Ankle And Foot Ortho

Front 1

Flat foot

Back 1

-loss of the medial longitudinal arch
-considered normal in children <2 due to fat pad

Front 2

Flexible flat foot

Back 2

-benign disorder considered a normal variant
-when weight-bearing heels are everted
-typically spontaneously corrects with age
-symptoms vary

Front 3

rigid flat foot

Back 3

-not passively correctable and is present without weight-bearing
-symptoms begin in early adolescence and have a gradual onset
-common Sx are everted heels, stiffness, and limp

Front 4

What deformity is associated with rigid flatfoot?

Back 4

-"tarsal coalitions"-congenital cartilaginous bridges

Front 5

tx for rigid flatfoot?

Back 5

-rest, heat, NSAIDs in early cases
-surgery

Front 6

rupture of posterior tibial tendinopathy can lead to ________

Back 6

acquired flatfoot (a degenerative overuse disorder)

Front 7

clubfoot

Back 7

-fixed, often bilat, deformity present at birth
-cause unknown
-characterized by equinus of ankle and forefoot, varus of the heel, and adduction of the forefoot

Front 8

tx for clubfoot

Back 8

-ortho referral for manipulation and casting
-prognosis is good if treated early

Front 9

_________is the most common neonatal foot disorder

Back 9

-calcaneovalgus

Front 10

calcaneovalgus

Back 10

-excessive eversion and dorsiflexion of the foot (so that toes can touch the tibia)
-cause unknown
-characterized by a laxity of the ligaments at birth
-NOT a fixed disorder

Front 11

tx for calcaneovalgus

Back 11

-none for mild cases
-advanced cases--passive strengthening of tendons and ligaments

Front 12

Kohler's disease

Back 12

-necrosis of the navicular bone secondary to ischemia

Front 13

__________presents with a painful limp around age 5, often with pain, tenderness, and swelling over navicular

Back 13

Kohler's disease

Front 14

how does Kohler's disease look on xray?

Back 14

-navicular bone small because it has necrosed due to insufficient blood flow

Front 15

___________are the most common of all ankle injuries and sports injuries

Back 15

ankle sprains

Front 16

85% of ankle sprains involve the __________

Back 16

lateral ligament complex

Front 17

which ankle sprain is more common? more severe?
anterior talofibular or calcaneofibular injury

Back 17

-anterior talofibular::more common
-calcaneofibular::more severe

Front 18

when presented with a possible ankle sprain, must first r/o fx by ?

Back 18

-checking for bony tenderness

Front 19

which stability test is the most reliable and least painful in ankle sprains?

Back 19

anterior drawer test

Front 20

tx of ankle sprains

Back 20

-RICE and rehab

Front 21

subluxation of peroneal tendons

Back 21

-caused by sudden forceful dorsiflexion of the foot with contraction of peroneal muscles(plantar flexion)
-results in tear in the retinaculum behind the lateral malleolus
-the released tendons sublux over the lateral malleolus

Front 22

what is the tx for subluxation of peroneal tendons

Back 22

-reduction and immobilization or surgery in chronic cases

Front 23

tarsal tunnel syndrome

Back 23

-nerve entrapment by compression of the posterior tibial nerve under the flexor retinaculum

Front 24

presentation of tarsal tunnel syndrome

Back 24

-vague symptoms often delay diagnosis
-burning pain, numbness and tingling in the sole of foot

Front 25

tx of tarsal tunnel syndrome

Back 25

-medial heel wedge or surgery

Front 26

talar dome fracture

Back 26

-small area of necrotic bone on tjhe articular surface of the talus
-caused by trauma

Front 27

primary Sx of talar dome fracture

Back 27

-restricted ankle motion

Front 28

dx/tx of talar dome fracture

Back 28

-xray
-prolonged non-weight bearing status

Front 29

plantar fasciitis

Back 29

-pain beneath the calcaneous that is worse after inactivity
-local point tenderness in the medial tubercle of the calcaneous
-caused by overuse
-typically bilateral

Front 30

tx/prognosis of plantar fasciitis

Back 30

-heel cups and orthodics
-steroid/lidocaine injection and NSAIDs
- prognosis is slow over a couple of years if ever

Front 31

plantar fibromatosis

Back 31

-fibrous tissue proliferation of the plantar fascia
-similar to Dupuytren's contracture, but rarely causes contracture
-

Front 32

how does plantar fibromatosis begin?

