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Foot and Ankle Fractures,Sprains, and Soft Tissue Disorders.

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Presentation on theme: "Foot and Ankle Fractures,Sprains, and Soft Tissue Disorders."— Presentation transcript:

1 Foot and Ankle Fractures,Sprains, and Soft Tissue Disorders

2 Ankle Sprain 25,000 people sprain an ankle every day 25,000 people sprain an ankle every day 85% of the time lateral collateral ligaments injured (anterior talofibular and calcaneofibular) 85% of the time lateral collateral ligaments injured (anterior talofibular and calcaneofibular) Inversion injury Inversion injury 5% syndesmosis injury 5% syndesmosis injury symptoms: pain, swelling, loss of function symptoms: pain, swelling, loss of function Treatmentis aimed at preventing chronic pain and instability Treatmentis aimed at preventing chronic pain and instability NSAIDS, ice, compression, elevation NSAIDS, ice, compression, elevation Air stirrup, WBAT, and physical therapy Air stirrup, WBAT, and physical therapy Should improve in 6 weeks Should improve in 6 weeks

3 Ankle Fractures Fractures involve the medial or lateral malleolus, the posterior lip of the tibia, the collateral liagamentous structures, or the talar dome Fractures involve the medial or lateral malleolus, the posterior lip of the tibia, the collateral liagamentous structures, or the talar dome Stable fractures= one malleolus, no ligaments Stable fractures= one malleolus, no ligaments Unstable fractures= both malleoli or a distal fibula and disruption of the deltoid ligament Unstable fractures= both malleoli or a distal fibula and disruption of the deltoid ligament Unstable fractures= vulnerable for displacement, instability, and posttraumatic arthritis Unstable fractures= vulnerable for displacement, instability, and posttraumatic arthritis

4 Symptoms: pain, swelling, tenderness, deformity Symptoms: pain, swelling, tenderness, deformity Examination: include evaluation of the posterior tibial pulse and posterior tibial nerve (plantar sensation) Examination: include evaluation of the posterior tibial pulse and posterior tibial nerve (plantar sensation) X-rays: AP, lateral, oblique (mortise view) X-rays: AP, lateral, oblique (mortise view) Cat Scan for complex fractures with articualr surface involvement or lateral portion of the distal tibia Cat Scan for complex fractures with articualr surface involvement or lateral portion of the distal tibia

5 Treatment: Treatment: Stable unimalleolar fxs= WB SLC Stable unimalleolar fxs= WB SLC Unstable fractures= ORIF Unstable fractures= ORIF

6 Maisonneuve Fracture Fracture of the proximal fibula with torn medial deltoid ligament, and disruption of the ankle mortise Fracture of the proximal fibula with torn medial deltoid ligament, and disruption of the ankle mortise Palpate proximal fibular with all medial ankle pain presentations Palpate proximal fibular with all medial ankle pain presentations Treatment= ORIF Treatment= ORIF

7 Fractures of the Hindfoot Fractures of the Hindfoot Talus fracture: usually result of severe trauma Talus fracture: usually result of severe trauma Calcaneus fracture: MVA or fall from a height Calcaneus fracture: MVA or fall from a height Sx: tenderness over talonavicular joint anterior to the medial malleolus, tenderness with side to side compression of the heel, swelling in the heel & ankle, and the inability to weight bear Sx: tenderness over talonavicular joint anterior to the medial malleolus, tenderness with side to side compression of the heel, swelling in the heel & ankle, and the inability to weight bear Tx: ORIF Tx: ORIF * watch for plantar compartment syndrome* * watch for plantar compartment syndrome* Talus fx: can lead to osteonecrosis Talus fx: can lead to osteonecrosis

8 Fracture of the Metatarsal Jones Fracture: proximal metaphysis of the fifth metatarsal propensity for non or delayed union NWBC 6 weeks, folllowed by WB cast until healing occurs Base of the Fifth Metatarsal Fracture: inversion injury R/O with suspicion of ankle fracture Most respond to closed reduction

