Foot and Ankle Injuries - Dr. Montijo

The Ankle
- 3 Bones
- 3 Primary Joints 
    - Medial mal with medial talus
    - Tibial plafond with talar dome
    - Lateral mal with lat talus

Ankle Xrays
- Medial clear space --- if over 4mm, its concerning for syndesmotic injury or possible deltoid ligament incompetence 

- Tib-fib clear space --- greater than 5mm is abnormal 

- Bi-mal and Tri-mal fxs often need surgery

- Pilon fractures ---- high injury mechanism!! - Be sure to get additional films to look at tibia, knee and also LUMBAR SPINE

- Pediatric patients are different
     - Ligaments stronger
     - More likely to fracture bone than sprain ligament

The Foot
- Foot has 28 bones
- Divided into hindfoot, midfoot and forefoot
     - Hindfoot controls inversion and eversion
     - Midfoot controls foot abduction and adduction
     - Forefoot controls plantarflexion and dorsiflexion

- Calcaneal fracture --- 10% associated lumbar fractures!!

- Talar neck fractures - very bad injury, minimal blood flow there; often times need OR for reduction  

- LisFranc fracture dislocation - axial load and foot planted.
     - Can be severe or subtle.
     - If concerned for subtle, then get full weight bearing films.

- Jones fx - 5th metatarsal head fracture - Put in post-op shoe or splint, follow up; Majority non-op

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