Clin Med Ii-Orthopedics-Disorders Of Foot And Ankle

Front 1

what is the most common area for injury?

Back 1

ankle sprain

Front 2

what is the most commonly injured ligament?

Back 2

ATF (grade 1)

Front 3

what is the most common mechanism of injury to ankle?

Back 3

inversion and plantar flexion

Front 4

which is weaker, lateral or medial collateral?

what are the three parts of the lateral collateral ligament?

Back 4

the lateral is weaker

Three parts of lateral are:
1. ATF(weaker than PTF)
2. CF(lg and strong)
3. PTF(rupture due to pronation-external rotation)

Front 5

what is the classification system of ankle sprains?

Back 5

Grade 1=stretch of lig w/ microtear (little swelling and little/no fxn loss)

Grade 2=stretch lig w/ partial tear, mod to severe swelling and ecchymosis

Grade 3=complete rupture of lig w/ imediate swelling, bruising and inability to bear wt

Front 6

what grade of sprain has no joint instability?

what ligaments are involved in a grade II sprain?

Back 6

Grade I

Grade II=atf and cf

Front 7

what is tx for ankle sprains?

Back 7

RICE

*ROM exercises, balance exercises
*progressive resistive exercises where amt of wt is being carefully increased

*posterior splint

Front 8

what is the most impt hx ? to ask about ankle injury?

what are two other impt ?'s to ask about?

Back 8

most impt ? is the mech of injry

next is:

Pain(immediate or delayed)

Sound(presence of popping type sensation)-->possible avulsion

Front 9

what are special tests of the ankle?

Back 9

*talar tilt
*ant drawer
*side to side
*squeeze

Front 10

what is talar tilt testing for?

Back 10

talar tile=Atf, cf rupture (grade II)

Front 11

what is an. drawer test looking for?

Back 11

*ATF rupture

Front 12

what is side to side test looking for?

Back 12

instability of tibiofibular ligament

Front 13

what is the sqeeze test testing?

Back 13

sydnesmosis sprain

Front 14

how will a pt present that needs an ankle xray?

Back 14

*lateral fibular malleolus pain in the distal 6 cm

*if unable to bear wt

Front 15

what are the ottawa ankle rules?

Back 15

xray is required if:

1. bone tenderness at post edge of distal 6cm
2. pt unable to bear wt for at least 4 steps

also if there is tenderness at navicular or base of 5th metatarsal

Front 16

what is the age cutoff 4 ottawa rules

Back 16

pt is over 55 and has acute ankle injury and is excluded and should undergo xray exam routinely

Front 17

what are three standard ankle xray views?

Back 17

1. Ap film in 5-15 degrees of adduction

2. a true lateral film

3. a 45 degree oblique film w/ the ankle in dorsiflexion(mortise view)

Front 18

what are the medical-legal pitfalls?

Back 18

1. failure to dx
~failure to obtain a radiography
~misintrepretation of radiograph
~failure to recognize ankle instability

2. failure to tx injry apprpriately
~failure to immobilize unstable injuries
~failure to refer significatn injuries to the appropriate specialist

Front 19

what is the most common site of midfoot frx?

Back 19

5th metatarsal

Front 20

what are 2 general types of 5th metatarsal frx?

Back 20

1. proximal avulsion frx(pseudo jones or tennis)

~heals well w/ compression and wt bearing as tolerated

2. Jones frx: less common, more problematic. transverse at base of metatarsal

~frx increases w/ continued wt bearing
~m35-50% develop persisiten nonunions and require bone grafting and internal fixation

Front 21

what structure helps support the longitudinal arch of foot?

where does it begin and end

Back 21

the plantar fascia

that runs from heel bone to ball of foot

Front 22

pt presents with mild edema, pain walking on toes unilaterally

*pain w/ dorsiflexion and resolves w plantar flexion

*may have supination of foot w/ gait

*obese or athletic

what is potential dx?

Back 22

plantar fascitis

Front 23

what is a sign that results form the chronic plantar fascitis?

Back 23

bone spurs that form from small tears in tendon that body tried to heal

Front 24

how is dx of plantar facittis generally made?

what must be r/o?

how do you r/o?

Back 24

dx based on H and P

must r/o systemic illness (RA, ankylosing spondylitis, Reiters) or stress fracture

order xrays and labs
*CBC, ESR if bilateral
*lat xray to r/o stress frx
*bone scan if osteolyelitis in ddx

Front 25

what is tx of plantar fascitits?

