Foot & Ankle; Compartment Syndrome; Neoplastic Disease


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Mar 13 2018 24 mins   6
This week on PA Study Sesh we will be discussing disorders of the foot and ankle, bone tumors, and compartment syndrome.

* Ankle Dislocation

* Most commonly posteriorly (calcaneus goes posterior)
* Risk to peroneal n

* Sx: foot drop

* Tx: closed reduction & posterior splint

* Ankle Sprain

* MOI: inversion
* Anterior talofibular ligament (ATFL) #1

* Eversion injury = deltoid ligament

* Test= anterior drawer
* X-ray criteria

* Ankle: TTP along medial or lateral malleolus
* Foot: Midfoot tenderness (navicular) or 5th metatarsal TTP
* Unable to weight bear 4 steps following injury or in office
* Are you concerned about a fx? Get an X-ray.

* Grading

* 1: stretch
* 2: partial
* 3: complete

* Achilles Tendon Rupture

* Major risk factor: fluoroquinolone (“floxacin”) use, recent increase in activity
* Thompson test: weak/absent plantar flexion when the gastroc is squeezed
* Tx: Progressive equinus splinting vs surgical repair.

* Lateral Ankle/Fibula Fx

* Weber Classification

* A: below ankle
* B: even with syndesmosis
* C: above syndesmosis

* Often with medial malleolar fx and deltoid avulsion
* Unstable
* Spiral=concerning
* Called Maisonneuve fx if proximal fibula

* Recall monteggia fx

* Transverse less concerning as usually direct trauma

* Take away: look for syndesmosis injury

* March fx

* Common military stress fracture
* 3rd metatarsal #1

* Plantar Fasciitis

* First step pain
* Tx: Conservative

* Tarsal Tunnel

* Tibial Nerve
* Medial malleolus, heel, sole numbness

* Bunion (Hallux Valgus)

* Risk factors: poorly fitted shoes #1, flat feet (pes planus)
* 1st metatarsal lateral deviation
* tx: wide toe box

* Hammertoe

* Flexion of PIP, hyperxtension of MTP & DIP
* Typically cause pain due to shoe contact

* Charcot Foot

* Joint damage & destruction 2/2 DM neuropathy
* Microtrauma leads to bone resorption & weakness (autonomic dysfunction)
* Redness decreases with elevation
* Midfoot deformity (foot becomes concave)
* Increased ESR, WBC, CRP
* Tx: NWB!!!! Splint & refer. Ultimately will get total contact cast

* Jones fx

* Transverse fx through diaphysis of 5th metatarsal (distal to 4/5 articulation)
* Risk of avascular necrosis
* Tx: boot/cast vs surgery

* Avulsion fx (pseudojones)

* Below 4/5 articulation

* Lisfranc injury

* Disruption of 2nd metatarsal and medial cuneiform articulation
* MOI: Step off a hole
* Plantar ecchymosis
* Fleck sign: fx at base of 2nd metatarsal= pathognomonic
* WEIGHT BEARING XRAYS
* Tx: NWB!! & boot/cast.

* Surgery if any displacement

* Calcaneus fx

* Fall from a height

* Compartment Syndrome

* Most common after long bone fractures

* Crush injuries
* Tight cast

* Pain out of proportion
* 6 Ps- PAIN, pulselessness, poikilothermia, pallor, paresthesia, paralysis,
* Pain on passive stretching = 1st indicator
* Tx: fasciotomy

* Primary Bone Malignancies

* “have sarcoma” in the name
* Present with bone pain
* Night pain= red flag