Term
| Main 3 bones articulating in ankle; ankle mortus |
|
Definition
|
|
Term
| What are the 4 components of clubfoot? |
|
Definition
| plantar flxn (equinus), heel addx (varus), high arch, forefort addx |
|
|
Term
| Prevalence of clubfoot: m v. f? genetics? race? |
|
Definition
| m>f 2:1; 3-4% risk in siblings; 25% risk w/parent and sibling; higher in hispanics and asians |
|
|
Term
| What should you check w/clubfoot? What should you rule out? |
|
Definition
| check correctability; r/o other neuromuscular involvements |
|
|
Term
| What is tx for clubfoot? Under what tx will clubfoot recur and how will shoe size vary? |
|
Definition
| casting x 2-4 mos; can recur up to age 7; shoe size 1-1.5 sizes smaller. surgery. |
|
|
Term
| What are 4 types of fallen arches? |
|
Definition
| apparent, flexible, rigid, acquired. |
|
|
Term
| How do you tx asymptomatic fallen arches? flexible arches? What purpose do arches serve? What stretching type helps fallen arches? What type of modification is helpful? How frequently is surgery used? |
|
Definition
| asymptomatic fallen arches are left alone. flexible need time. arches are not helpful. achilles' stretching. activity and wt modification;. surgery rare. |
|
|
Term
|
Definition
|
|
Term
| What is defined as an injury to the ligamentous or musculotendinous structures of ankle?? |
|
Definition
| ankle sprains and strains |
|
|
Term
| What is the most common ankle due to structural anatomy of ankle? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Which of the following is most and least common: cfl, atfl, ptfl? |
|
Definition
|
|
Term
| What type of ankle sprain is usually most severe? |
|
Definition
| eversion injury usually more severe |
|
|
Term
| What type of ankle sprain is VERY SERIOUS? |
|
Definition
|
|
Term
| What are 4 aspects of pe for ankle sprains and strains? |
|
Definition
| pain and ttp over injury. graded injury. talar tilt test. anterior drawer. |
|
|
Term
| What is tx of ankle sprains and stains? |
|
Definition
| RRICE/NSAIDS/ splint. pt (arom/strength/proprioception). surgery rare. |
|
|
Term
| With what problems in addition to pain in malleolar zone (nav to 6 cm up) are x-rays REQUIRED for ankle pain? |
|
Definition
| pain in malleolar zone (nav to 6 cm up). AND Bone tenderness @ post edge/tip of malleolus (med or lateral) OR inability to bear weight regardless of limping (4 steps or less) |
|
|
Term
| With what problems in addition to pain in midfoot region (navicular to mid MT) are x-rays REQUIRED for ankle pain? |
|
Definition
| Pain in midfoot region (navicular to mid MT) and bone tenderness @base of 5th mt OR bone tenderness @ navicular OR inability to bear weight regardless of limping |
|
|
Term
| Ankle fractures involve what bones/jts? |
|
Definition
| maleoli or syndesmosis (typically involve physis in children) |
|
|
Term
| What is the "too many toes sign"? |
|
Definition
| pes planus. from behind, you see 3/4 toes. |
|
|
Term
| What are 2 clasifications of ankle fx? |
|
Definition
| lauge-hansen system (position and force) or weber/ao system (anatomic level of fib fx) |
|
|
Term
| Regarding pe for ankle fx, what must you always palpate? how do you eval syndesmosis. how hard is a stress test? what should you watch for? |
|
Definition
| always palpate up to knee. squeeze test (5 cm up) to eval syndesmosis. stress testing hard initially. watch for lacerations. |
|
|
Term
| 3 ligs on lateral side of ankle |
|
Definition
| anterior, calcaneal, posterior talar fibular |
|
|
Term
| What views do you typically order for x-ray of ankle fx? |
|
Definition
| ap lat, mortise. lat and mortise probably sufficient |
|
|
Term
| you have ankle fx w/syndesmosis- for what else do you look? |
|
Definition
| eversion lig deltoid sprain leading to prox fibular fx (masonneuve) |
|
|
Term
| Which ankle view involves tib/fib overlap 10 mm; and talar tilt < 2mm? |
|
Definition
|
|
Term
| Which ankle view involves the talus dome centered? |
|
Definition
|
|
Term
| Which ankle view involves medial <4mm, lateral <5.5 mm, and tibiofib overlap 1 mm? |
|
Definition
|
|
Term
| On what does tx of ankle fx depend? |
|
Definition
|
|
Term
| If pt hears a pop w/ankle fx, what do you think? |
|
Definition
| much more serious injury than it may appear |
|
|
Term
| How are most ankle fx tx? |
|
Definition
| most tx w/immob and NWB x 6-8 weeks. slow return to fwb |
|
|
Term
| In what position must ankle fx be immobilized? Do you splint or cast? |
|
Definition
| in neutral (90deg). splint until swelling decreases then cast. |
|
|
Term
| What was a study done where er pts w/ankle pain were observed and clinical indications for x-rays determined? |
|
Definition
|
|
Term
| What imaging is useful for forefoot fx? |
|
Definition