Back 25

*Rest, unload, stabilize
*shoes w/ arch support and heel cups
*anti inflammatory meds
*surgery to release fascia or remove spur

*strengthen muscles

*NIght splingts (avoid equinus position)

Front 26

what is px of severe plantar fascitis case if treated early?

Back 26

can resolve in 6 weeks

Front 27

patient present with painful, swollen and tender great toe and local discharge

PE reveals edema, erythema and warmth

what is possible dx?

Back 27

ingrown toenail

Front 28

which toes are affected by ingrown toenail?

what is pathophys of ingrown toenail?

Back 28

big toe only

foregn body rxn when nail bed is compressed from side of nail and penetrates the cuticle

Front 29

what is tx of ingrown toenail?

Back 29

*proper footwear

*edge of nail must be elevated from nail bed

*partial nail removal w/ cautery of nail matrix is curative 70-90% of time

Front 30

what is onychomycosis?

what is tx?

Back 30

it is a fungal infection of the nail

tx:
~lamisil 250 mg qd x 12 weeks
~sporonox 100 mg 2 tabs bid x 7days off for 3 wks then repeat x2

Front 31

an other wise helathy 34 yo female presents w/ an obvious ingorwn great toenail. what is appropriate tx?

Back 31

perform a partial unguinectomy w/ nail bed ablation

Front 32

which of the following pats shoudl be considered for referral after a partial unginectomy?

Back 32

*vascular insufficiency or DM

Front 33

what is a bunion

Back 33

is a prominence of the medial portion of the head of the 1st metatarsal bone. The cause is often variations in position of the 1st metatarsal bone or great toe, such as lateral angulation of the great toe (hallux valgus). Secondary osteoarthritis and spur formation are common. Symptoms may include pain and redness, bursitis medial to the joint, and synovitis. Diagnosis is usually clinical. Treatment is usually a shoe with a wide toe box, protective pads, and orthotics. For bursitis or synovitis, corticosteroid injection is helpful.

Front 34

what is hallux valgus

Back 34

*deformity of big toed caused by tight fitting shoes, hereidatry hyperpronated flat feet

*toe is angled in towards other toes

*usual tx is to have toe straigtened w/ arthritic bone and have bunion surgically removed

Front 35

what is a corn?


what is a callous?

what are both underlying signs of ?

Back 35

corn=hard thickened skin ON TOP , btw or on tip of toe

callus=hard thickened skin ACROSS BALL OF FOOT

both are underlying visible signs of bone problems

Front 36

what is tx for corns and calluses?

Back 36

*salicyclic acid pads a


*soak feet in warm soapy water
*pumice stone
*vit E oil
*surgery to remove bone
*shoes

Front 37

what is initial tx of corn/callus fails?

Back 37

refer to podiatrist or othopedic surgoin is simple measure fail

*latex, plastic or silicone molds can be made to prevent localezed pressure

Front 38

what is subungual hematoma?

what is tx?

Back 38

when blood becomes trapped under toenail


tx=electrocautery 18 gg needle, heated paperclip

Front 39

what is tx for pts w/ significant crush injury or subungual hematoma that involve lacerations to skin fold or disrupt the nail?

Back 39

remove the nail and inspect the matrix

Front 40

what is conservative tx of subungual hematoma?

Back 40

*w/o nail removal and is recommended for pts w/ closed hematomas an intact nail w/ no laceration to skin fold or nail disruption

also indicated for crush injuries that frx the terinal phalanx but do not caus a hematoma

Front 41

what can untreated nail bed lacerations develop into?

Back 41

subsequent nail deformities

*when amputation w/ loss of two thirds of nail occurs, half of fingers develop beaking or a curved nail

Front 42

how long does full growth of nail take?

what is avg healing time for fingertip amputation

how long before sutures should be removed?

Back 42

nail takes an avg of 100 days but fingertrip trauma may delay growth by 20 days

avg heal time for fingertip amputation is 21-27 days

remove sutures after 7-10 days

Front 43

what does nail complex require to prevent hook nail deformity?

what should not be sued for anesthesia before trphinating a subungual hemotoma w/ cautery?

Back 43

nail cpmoe x requires distal bone and soft tissue support to prevent hook nail deformity

*do NOT use ehtyl chloride b/c of flammability for anesthesia befor trphinating

(be careful w/ artificial nails as well)

Front 44

how can you control the nailbed from bleeding?

Back 44

suture it

Front 45

which of the following is not a criterion for conservative tx of a subungual hematoma?

Back 45

an intact nail
*a closed hemtoma
*no laceration of skin fold
*hematoma involving less than 50% of nail surface


~all of these are criteria