Foot and Ankle

Foot and Ankle

by Kate Comeaux

Multiple Choice

Eversion (medial) ankle sprains happen _______ as inversion (lateral) ankle sprains)

• less often

• more often

• as often

Multiple Select

Which of the following is a symptom of a fracture in the foot or ankle? Select all that apply

• Swelling or Deformity at fracture site.

• performing a squat in the weight room

• Discoloration/Bruising

• Inability to bear weight

Common foot and Ankle Injuries

​

​Achilles Tendonitis or tear

​​Ankle Spain

​​Fracture of the ankle

​Stress Fracture of the foot/ lower leg

​Achilles Tendonitis or tear

​The largest tendon in the body, the Achilles connects the two primary calf muscles (gastrcomemious and soleuos) to the bone in the heel (calcaneous). The tendon runs lengthwise down the back of the ankle and it is particularly susceptible to inflammation because of overuse - Achilles tendonitis.

​

Those suffering from Achilles tendonitis are also more prone to an Achilles tear or full rupture after repetitive inflammation and damage have been built up over time. However, this injury can also occur because of sudden trauma.

Multiple Select

Which of the following are signs/symptoms of an achilles tendon strain or tendonitis? (check all that apply)

• Stiffness in the morning

• Thickening over the tendon

• Consistent swelling that gets worse throughout the day

• Pain following a workout

​Inversion Ankle Sprain

​occurs when you twist your foot upward and the ankle rolls inward

​

​Injured ligaments

1. Anterior talo-fibular ligament (ATFL)

2. Calcaneofibular ligament

3. ​Posterior talo-fibular ligament

Multiple Choice

Caused by the foot inverting, resulting in ligaments tearing.

• Medial Tibial Stress Syndrome

• Anterior Compartment Syndrome

• Jones Fracture

• Turf toe sprain

• Ankle sprain

Multiple Select

What are the bones that make up the ankle joint?

• Tibia

• Calcaneus

• Talus

• Fibula

• Tarsal

​Fracture of the ankle

​Ottawa Ankle Rules

​The Ottawa ankle rules are a clinical decision-making strategy for determining which patients require radiographic imaging for ankle and midfoot injuries. Proper application has high (97.5%) sensitivity and reduces the need for radiographs by ~35% ^1,2,4. 

There are two components, assessing for ankle and midfoot fractures. A patient with traumatic ankle pain qualifies for ankle radiographs if they have any of the following ^1,3:

• point tenderness at posterior edge (of distal 6 cm) or tip lateral malleolus

• point tenderness at posterior edge (of distal 6 cm) or tip medial malleolus

• inability to weight bear (four steps) immediately after the injury and in emergency department

A patient with traumatic midfoot pain qualifies for foot radiographs if they have any of the following ^1,3:

• point tenderness at the base of the fifth metatarsal

• point tenderness at the navicular

• inability to weight bear (four steps) immediately after the injury and in emergency department

The Ottawa ankle rules have been validated in children, although children need to be normally ambulating to apply the rule, and due to a lack of data the rules should applied with caution in children <6 years old ^4,5. 

​Stress Fracture of the foot/lower leg

​Stress fractures are tiny cracks in a bone. They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also develop from normal use of a bone that's weakened by a condition such as osteoporosis.

Stress fractures are most common in the weight-bearing bones of the lower leg and foot. Track and field athletes and military recruits who carry heavy packs over long distances are at highest risk, but anyone can sustain a stress fracture.

Multiple Choice

Stress fractures are microscopic fractures in the bone that will eventually lead to a full fracture if left untreated.

• True

• False

​Stress fractures of the tibia are typically caused by too much stress placed on the tibia and surrounding muscles. This injury usually happens due to repetitive, high-impact exercise over a long period of time. Athletes may be at greater risk when they initiate a new training program or increase the volume or intensity of their normal running or exercise regimen. A stress fracture can also happen when the tibia is weakened due to low bone density (osteoporosis) or poor nutrition.

​

​An x-ray may be ordered, though it’s important to understand that because stress fractures may be very small, they do not always show up on an x-ray, especially soon after the injury. Other imaging tests, such as a bone scan or magnetic resonance imaging (MRI) test, may also be ordered to help confirm the diagnosis.