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Foot and Ankle Injuries

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by

Peter Lazzopina

on 13 February 2013

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Transcript of Foot and Ankle Injuries

Foot and Ankle Injuries Ankle Sprains Mechanism Exam Ottowa Ankle Rules Anatomy High Ankle Sprains Physical Exam:
High Ankle Sprain Squeeze Test Crossed Leg Test External Rotation Test Rotational stress is applied to the ankle joint Disruption of the anterior tib-fib, posterior superficial and deep tib-fib ligaments and interosseous membrane Syndesmotic Inury Treatment R I C E M M P est revention ce ompression levation obilize odalities (relative) Commonly Misdiagnosed Foot and Ankle Injuries Lateral Talar Dome Thin, wafer shaped Inversion injury with
dorsiflexion Tender anterior to
lateral malleolus along
anterolat border of talus Medial Talar Dome Deep, cup shaped
(May appear nl initially) Inversion injury with
plantar flexion or
atraumatic (OCD) Tender posterior to
medial malleolus along
posterior border of talus Lateral Talar Process Rapid inversion and
dorsiflexion injury
(snowboarding, mva,
falls) Lateral process point
tenderness Fifth metatarsal
avulsion fracture Ankle inversion injury Peroneus brevis pulls off
the tuberosity of the 5th
metatarsal Tender at the base of the
5th metatarsal Jones Fracture
Proximal 4th or 5th
metatarsal fracture Large adductive force
applied to plantar flexed
ankle Tender at the base of the
5th metatarsal Prolonged healing
and nonunion
common
Refer athletes for
surgery 5th metatarsal stress
fracture Sudden increase in
running or walking Tender at the base of the
5th metatarsal Refer displaced fractures Navicular stress fracture Insidious onset, overuse
injury Vague dorsal midfoot
pain increases with
activity Peroneal tendon strain Dorsiflexion + inversion
+ contraction peroneal
muscles (cutting) Untreated injury can
result in ankle instability 0.3-0.5% of ankle injuries TTP behind lateral
malleolus. Plantar flex
and invert foot, ask
patient to dorsiflex and
invert and subluxation
may occur Conservative mgmt
unless subluxation or
dislocation Peter Lazzopina MD
February 12, 2013 References 1. Hall S, Lundeen G, Shahin A. Not just a sprain: 4 foot and ankle injuries you may be missing. J Fam Pract. 2012;61:4
2. Judd DB, Kim DH. Foot Fractures Frequently Misdiagnosed as Ankle Sprains. Am Fam Phys. 2002;66:785-794
3. Netter FH. Atlas of Human Anatomy, 3rd ed. Section VII: Lower Limb. 2003: Teterboro; Icon Learning Systems
4. Tiemstra JD. Update on acute ankle sprains. Am Fam Phys. 2012;85:1170-1176
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