Download Free Medical Ankle Injuries PowerPoint Presentation

Ankle Injuries PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Orthopaedics, which is titled "Ankle Injuries", to know about Ankle Injuries.

Tags : Orthopaedics, Ankle Injuries

Published on : Aug 18, 2021 | Views : 1645 | Downloads : 3

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

ppt slide no 1 content not found
Slide 2-

Ankle Injuries Ankle injuries fall into the same basic categories as do all athletic injuries: Contusions Sprains Strains Fractures
Slide 3-

85% of all ankle sprains involve some plantar flexion of the ankle and inversion of the foot. The remaining 15% consist of eversion mechanisms which are often the result of an outside force such as being fallen on from the outside.
Slide 4-

The syndesmosis ligament is often also injured with an eversion force. If the tibia and fibula spread on the talus, the ankle mortise is disrupted and the ankle can become very unstable. It is also not unusual to see an associated fibula fracture with an eversion mechanism. (see x-rays below) Assessment of a syndesmosis sprain will be difficult for the initial 24 to 48 hours. If the ankle is quite swollen and edematous assessment of a syndesmosis sprain may be difficult until the pain and swelling have isolated to individual areas or x-rays show some spreading of the ankle mortise.
Slide 5-

ppt slide no 5 content not found
Slide 6-

ppt slide no 6 content not found
Slide 7-

Ankle Ecchymosis
Slide 8-

ppt slide no 8 content not found
Slide 9-

Maison - Neuve type fracture.
Slide 10-

ppt slide no 10 content not found
Slide 11-

Distal Fibula fracture with associated medial deltoid ligament disruption. This injury is frequently the result of the foot being planted with a valgus load applied to the leg.
Slide 12-

Notice the disruption of the medial deltoid ligament and the widening between the medial malleolus and the talus. This is indicative of a ruptured deltoid ligament.
Slide 13-

ppt slide no 13 content not found
Slide 14-

ppt slide no 14 content not found
Slide 15-

Os Trigonum
Slide 16-

ppt slide no 16 content not found
Slide 17-

This fracture requires surgical fixation of the fibula using a screw and plate system. The plate should be removed prior to return to competitive athletic activity as it will cause stress areas in the bone at each end of the plate. Recovery time (return to athletic activity) for a generally healthy patient with this type of fracture will be in the 6 month range.
Slide 18-

Name the Injury
Slide 19-

Talar Dome - AVN
Slide 20-

Talar Dome - AVN
Slide 21-

ppt slide no 21 content not found
Slide 22-

Ankle dislocation with no fractures. This takes a high degree of trauma and force. In this case this was generated as the result of a high flip off of a trampoline and impact with the ground. The ankle was in a plantar flexion and inverted position upon impact. This was an open dislocation.
Slide 23-

ppt slide no 23 content not found
Slide 24-

ppt slide no 24 content not found
Slide 25-

Negative Thompson Test
Slide 26-

Positive Thompson Test
Slide 27-

ppt slide no 27 content not found
Slide 28-

Achilles Tendon Tear and Repair
Slide 29-

ppt slide no 29 content not found
Slide 30-

Foot Injuries
Slide 31-

ppt slide no 31 content not found
Slide 32-

Plantar Fasciitis/Arch Strain A. Mechanism of Injury 1. strain of plantar fascia-usually at medial insertion into calcaneus 2. middle strip of plantar fascia sometimes involved 3. lateral strip almost never involved B. Possible Responsible Factors 1. shoes 2. artificial turf 3. severe pronation 4. excessive weight 5. leg length discrepancy 6. tight bed sheets
Slide 33-

ppt slide no 33 content not found
Slide 34-

Treatment 1. stretching, Achilles, plantar fascia (night splints) 2. strapping 3. shoe padding - medial heel wedge -saddle pads -arch supports -lift type / padded heel pad -heel lift for short leg
Slide 35-

