- MVA

- falls from height

- horse back riding

Tx of lisfranc fx?

- usually operative w/ ORIF/arthrodeisis

Which tarsal bone is most commonly fractured?

Calcaneus

MOI of calcaneal fx?

- traumatic axial load

- fall from height

- MVA

Dx/Tx of calcaneal fx?

- X-ray, CT for planning

- tx: can be operative or non-operative

___ is a rare fx/dislocation of the mid-tarsal joint of the foot

Chopart fx

MOI for achilles tendon ruptures?

- pushing off from running

- hard lateral movement

PE of achilles tendon rupture?

- loss of plantar flexion

- palpable gap

- TTP/ecchymosis

Tx of achilles tendon rupture?

- immobilization in plantar flexed position x6wks

- surgery may have higher rates of re-rupture

Kager's triangle sign is present in ___

Achilles tendon rupture