9 Fracture of the Midfoot Lisfranc Fracture-Dislocation Lisfranc Fracture-Dislocation –Critical injury to the second tarsometatarsal joint=stabilizing apex for the other tarsometatarsal joints since it keys into a slot in the cuneiforms –*Easily missed and misdiagnosed as an ankle sprain*

10 Exam Exam –Careful examination will reveal area of maximum tenderness over the tarsometatarsal joint –Stabilize the calcaneus and rotate and/or adduct the forefoot=severe pain X-rays X-rays –AP, laterl, oblique views of the foot, standing if possible –Common error is to obtain only ankle films –Normal alignment=medial aspect of the middle cuneiform with the medial aspect of the second metatarsal base –Stress views, CT, MRI

11 Treatment Treatment –Significant swelling occurs-elevate and ice –Beware of Compartment Syndrome –Nondisplaced injuries=NWBC –Displaced=ORIF

12 Mortons Neuroma Fibrosis of the common digital nerve as it passes between the metatarsal heads Fibrosis of the common digital nerve as it passes between the metatarsal heads *commonly between the third and fourth toes* *commonly between the third and fourth toes* Sx: plantar pain, numbness, and walking on a marble Sx: plantar pain, numbness, and walking on a marble * firmly squeeze metatarsal heads with one hand while applying direct pressure to the interspace with the other * firmly squeeze metatarsal heads with one hand while applying direct pressure to the interspace with the other Tx: metatarsal bar, injection, surgical excision Tx: metatarsal bar, injection, surgical excision

13 Plantar Fasciitis Plantar heel pain that occurs where the plantar fascia arises from the medial calcaneal tuberosity Plantar heel pain that occurs where the plantar fascia arises from the medial calcaneal tuberosity Sxs: focal pain often increased upon awakening or when rising from a resting postion Sxs: focal pain often increased upon awakening or when rising from a resting postion Tx: 95% conservative treatment Tx: 95% conservative treatment –Achilles & plantar fascia stretching, night splints, NSAIDs, injection

14 Achilles Tendinitis & Rupture Rupture: sudden, severe calf pain described as a gunshot wound or direct hit Rupture: sudden, severe calf pain described as a gunshot wound or direct hit Middle-aged men = weekend athletes Middle-aged men = weekend athletes Swelling and ecchymosis from the calf to heel Swelling and ecchymosis from the calf to heel Weakness with push-off Weakness with push-off + Thompson test=absence of plantar flexion with calf compression + Thompson test=absence of plantar flexion with calf compression

15 Tendinitis: insertional or 4-5 cm proximal Tendinitis: insertional or 4-5 cm proximal –Insidious pain that increases with exercise –Often after a change in training habits –Protuberant posterolateral bony proces of the calcaneus –Treat conservatively

16 Shin Splints Chronic leg Pain- palpation of the tibial crest will usually identify a pinpoint spot Chronic leg Pain- palpation of the tibial crest will usually identify a pinpoint spot –Compression of the tibia and fibula will result in pain at the fracture site –Tx: reduction in athletic activity 4-6 wks –NSAIDs –Removable cast for ambulation –Progressive training shedule: no more than 10% week

17 Diabetic Foot: Charcot Foot Insensate foot fails to provide sensory feedback, causing the skin to break down due to unperceived repetitive trauma Insensate foot fails to provide sensory feedback, causing the skin to break down due to unperceived repetitive trauma 3 major clinical problems=diabetic ulceration, deep infection, and Charcot joints 3 major clinical problems=diabetic ulceration, deep infection, and Charcot joints Sxs: hot, red, swollen with intact skin Sxs: hot, red, swollen with intact skin –Elevate foot 5 mins=Charcot will lose redness

18 Evaluation must include checking for cellulitis, osteomyelitis, and gout Evaluation must include checking for cellulitis, osteomyelitis, and gout X-rays X-rays Vascular studies if pulses are absent or a nonhealing ulcer is present Vascular studies if pulses are absent or a nonhealing ulcer is present There is no noninvasive study that differentiates Charcot xray changes from osteomyelitis: GENERALLY- osteomyelitis will develop only if the skin has been violated There is no noninvasive study that differentiates Charcot xray changes from osteomyelitis: GENERALLY- osteomyelitis will develop only if the skin has been violated


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