4. orthotics-rigid (for heavy lineman, need more support & control) -sports orthotics (lighter in weight with more flexibility for backs and wide receivers) 5. Non Steroidal Anti Inflammatories 6. Steroid Injections - once weekly for 3 weeks 7. Surgical intervention - fasciotomy last resort, after 1 year of conservative treatment
Slide 36-

Chronic plantar fasciitis can lead to formation of heel spurs. Plantar Fasciitis is the most common injury seen among long distance runners. It is very painful and can be chronic, extending over several years. The heel spur does not cause the plantar fasciitis, the fasciitis causes the heel spur.
Slide 37-

Morton's Neuroma A. Mechanism of Injury 1. direct or microtrauma to an interdigital nerve 2. 90% of neuromas involve the 3rd common digital nerve approximately 10% involve the 2nd common interdigital nerve - 3 & 4 metatarsals B. Possible Responsible Factors 1. poorly cushioned and or tight shoes, high heels 2. pronation - nerve gets pinched between the heads of the 3rd and 4th metatarsals and the base of the proximal phalanx of the 3rd & 4th toes 3. hard surfaces 4. leg length discrepancy
Slide 38-

Calcaneal Apophysitis (Severs Disease) (pump bumps) Mechanism of Injury direct or microtrauma to the growth center of the posterior calcaneus 2. causes avascularity to the apophysis 3. Usually 8 - 12 year olds
Slide 39-

B. Possible Responsible Factors 1. hard playing surfaces 2. shoes - poorly padded - cleats - poor support 3. cavus type foot 4. tight Achilles and or plantar fascia
Slide 40-

C. Treatment 1. get out of cleats 2. shock absorbent heel pads 3. strapping - to help support plantar fascia 4. orthotic or heel stabilizers 5. in resistant cases immobilization for 4 - 6 weeks may be needed
Slide 41-

Sesamoiditis/Sesamoid Fractures Sesamoid fractures must be differentiated from a normal bipartite sesamoid. Mechanism of Injury 1. direct trauma to tibial (medial) sesamoid - most common 2. direct trauma to fibular (lateral) sesamoid - rare 3. overuse - chronic microtrauma
Slide 42-

B. Possible Responsible Factors 1. hard playing surfaces 2. hallux valgus - tibial sesamoid directly under mp joint 3. lack of cushioning in shoes C. Structures involved 1. sesamoids 2. joint capsule 3. flexor brevis 4. plantar 1st metatarsal head
Slide 43-

Treatment Sesamoiditis 1. shoe padding - transfer weight away from sesamoid 2. super cushion inner soles 3. ice, elevation, compression 4. possible post-op shoe 5. steroid injection Sesamoid fracture 1. cast for 3 weeks - BK 2. post-op shoe
Slide 44-

Surgical excision of affected sesamoid in resistant cases very often will not heal. If hallux valgus present should correct at time of surgery, because weakening of flexor apparatus will increase deformity. This is a last resort in most cases as it changes the bio mechanical forces on the flexor tendons and if a single sesamoid is left in place, the weight bearing mechanics of the foot are greatly altered.
Slide 45-

Turf Toe Mechanism of Injury 1. hyperextension (most common) 2. hyperflexion 3. valgus injury - usually from sudden acceleration B. Possible Responsible Factors 1. artificial turf - no give, can be like playing on hard asphalt 2. shoes - too much forefoot flexion (no turf toe plate) 3. combination of turf & shoes
Slide 46-

Specific Structures Involved capsular & ligamentous structures 2. flexor apparatus 3. possibly sesamoids
Slide 47-

D. Treatment 1. rest, ice, elevation, compression 2. possible immobilization and non weight bearing 3. shoe modifications - spring steel splint 4. activity is resumed within the limits of pain Starting with flat foot walking, then normal gait, then jogging, then straight ahead running at full speed, next running from stance, last performing cutting maneuvers.
Slide 48-

5. taping the toe to prevent injury from recurring 6. anti-inflammatories 7. surgery - for capsular repair in non responsive cases
Slide 49-

