Foot & Ankle; Compartment Syndrome; Neoplastic Disease

PA Study Sesh

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