| wb x-rays w/low beam intensity. bone scan for occult stress fx |
|
|
Term
| When do ankle fx require sx? |
|
Definition
| if mortise widened or coumpound fx |
|
|
Term
| What are 3 purposes of pt for ankle fx? |
|
Definition
| regain rom, proprioception, strengthening |
|
|
Term
| What variant of ankle fx involves high likelihood of post-traumatic arthritis? |
|
Definition
|
|
Term
| What variant of ankle fx involves unstable fx of prox fibula, disruption of deltiod lig and syndesmosis? |
|
Definition
|
|
Term
| What is a high energy fx that is difficult to manage d/t wb and comminution? |
|
Definition
|
|
Term
| With what does calcanes fx have high association? |
|
Definition
| w/ spinal injury (10%) and bilat in 5-10% |
|
|
Term
| Pt pressents w/extreme pain/tenderness, gross heel widening, and soft tissue ecchymosis (esp. into arch). What do you suspect? |
|
Definition
|
|
Term
| what x-ray views are ordered for calcaneus fx? when might you order ct scan? |
|
Definition
| same x-rays as ankle + calcaneus axial view. ct scan for sx planning (spec 3-5 mm slices) |
|
|
Term
| What is tx for calcaneus fx? |
|
Definition
| elevation is critical for wound healing. nwb x 6+ wks. no real guidelines for conservative vs. operative tx |
|
|
Term
|
Definition
| forefoot fx that involves tarso/mt articulations |
|
|
Term
| What are 5-6% of primary care fxs? |
|
Definition
|
|
Term
| originates and is contained below jt level lateral malleolar jt fx? |
|
Definition
| weber type a- easier to tx |
|
|
Term
| lgr medial gutter space. widening of syndesmosis. fibular fx originates at jt line. |
|
Definition
|
|
Term
| fx of fibula originates above jt line. |
|
Definition
|
|
Term
| What is the usual cause of a forefoot fx? What are other causes? |
|
Definition
| usually traumatic. can also be twisting, avulsion, stress related. |
|
|
Term
| What fx disrupts the major wbing complex of foot and can cause metatarsalgia and transfer lesions. |
|
Definition
|
|
Term
| what 4 things do you look for w/pe of forefoot fx? |
|
Definition
| painful swelling and tender over fx site. check nv status. forefoot abdx/rot. hlocs. |
|
|
Term
| actual tibial superficial surface of mortus is fx (type of ankle fx) |
|
Definition
| plamond/pilon fx. high likelihood of post-traumatic arthritis |
|
|
Term
|
Definition
| lot of sig swelling acutely in sm confined area- no cast until resolved. |
|
|
Term
| widening of medial gutter space |
|
Definition
|
|
Term
| On what does tx of forefoot fx depend? Which are very important? Which are less important? What is critical? |
|
Definition
| which ray. 1st and 5th very important? 2nd-4th less so. anatomical alignment critical! |
|
|
Term
| How is a non-displaced forefoot fx tx? |
|
Definition
|
|
Term
| Which forefoot fx typically go to sx? |
|
Definition
|
|
Term
| What fx involves the proximal metaphyseal/diaphysieal jct that is often a stress fx that often needs sx? |
|
Definition
|
|
Term
| What type of fx is typically an avulsion injury of the peroneus brevis at he very proximal tip? how do you tx? |
|
Definition
| pseudo-jones. splint/cast and f/u |
|
|
Term
| What is the cause of most toe fx? |
|
Definition
| most d/t use of improper footwear |
|
|
Term
| Which toes are most vulnerable to toe fx? |
|
Definition
|
|
Term
| What are the moi of toe fxs? |
|
Definition
| stubbed toe, direct fall/trauma |
|
|
Term
| What do you look for on a a pe of toe fx? |
|
Definition
| pain swelling, bruising, and deformity. ttp over fx site |
|
|
Term
|
Definition
|
|
Term
| What is tx for distal toe fx? |
|
Definition
| splint/buddy tape. stiff soled shoes. |
|
|
Term
| What tx is involved w/interphalangeal fxs? |
|
Definition
| splint in lesser toes. stiff soled shoes |
|
|
Term
| How is tx forproximal phalanx and ip jt fx tx? |
|
Definition
| fix w/k-wires or lag screw |
|
|
Term
| What are complications of toe fx? |
|
Definition
| non-union (rare); post-traumatic OA (debilitating in great toe) |
|
|
Term
| How are sesamoid "fx's" often dx? what type of sesamoid fx is most common? What is another type? what do you look for to tell if it is a fx? |
|
Definition
| often misdx. bipartite in 10-30%. bilat in 85%. rounded edges. no callus in 3 wks. |
|
|
Term
| Are medial or lateral sesamoid fxs most commmon? |
|
Definition
|
|
Term
| What are sesamoid fx d/t? |
|
Definition
|
|
Term
| Where does achilles tendon injury usually occur? |
|
Definition
| 2-6 cm proximal to insertion |
|
|
Term
| What age and gender is usually associated w/achilles tendon injury? |
|
Definition
|
|
Term
| What is felt as a sudden "snap " or "pop" or "gunshot" and is often audible by others? |
|
Definition
|
|
Term
| What is looked for w/pe of achilles tendon injury? How frequently is it missed? What type of test must you do? |
|