Misc. Aggravations A. Hallux Valgus (bunions) 1. Possible Responsible Factors a. heredity b. shoes - irritate but don't cause c. pronation - accentuates 2. Specific Structures Involved a. 1st MP - all structures b. sesamoids c. lst metatarsal - medial cuneiform joint
Slide 50-

3. Treatment a. accommodate in wider shoes b. shoe stretching c. surgical correction in off season if chronically painful (may cause some limitation of joint movement)
Slide 51-

Hallux Limitus 1. Possible Responsible Factors a. heredity b. trauma to joint c. foot type - plantar flexed 1st digit 2. Specific Structures Involved a. 1st MP - degeneration of joint cartilage with osteophytic limping of 1st metatarsal head and base of proximal phalanx b. sesamoids - in advanced cases
Slide 52-

3. Treatment a. rigid soled shoes which limit dorsiflexion b. taping c. injection with local and steroid when symptoms acute d. when condition becomes debilitating & conservative measures fail then surgical intervention is necessary - usually with placement of plastic implant (will weaken push off)
Slide 53-

Corns (digital clavi) Calluses (tylomas) 1. Possible Responsible Factors a. Cavus foot - toes hammer - plantar flexion of forefoot causes excess pressure on metatarsal heads b. pronated foot - abnormal weight transfer c. poor fitting shoes
Slide 54-

Specific Structures Involved a. interphalangeal joints of toes b. extensor & flexor tendons c. metatarsal heads 3. Treatment a. deep & wide toe box b. débride hyperkeratotic tissue regularly c. Vaseline d. padding - Spenco 2nd skin - moleskin
Slide 55-

Ingrown Nails 1. Possible Responsible Factors a. improper cutting of nails b. heredity c. injury d. tight shoes 2. Specific Structures Involved a. tibial & fibular borders, usually hallux nails b. nail groove 3. Treatment a. packing cotton under affected border b. wedge resection of affected border c. partial radical nail procedure with matrix destruction (phenol method)
Slide 56-

Black Toe (Subungual Hematoma) Possible Responsible Factors a. shoes too tight b. shoes too loose c. low toe box d. long 2nd toe e. cleats f. kicking g. direct trauma
Slide 57-

Specific Structures Involved a. pedal nails b. nail bed c. distal phalanx - possible formation of subungual exostosis 3. Treatment a. drain hematoma as soon as possible b. if nail partially avulsed - remove nail completely & débride the nail bed - start soaks & topical antibiotics c. if chronic, hypertrophied nail - keep nail débrided back & thinned as much as possible - complete avulsion of nail plate with destruction of matrix
Slide 58-

Plantar Verruca (Warts) 1. Possible Responsible Factors a. hyperhidrosis b. abrasions to plantar surface of the foot c. exposure to verruca virus - showers- locker rooms - brothers & sisters d. age - most commonly seen in teen years
Slide 59-

Specific Structure Involved a. skin - warts do not penetrate the basement membrane of the skin b. metatarsal heads and/or calcaneus- areas of most pressure in weight bearing 3. Treatment a. mechanical debridement prn. b. topical acids c. cryotherapy d. surgical removal - does not leave scar e. laser
Slide 60-

Name the Injury
Slide 61-

Rodeo Clown Foot
Slide 62-

Foot Fractures
Slide 63-

This is a ballerina type fracture of the 5th metatarsal. The etiology involves and avulsion of the proximal tip of the 5th metatarsal where the peroneus brevis muscle tendon attaches.
Slide 64-

Fracture of Styloid process of 5th metatarsal Mechanism of injury 1. severe inversion ankle sprain causes peroneus brevis tendon to pull away the base of the 5th metatarsal (Ballerina fracture)
Slide 65-

These X-Rays show a fracture of the proximal end of the 5th Metatarsal. This fracture is commonly called a "Jones Fracture".
Slide 66-

Direct trauma to base of 5th (Jones fracture) Possible Responsible Factors 1. Cavus foot type 2. chronic ankle sprains 3. poor shoe and/or tape support B. Specific structures involved 1. peroneus brevis tendon 2. styloid process 5th metatarsal base
Slide 67-

