Foot and Ankle Surgery
Principles of Foot and Ankle Surgery
Candidates must understand ankle fractures (Danis-Weber classification), ankle sprains, Achilles tendon injuries, plantar fasciitis, hallux valgus, flatfoot, and diabetic foot problems. Know biomechanics of gait and imaging (weight-bearing X-rays).
Key Concepts
- Ankle fractures: Danis-Weber (A: below syndesmosis, B: at syndesmosis, C: above syndesmosis). Lauge-Hansen classification (supination-external rotation most common). Treatment: stable fractures nonoperative; unstable (bimalleolar, trimalleolar) require ORIF. Syndesmotic injury: stress test, screw or tightrope fixation.
- Ankle sprain: Lateral ligament complex (ATFL most common). Treatment: RICE, early mobilization. Chronic instability: ligament reconstruction.
- Achilles tendon rupture: Thompson test positive. Treatment: nonoperative (cast) vs operative (repair); higher re-rupture with nonoperative.
- Hallux valgus: First metatarsal varus, great toe valgus. Treatment: wide shoes, bunion pad; surgery (osteotomy) for severe.
- Diabetic foot: Neuropathy, ischemia, infection. Charcot arthropathy: midfoot collapse; treatment: offloading, immobilization.
- Plantar fasciitis: Heel pain, worse in morning. Treatment: stretching, orthotics, steroid injection.
Traps
- Ankle fracture stability: Isolated lateral malleolus fracture may be stable if medial clear space normal; stress radiographs needed.
- Achilles rupture: Missed diagnosis if Thompson test not performed; high index of suspicion.
- Charcot foot: Often misdiagnosed as infection; requires offloading and referral.
- Hallux valgus: Recurrence rate after surgery; patient education.
Worked Example
A 45-year-old male twists his ankle playing basketball. Exam: swelling, tenderness over ATFL. X-rays normal. Diagnosis: lateral ankle sprain. Rule of thumb: Most ankle sprains are treated nonoperatively with early functional rehabilitation. However, if there is a high ankle sprain (syndesmotic), recovery is prolonged and may require surgery. Ottawa ankle rules guide X-ray use.