Back 32

-begins as a painless subQ nodule that slowly enlarges and becomes tender

Front 33

tx for plantar fibromatosis?

Back 33

-surgery once weight-bearing becomes painful

Front 34

achilles tendonitis is caused by?

Back 34

-overuse of the calf muscles either acutely or chronically
-frequently seen in athletes

Front 35

Sx of achilles tendonitis

Back 35

-pain, local tenderness, swelling, and crepitus

Front 36

Tx of achilles tendonitis

Back 36

-rest, heat, gentle stretching
-NSAIDs (questionable benefit)
-small heel lift

Front 37

_______and ________are known to cause tendon rupture

Back 37

steroids and quinolones

Front 38

__________are present near the insertion of the Achilles tendon and if they become inflamed tx is ________________

Back 38

1. two bursae
2. heat, heel elevation with soft cushion (can use steroid injections, but must avoid tendon)

Front 39

calcaneal apophysitis AKA _______

Back 39

"Sever's Dz"

Front 40

Sever's disease

Back 40

-low grade inflammatory reaction at the insertion of the achilles tendon with sclerosis of calcaneal growth plate
-more common in males 8-14yrs

Front 41

Sever's dz is similar to ______ of the knee

Back 41

Osgood Schlatter

Front 42

Sever's dz Sx

Back 42

-often bilateral
-local pain, tenderness, and swelling
-pain upon passive stretching of the heel on PE

Front 43

Sever's dz tx

Back 43

NSAIDs, local heat, avoidance of activity

Front 44

Achilles tendon rupture is preceded by a history of ________

Back 44

gradual degeneration

Front 45

where and when does achilles tendon rupture usually occur?

Back 45

-2-5 cm above the insertion
-typically occurs during activity and is associated with a "pop"

Front 46

post injury of achilles tendon rupture, the pt walks _____and is unable to ________

Back 46

1. flatfooted
2. stand on the ball of the foot (most plantar flexion is lost)

Front 47

common symptoms of a ruptured achilles tendon are?

Back 47

-tenderness and hemorrhage

Front 48

_____can occasionally be palpated with an achilles tendon rupture

Back 48

-defect at the site of rupture

Front 49

Thompson's squeeze test

Back 49

-used to help dx a ruptured achilles tendon
-squeezing calf should yield plantar flexion in an unruptured acilles tendon

Front 50

plantaris tendon rupture/location

Back 50

-sudden sharp pain in calf with no associated loss of calf strength (plantar flexion)
-plantaris tendon lies medial to the heel cord in the calf

Front 51

morton's neuroma

Back 51

-caused by perineural fibrosis of plantar nerve divisions secondary to repetitive trauma
-females more than males due to tight shoes
-typically the 3rd web space is affected

Front 52

morton's neuroma presentation

Back 52

-typically the 3rd web space is affected
-severe burning pain that is worse with activity with associated numbness in affected toes
-common cause of pain in the forefoot

Front 53

tx of morton's neuroma

Back 53

-NSAIDs
-physical seperation of affected metatarsal heads
-surgical removal of neuroma is often needed

Front 54

metarsalgia

Back 54

-idiopathic pain beneath metatarsal heads

Front 55

Sx of metarsalgia

Back 55

-burning or cramping pain
-worse with activity
-tender calluses develop under the affected heads

Front 56

tx of metarsalgia

Back 56

-balance weight-bearing pressure away form affected heads

Front 57

MTP synovitis characteristics

Back 57

--unknown cause
-2nd toe most affected
-chronic highheel use is a RF
-exam shows swelling and tenderness of affected joint

Front 58

MTP synovitis Tx

Back 58

-NSAIDs
-shoe modification
-steroid injections

Front 59

Hallux valgus

Back 59

-lateral deviation of the great toe at MTP joint
-presents with pain and deformity

Front 60

tx of hallux valgus

Back 60

-pressure and relief over resulting bunion

Front 61

hallux rigidus ("turf-toe") presentation

Back 61

-pain with restricted movement in the MTP joint of great toe
-usually secondary to traumatic osteoarthritis
-most common in the 3rd-4th decade
-gradually increasing pain and stiffness, often precipitated by a minor injury (gout is acute with no hx of injury)

Front 62

tx of hallux rigidus

Back 62

-rest, moist heat, and antiinflammatory meds

Front 63

hallux varus

Back 63

-medial deviation of great toe at MTP
-mostly affects children

Front 64

tx of hallux varus

Back 64

-passive stretching and proper shoe wear