Sore feet

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Foot injuries

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Sore feet

  1. 1. +SORE FEET Dr Dane Horsfall
  2. 2. + Overview  Common fractures  Midfoot  Calcaneus  5Th Metatarsal  Cases  Easily missed injuries  Classification
  3. 3. + Case: 19yoM with painful R foot  Waterskiing accident - 3/7 ago - fell at high speed, pain since in R midfoot and unable to wt bear
  4. 4. +
  5. 5. +
  6. 6. + Diagnosis  Widened gap at base of 1st/2nd Metatarsals with avulsion # of Lisfranc Ligament  Other Ix ?  Mitch Clark
  7. 7. + CT
  8. 8. + Progress  Mx Backslab, elevate-high risk compartment Sx  Ortho ref - seen in rooms 2/7 later  Admitted 11/7 later for ORIF 2x screws inserted, 6/52 non wt bearing in backslab
  9. 9. + LisFranc  Jacques Lisfranc de St Martin 1790-1847 French Surgeon/Gynae described injury 1815 after War of the 6th Coalition-falls from horses  The Lisfranc joint 5 tarso-metatarsal joints.  The Lisfranc ligament from medial cuneiform to base 2nd MT  LisFranc injuries  Lig rupture  Lig Avulsion  Subluxation/Dislocation-assoc # MT  up to 20% are Lisfranc joint injuries missed
  10. 10. + Diagnosis  Mechanism-rotation, twisting, fall off horse, severe axial load- MCA, fall  Point tenderness over midfoot  Plantar ecchymosis sign  Wt bearing xrays
  11. 11. + Types  LisFranc -Ligament rupture +/- Avulsion +/- #’s
  12. 12. + Xray Gap >1mm btw bases 1st/2nd MT MT
  13. 13. + Calcaneal Fractures  Fall from height onto heels-axial load  Associated injuries  other calcaneal #  spinal wedge #  pelvis
  14. 14. + Bohler’s Angle  Intersection of 2 lines  Line from post articular surface calcaneus to anterior articular process of calc  Post art process to sup angle of calc tuberosity  Normal 20-40° Abnormal if < 20°
  15. 15. + Calcaneal #  Image with CT-often worse # than appears on plain films-ref all to ortho  Calcaneal # without extension into subtalat jt and minimal displacement-can consider conservative Mx-watch for achilles tendon causing further displacement of #  If significant displacement and/or involvement Subtalar joint=ORIF
  16. 16. + Horizontal #  2 types  Most common-post sup angle of calc without achilles tendon insertion involvement “beak” # – from direct trauma eg kick  Avuslion # of achilles tendon from sudden calf muscle contraction  Thompson Test  http://www.youtube.com/watch?v=AmDi08rlR3I  Mx Ortho ref - ORIF
  17. 17. + # Base 5th MT Jones or not?  Jones fracture = transverse # of proximal diaphysis of 5th MT, 10- 20mm from the proximal end. Sir Robert Jones 1902 while dancing  “Pseudo Jones” = Avulsion # of the tuberosity of the base of 5th MT  Most common lower limb #  From forceful inversion (“sprained ankle”)-Peroneus Brevis  “sprained ankle” palp base 5th MT- Ottawa foot rules
  18. 18. + Golden Rule:  If fracture enters or distal to the intermetatarsal joint = Jones fracture  If it enters cubo-metatarsal joint = Pseudo Jones/Avulsion
  19. 19. + Why differentiate?  Jones  high non-union rate Rx due to poor blood supply and tension from tendons  Rx - non wt bearing cast 6/52  Pseudo Jones  Cast shoe/CAM walker 4/52
  20. 20. + Jones or Pseudo? 19yo Basketballer –Inversion injury
  21. 21. + Jones or Pseudo?
  22. 22. + Jones or Pseudo? 39yoM fell off chair
  23. 23. + References  Emedicine -Lisfranc  Tintinalli et al, Emergency Medicine  Max Esser and his book-Practical Fracture Management, R McRae, Max Esser  Wheeless Textbook of Orthopaedics online

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