Foot

Question 1

the excessive eversion or inversion of the ankle exceeding the strength of the ligament that stabilizes it

Answer 1

ankle sprain

Question 2

maneuvers that help the diagnosis of ankle srain

Answer 2

anterior drawer test, talar tilt test

Question 3

ankle sprain grading

Answer 3

I overstretching of the fibers of supporting ligament
II partial tear of the ligament
III complete tear of the ligament

Question 4

t/f all ankle sprains need radiographic exams

Answer 4

false!! check ottawa rules

Question 5

ottawa rules for ankle xray

Answer 5

pain at the malleolar zone and:

• bone tenderness at posterior edge or tip of lateral malleolus,
• bone tenderness at post edge or tip of medial malleolus,
• inability to bear weight immediately/er

Question 6

ottawa rules for foot xray

Answer 6

• pain in the midfoot zone and:
• bone tenderness at base of 5th metatarsal
• bone tenderness at navicular
• inability to bear weight immediately/er

Question 7

conservative treatment for ankle sprains

Answer 7

• immobilization with brace or case

- aggressive rehabilitation: for mobility and proprioception around joints

Question 8

other treatment options for ankle sprains

Answer 8

• best for displaced fractures: reduction and fixation using plates and screws

Question 9

what is a hallux valgus (bunion)

Answer 9

• excessive valgus angulation of first metatarsophalangeal joint
• cc: cosmetically unappealing appearance (no pain)
• more severe valgus angulation = severe pain and dysfunction

Question 10

management of hallux valgus

Answer 10

• shoes with wide toe box
• toe separators to align
• distal osteotomy
• proximal osteotomy

Question 11

what is plantar fasciitis

Answer 11

• inflammation of plantar fascia

- pain around heel area

Question 12

etiology of plantar fasciitis

Answer 12

• joint bursae around achilles tendon
• origin of plantar fascia
• heel fat pad
• bone spurs at heel = direct trauma

Question 13

treatment for plantar fasciitis

Answer 13

• short term: pain medication and anti-inflammatory drugs
• long term: stretching of achilles tendon and plantar fascia
• orthotic devices (heel cups)

Question 14

changes in flatfeet

Answer 14

• heel: valgus, ext rot, plantar flexion
• talus: abducted, plantaflexed
• forefoot: supinated
• navicular: subluxation

net effect: decrease in height of plantar arch = less efficient

Question 15

most common cause for flatfeet

Answer 15

• generalized ligamentous laxity !!
• cerebral palsy
• marfan’s syndrome
• other neuro/endo disorders

Question 16

distribution of weight in normal vs flatfoot

Answer 16

• normal: heel 61% ball of foot 35% midfoot 4%

- flatfoot: no weight bearing or contact at heel, midfoot 17-30%

Question 17

management of flatfoot

Answer 17

• arch support: shifts weightbearing area but does not correct
• surgery not indicated in growing child
• surgery for symptomatic adolescents near maturity and failure of conservative management

Question 18

natural history of flatfeet

Answer 18

• growth = ligaments become stronger and tighten

- ligaments pull on bones and restore arch as child matures

Question 19

management for flexible flatfeet with tight ta

Answer 19

• nonpainful: family and patient education

- painful: ta stretching/serial casting

Question 20

epidemiology of clubfeet

Answer 20

• male > female

- 80% idiopathic but watch out for neural tube defects, hip dislocation, other joint problems

Question 21

presentation of clubfeet

Answer 21

• heel in equinus
• navicular and tarsals in varus
• forefoot is adducted

Question 22

management of clubfeet in children

Answer 22

• toc: ponseti method (serial casts)
• heel cord tenetomy
• denis-browne shoes/splints (wear for 23 hours/day until ambulation, maintenance until 3 yo)

Question 23

t/f clubfeet will never look normal even after treatment

Answer 23

true

Question 24

management of clubfeet in adults

Answer 24

• no treatment: child will walk with deformity
• weight bearing on dorsal or lateral side of foot
• tx: bone reshaping