Treatment 1. ice, elevation, compression and lift under 5th metatarsal base 2. short leg walking brace 3. if severe avulsion of fragment, open reduction screw fixation
Slide 68-

Treatment of Jones Fractures includes several options. Option 1 - immobilization of foot and ankle with non weight bearing for a period of 1 month to 6 plus weeks and more time may be required if the bone healing is delayed. The peroneus brevis tendon attaches at the proximal end of the 5th Metatarsal and treatment without ankle immobilization is not effective. Every time the muscle contracts and pulls on the tendon, the fracture site is disrupted. This type of fracture is known to form a non union.
Slide 69-

Option 2 - insertion of a intramedullary screw into the fracture to compress the fragment and the bones back together. May or may not be used with a bone graft. Many physicians will also opt to use a bone growth stimulator on this fracture to insure that healing occurs. Option 2 is certainly preferred in the authors opinion since the fracture site is stabilized and the ends of the fracture are approximated. The screw fixation allows for earlier return to weight bearing and decreased immobilization time. (Dr. Joe Milne, Dr. Steve Brotherton)
Slide 70-

ppt slide no 70 content not found
Slide 71-

ppt slide no 71 content not found
Slide 72-

ppt slide no 72 content not found
Slide 73-

ppt slide no 73 content not found
Slide 74-

ppt slide no 74 content not found
Slide 75-

ppt slide no 75 content not found
Slide 76-

Ankle Evaluation How did it happen? (etiology) Previous history of injury to that area? Sight evaluation a) swelling? b) deformities? c) discoloration?
Slide 77-

Palpation evaluation examine ligaments medial: deltoid / anterior, medial, and posterior portions (2) lateral: Anterior talo-fib
Slide 78-

Anterior drawer tests should always be performed with the knee bent to eliminate the Achilles and Gastrocnemius muscles from providing any stability to the ankle. A lateral talar tilt test can be conducted at the same time.
Slide 79-

Talar Tilt
Slide 80-

Inversion Stress Test
Slide 81-

Ottawa - Buffalo Modification for Ankle Exam The incidence of ankle fractures in athletes involved in controlled sports activities is relatively low. However, the decision(s) on which ankles to study radiographically with x-rays is not always easy. Not all ankle or foot injuries require immediate x-rays. The allied health practitioner can determine to a relatively accurate degree the need for futher study through a good clinical exam and by following the Ottawa Ankle Rules and with the use of the Buffalo Modification. (for more information, consult the AJSM, Vol 26, No 2. 1998)
Slide 82-

Research has shown that in a hospital based E.R. of every 6 ankles approved for x-ray under the O.A.R. (Ottawa Ankle Rules), 5 have no radiographic findings. Steill, I.G., JAMA, 269:1127-1132, 1993. Clinical ankle exam If the patient needs x-rays, they will usually present with lateral fibular malleolus pain in the distal 6 cm, medial tibial malleolus pain in the distal 6 cm or pain to palpation over the proximal tip of the 5th metatarsal or the Navicular. The inability to bear weight may indicate a lesion to the dome of the Talus or other associated trauma to the other structures of the ankle which may require x-ray study.
Slide 83-

Squeeze test - check malleolus (2) Check tibia and fibula 7. Functional tests a) walking - check gait b) toe raises 1) both feet 2) one foot c) jump and land on both feet and then on one foot 8. Refer to doctor for further evaluation and possible x-ray
Slide 84-

Refer to physician for further evaluation and possible x-ray Non weight bearing x-rays Weight bearing x-rays (syndesmosis spreading) Stress x-rays for talar tilt and syndesmosis spreading Other associated ankle and lower leg tests Homan's Sign - patient is supine on the table, the knee is fully extended and the foot is dorsi flexed. Reproduction of pain with localized edema is considered a positive test for deep venous thrombophlebitis.
Slide 85-

ppt slide no 85 content not found
Slide 86-

ppt slide no 86 content not found
Slide 87-

That’s All