Flashcards in Ankle and foot Deck (76)
Outline Weber's classification of ankle fractures
Classification of lateral malleolar fractures
Type A: fracture inferior to syndesmosis
Type B: fracture at level of syndesmosis
Type C: fracture above ankle joint
Describe the features of a Type A weber ankle fracture
May fracture medial malleolus
How is a Type A weber ankle fracture treated?
Reduction and cast if stable, may need ORIF
If stable: advise early weight bearing
Describe the features of a Type B weber ankle fracture
Syndesmosis intact or partially torn
Possible medial fracture or deltoid ligament damage
How is a Type B weber ankle fracture treated?
Reduction and cast if stable
May need ORIF if unstable
If stable: advise early weight bearing
Describe the features of a Type C weber ankle fracture
Syndosmosis damaged ➔ widened joint
Usually medial fracture or deltoid ligament injury
Unstable ➔ fracture-subluxation
How is a Type C weber ankle fracture treated?
ORIF required due to instability
What is a bunion?
Swelling over the medial side of the first metatarsal head
How do the heels normally appear when standing?
Heels are normally in slight valgus while standing
How do the heels normally appear when on tiptoes?
Heels are normally inverted when on tiptoes
Describe the phases of the walking cycle
1. Heel strike
2. Move into stance
What is the cause of foot-drop?
Weak ankle dorsiflexors
What gait abnormality may be seen with foot-drop?
Name the 3 standard views of the ankle for imaging
Mortise: AP view with inversion 15-20 degrees
N.B. always image both ankles for comparison
Define Pes planovalgus
Flat-foot: flattened longitudinal arch, with the medial border in contact (or nearly in contact) with the ground.
Anterior flat-foot, if dropped metatarsal arch also
Define Pes cavus
Foot with excessive high longitudinal arch
Define Hallux valgus
Excessive lateral deviation of the big toe
Define Hammer toe
Flexion deformity of the PIPJ of one of the lesser toes, usually second or third. Hyperextension of DIPJ and MTPJ.
Curled flexion of all the toes. MTP hyperextension with IP joint flexion.
Typically bilateral, and may severely restrict walking.
Seen with intrinsic muscle weakness.
Define Mallet toe
Flexion deformity of DIPJ of one of the lesser toes
Describe the presentation of idiopathic club-foot (congenital talipes equinovarus)
Ankle in equinus
Heel in varus
Forefoot adducted, flexed, and supinated
-adducted at talonavicular joint
Soles face posterior-medially
Heel usually small, deep creases posterior and medial
Skin and soft tissue of calf and medial side of foot are short and under-developed
Describe the epidemiology of club-foot
1-3 per 1000 births
FHx increases risk be 20-30x
What conditions must be examined for alongside club-foot?
Developmental dysplasia of the hip
Describe the treatment of club-foot
Ponseti method: successive manipulation and casting on a weekly basis, typically for 6 casts.
-Requires strict follow-up regime of splintage in de-rotation boots until 3 years of age
-Open release of joint tethers
-Tendon elongation: achilles tendon
-Tendon transfer: anterior tibialis (medial cuneiform -> lateral cuneiform) to improve dorsiflexion
Differentiate metatarsus adductus and club-foot
Metatarsus adductus: adduction occurs at tarsometatarsal joints
Club-foot: adduction occurs at talonavicular joint
What is the prognosis and treatment of metatarsus adductus?
90% improve spontaneously or can be managed non-operatively using serial corrective casts followed by straight-last shoes.
Resistant: abductor hallucis muscle release
Describe the pathogenesis of rocker-bottom foot
Plantar dislocation of the head of talus from the navicular.
-cannot be passively corrected
Appears as a 'vertical' talus on lateral x-ray.
How can congenital vertical talus be differentiated from flexible forms of flat-foot?
Lateral x-ray whilst plantarflexed: Talus will not line up with the first metatarsal
How is congenital vertical talus treated?
Resistant: open surgery