Foot And Ankle I

Front 1

1. What does bilateral foot pain point to?

Back 1

a. Systemic process

Front 2

2. What ligaments are most often affected in ankle inversion?

Back 2

a. Anterior talofibular
b. Inferior calcaneofibular ligament

Front 3

a. What is the most common lateral inversion injury?

Back 3

i. Ankle sprain

Front 4

b. What is a grade I West Point sprain?

Back 4

i. Microscopic tearing
ii. Minimal swelling
iii. No joint instability
iv. Fully/partial weight bearing

Front 5

c. What is a grade II West Point sprain?

Back 5

i. Partial tearing
ii. Moderate/severe swelling
iii. Mild/moderate joint instability
iv. No weight bearing

Front 6

d. What is a grade III West Point sprain?

Back 6

i. Complete rupture
ii. Severe swelling
iii. Moderate/severe joint instability
iv. No weight bearing

Front 7

e. What are the Ottawa ankle rules for X-rays?

Back 7

i. Ankle plain +
ii. Bone tenderness along distal 6 cm of posterior edge of tibia or tip of medial malleolus
iii. Bone tenderness along distal 6 cm of posterior edge of fibular or tip of lateral malleolus
iv. Inability to bear weight immediately after injury and during clinical evaluation for four steps

Front 8

f. How can you distinguish strain/sprain?

Back 8

i. Palpate malleoli and ligaments

Front 9

g. What tests should you do in a PE for an ankle sprain?

Back 9

i. Anterior drawer test
ii. Squeeze test
iii. Stress test
iv. X-ray

Front 10

h. What talus tilt is considered normal?

Back 10

i. <10 degrees is normal
ii. >10 degrees is unstable→ at least grade II

Front 11

i. How do you tx an ankle sprain?

Back 11

i. NSAID
ii. RICE
iii. Contrast baths
iv. Ankle supports
v. Surgery

Front 12

j. What imaging modality is best for ankle sprains?

Back 12

i. MRI

Front 13

a. With what condition is ankle dislocation usually associated?

Back 13

i. Fracture

Front 14

b. What can cause total talor dislocation?

Back 14

i. AVN

Front 15

c. What is the tx for ankle dislocation?

Back 15

i. Immediate reduction
ii. Splinting
iii. No weight bearing
iv. RICE

Front 16

d. What would indicate an open reduction in ankle dislocation?

Back 16

i. Tendon entrapment

Front 17

a. What is cuboid syndrome?

Back 17

i. Cuboid remains plantar flexed while rest of foot returns to normal position

Front 18

b. How can you tx cuboid syndrome?

Back 18

i. OMM

Front 19

a. What are some nerve entrapment syndromes?

Back 19

i. Tarsal tunnel syndrome
ii. Superficial peroneal nerve
iii. Jogger’s foot
iv. Morton’s neuroma

Front 20

b. What is the most common nerve entrapment of the foot?

Back 20

i. Tarsal tunnel
ii. Posterior tibial nerve

Front 21

c. Where does the entrapment occur in tarsal tunnel syndrome?

Back 21

i. Below medial malleolus

Front 22

d. What can be confused with tarsal tunnel syndrome? What symptoms would make you consider the alternatives?

Back 22

i. Diabetic neuropathy and RSD
ii. Chronic burning pain

Front 23

e. What are the symptoms of tarsal tunnel syndrome?

Back 23

i. Proximal calf pain at night
ii. Paresthesia and/or dysesthesia at bottom of foot
iii. May go into medial two toes→ medial plantar nerve

Front 24

f. What will an x-ray tell you in tarsal tunnel syndrome?

Back 24

i. X-ray will be negative
ii. Need it to r/o mass or bony changes for impingement

Front 25

g. What will a PE reveal in tarsal tunnel syndrome?

Back 25

i. Tingling/burning
ii. Positive Tinel’s
iii. Posterior tibial nerve just inferior to medial malleolus
iv. Pain increases with activity
v. Occasional sensory loss and intrinsic motor loss

Front 26

h. What is the conservative tx for tarsal tunnel syndrome?

Back 26

i. Tx generally not conservative
ii. NSAIDs and non-rigid orthotic
iii. Cortisone

Front 27

i. What is the aggressive tx for tarsal tunnel syndrome?

Back 27

i. Decompression of all three branches of posterior tibial nerve

Front 28

j. What will superficial peroneal nerve impingement mimic?

Back 28

i. Compartment syndrome
ii. Pain is usually in foot with numbness along nerve

Front 29

k. How do you tx superficial peroneal nerve impingement?

Back 29

i. Conservative stretching
ii. Possible surgical release

Front 30

l. What is jogger’s foot?

Back 30

i. Entrapment of plantar nerve at master knot of Henry

Front 31

m. How can you tx jogger’s foot?

Back 31

i. Heat
ii. Massage
iii. US
iv. Cortisone
v. Surgery

Front 32

n. What is Morton’s neuroma?

Back 32

i. Perineurial fibrosis of common digital nerve

Front 33

o. Where is the most common site for Morton’s neuroma?

Back 33

i. 3rd intermetatarsal space

Front 34

p. What can cause Morton’s neuroma?

Back 34

i. Too tight shoes

Front 35

q. What will a PE show in Morton’s neuroma?

Back 35

i. Severe burning in 3rd IMS aggravagted by activity
ii. Forefoot compression may reproduce pain and click

Front 36

a. How do you tx Morton’s neuroma?

Back 36

i. NSAID
ii. Injection through DORSUM of foot
iii. Metatarsal pad
iv. Surgery-- last resort

Front 37

a. What can contribute to Achilles tendonitis?

Back 37

i. Pronation of forefoot
ii. Ill-fitting shoes

Front 38

b. What are the symptoms of Achilles tendonitis?

Back 38

i. Pain more severe with exercise
ii. Generally not severe acute pain

Front 39

c. What will a PE reveal in Achilles tendonitis?

Back 39

i. Negative thompson’s test
ii. +/- Haglund’s deformity

Front 40

d. How do you tx Achilles tendonitis?

Back 40

i. NSAID
ii. RICE
iii. Stretching
iv. RARE-- surgery/injection

Front 41

a. What are the signs/symptoms of an Achilles rupture?

Back 41

i. Severe onset of pain
ii. “Feels like someone hit me in the leg with a baseball bat.”

Front 42

b. What will a PE reveal in an Achilles rupture?

Back 42

i. Unable to walk normally with toe-off
ii. + Thompson’s test
iii. Palpable defect at rupture site
iv. Ecchymosis in first 24 hours

Front 43

c. What will imaging reveal in an Achilles rupture?

Back 43

i. X-ray -
ii. MRI determines severity

Front 44

d. How do you tx an Achilles rupture?

Back 44

i. The more active the patient, the more you should think about surgery
ii. Splinting w/ early passive motion
iii. Non weight-bearing for 6-8 weeks