Page 974 - TNFlipTest

OR40 Orthopedics
Foot Toronto Notes 2019
Calcaneal Fracture Treatment Principles
• Avoid wound complications (10-25%)
• Restore articular congruity
• Restore normal calcaneal width and height
• Maximum functional recovery may take
longer than 12 mo
Foot
Talar Fracture
Mechanism
• axialloadingorhyperdorsiflexion(MVC,fallfromheight)
• 60%oftaluscoveredbyarticularcartilage
• talarneckismostcommonfractureoftalus(50%)
• tenuousbloodsupplyrunsdistaltoproximalalongtalarneck
■ high risk of AVN with displaced fractures
Investigations
• X-ray:AP,lateral,Canaleview
• CTtobettercharacterizefracture
• MRIcanclearlydefineextentofAVN
Treatment
• non-operative
■ indication: non-displaced
■ NWB, below-knee cast x 6 wk
• operative
■ indication: displaced
■ ORIF (high rate of nonunion, AVN) ■ neck fracture: ORIF
Calcaneal Fracture
• mostcommontarsalfracture
Mechanism
• highenergy,axialloading:fallfromheightontoheels
• 10% of fractures associated with compression fractures of thoracic or lumbar spine (rule out spine
injury)
• 75%areintra-articularand10%arebilateral
Clinical Features
• markedswelling,bruisingonheel/sole
• wider,shortened,flatterheelwhenviewedfrombehind • varusheel
Investigations
• X-rays:AP,lateral,obliquefoot(mandatoryviews);canalsoassesswithBrodenview,Harrisview,orAP ankle
• lossofBohler’sangle
• CT:gold-standard,assessintra-articularextension
Treatment
• closedvs.openreductioniscontroversial
• NWBcastx3mowithearlyROMandstrengthening
Achilles Tendonitis
Mechanism
• chronicinflammationfromactivityorpoor-fittingfootwear
• mayalsodevelopheelbumps(retrocalcaneobursitisorHaglunddeformity)
Clinical Features
• pain,stiffness,andcrepituswithROM • thickenedtendon,palpablebump
Investigations
• X-ray:lateral,evaluatebonespurandcalcification;U/S,MRI(toassessdegenerativechange)
Treatment
• non-operative
■ rest, NSAIDs, shoe wear modification (orthotics, open back shoes)
■ heel sleeves and pads are mainstay of non-operative treatment
■ gentle gastrocnemius-soleus stretching, eccentric training with physical therapy, deep tissue calf
massage
■ shockwave therapy in chronic tendonitis
■ DO NOT inject steroids (risk of tendon rupture)
Haglund Deformity: an enlargement of the posterior-superior tuberosity of the calcaneus