Definition
| palpable defect. often missed (up to 25%). thompson test w/in 48hrs |
|
|
Term
| What imaging is used for achiles' tendon injury? |
|
Definition
| x-ray to check bones. ct to eval bony avulsion. mri superior for tendon. |
|
|
Term
| What is superior to dx achilles' tendon injury? |
|
Definition
|
|
Term
| How is achilles' tendon injury tx? for what is sx repair reserved? Why is sx repair better? |
|
Definition
| progressive casting & wb. sx repair. usually reserved for complete ruptures. less cast time better strength, decreased recurrence. pt. no jumping x 9-12 mos. |
|
|
Term
| What involves heel pain assoc. w/microtrauma of calcaneal insertion? |
|
Definition
|
|
Term
| In what age group is plantar fasciitis most common? gender? |
|
Definition
|
|
Term
| PE reveals tender over heel and plantar facia, usually worse w/toe dorsiflxn. |
|
Definition
|
|
Term
| What imaging is indicated for plantar fasciitis? |
|
Definition
|
|
Term
|
Definition
| pt for stretching & u/s. nsaids. night splints. orthotics/heel pads. cortisone injections. stiff soled shoes. |
|
|
Term
| What involves growing of nail into surrounding tissue? What is often the cause? |
|
Definition
| ingrown toenail. often d/t shoes, sports. poor trimming habits |
|
|
Term
| the more distal the toe fx, |
|
Definition
| the more you can tx it nonoperatively |
|
|
Term
| Which ingrown toenail stage involves red skin? |
|
Definition
|
|
Term
| Which ingrown toenail stage involves infection/pus? |
|
Definition
|
|
Term
| Which ingrown toenail stage involves granulation? |
|
Definition
|
|
Term
| What does conservative tx of ingrown toenails involve? |
|
Definition
| elevation of nail plate. freq warm soaks. loose fitting shoes. selective nail trimming. |
|
|
Term
| What is definitive tx of ingrown toenails? |
|
Definition
| partial/total nail excision. |
|
|
Term
| What are 2 complications of ingrwon toenails? |
|
Definition
|
|
Term
| How do you anesthetize toe for teonail removal? |
|
Definition
| ring block/4 digital nn. 1 mL around ea |
|
|
Term
| How do you prep and drape toe for toenail removal? |
|
Definition
|
|
Term
| How do you cut toenails for toenail removal? |
|
Definition
| lengthwise. PRTL; 4-5 mm from edge. WHOLE: halfway |
|
|
Term
| How do you release toenail from nail bed? |
|
Definition
| elevator or scissors. gentle pulling to decrease trauma. |
|
|
Term
| After you anesthetize toe, prep and drape, cut toenail lenthwise, and release nail from bed, what do you do? |
|
Definition
|
|
Term
| compress calf causing plantar flexion |
|
Definition
| thompson test w/in 48 hrs to test for achilles tendon injury |
|
|
Term
| What is the purpose of proper soewear? |
|
Definition
| protect, cushion, and fashion |
|
|
Term
| How do feet change w/age? |
|
Definition
| inc. in size w/age- same shoe size! |
|
|
Term
| What is teh nml wear pattern for proper shoewear? |
|
Definition
| outer sole, medial at toe, lateral at heel |
|
|
Term
| When should proper fit be determined? How should the foot be positioned? How much further beyond toe should shoe extend? How tight should shoes fit? How should shoe feel? How should laces be positioned? |
|
Definition
| end of day. weight bearing. upper w/o wrinkle. no bulge over welt. 3/8 to 1/2 beyond toe. snug but not crowded. comfortable from get go. laces should parallel. |
|
|
Term
| What is teh goal of crutch training? |
|
Definition
|
|
Term
| How should the gait change w/ cane? At which side should cane be used? Where should the top of the cane be positioned? |
|
Definition
| nml gait. contralateral side. top @ grtr troch. light portable and fashionable. |
|
|
Term
| How should crutches fit? What is teh stance for crutches? |
|
Definition
| more support. requires more balance coordination and upper body strength. 1-2" below axilla. grip @ grtr troch. stance: tripod. |
|
|
Term
| What walking support mechanism provides greater support balance and bulk w/ lots of options incl seats, wheels, handgrips, and bags? |
|
Definition
|
|
Term
| How should steps begin w/crutch training? How should pt lean on crutches? How does teh gait change once pt is comfortable? |
|
Definition
| begin w/smaller steps and "swing to" the device. do not lean on crutches- brachial plexus injury. "swing through" gait once comfortable. |
|
|
Term
| How do pts on crutches take stairs? Are crutches associated w/good or bad? |
|
Definition
| up w/the good; down w/ the bad. the crutches are associated w/the bad. sit and scoot. pt referral for crutch training, gait training, balance and proprioception, and fall prevention (in home). |
|
|
Term
| Why might you refer for pt w/crutch training? |
|
Definition
| crutch training, gait training, balance and proprioception, and fall prevention (in home). |
|
|
