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Common Foot And Ankle Injections - Everything You Need To Know - Dr. Nabil Ebraheim
Dr. Ebraheim’s educational animated video describes injection techniques for painful conditions of the foot and ankle. Conditions which cause pain and inflammation are treatable with the use of diagnostic and therapeutic injection. Ankle joint The ankle joint is formed by the articulation of the tibia and talus. Injection is done to alleviate pain occurring from trauma, arthritis, gout or other inflammatory conditions. Anterolateral ankle impingement •Can occur due to the build-up of scar tissue in the ankle joint or from the presence of bony spurs. •With the ankle in a neutral position, mark the injection site just above the talus and medial to the tibialis anterior tendon. •The injection site is disinfected with betadine. •The needle is inserted into the identified site and directed posterolaterally. •Injection of the solution into the joint space should flow smoothly without resistance. •Pulling on the foot to distract the ankle joint is helpful. First metatarsophalangeal joint •The MTP joint is a common injection site frequently affected by gout and osteoarthritis. •The injection site is disinfected with betadine. •The needle is inserted on the dorsomedial or dorsolateral surface. •The needle is angled to 60-70 degrees to the plane of the match the slope of the joint. •Injection of the solution into the joint space should flow smoothly without resistance. •Pulling on the big toe is sometimes helpful in distraction of the joint. Peroneal tendonitis •Peroneal tendonitis is an irritation to the tendons that run on the outside area of the ankle, the peroneus longus and peroneus brevis. •The injection site is disinfected with betadine. •Insert the needle carefully in a proximal direction when injecting the peroneus brevis and longus tendon sheath. •Advance the needle distally to inject the peroneus brevis alone at its bony insertion. Achilles tendonitis •Achilles tendonitis is irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common overuse injury that occurs in athletes. •Injection of steroid should be given around the tendon, not through the tendon. •Injections directly into the tendon is not recommended due to increased risk of tendon rupture. •Platelets injection can be done through the tendon with needling and fenestration. Tarsal tunnel syndrome •The condition of pain and paresthesia caused by irritation to the posterior tibial nerve. •Feel the pulse of the posterior tibial artery, the nerve is posterior, find the area of maximum tenderness, 1-2 cm above it will be the injection site that is marked on the medial side of the foot and disinfected with betadine. •The solution is injected at an angle of 30 degrees and directed distally. •Warn the patient that the foot may become numb. •Care should be taken In walking an driving. •Usually performed after a treatment program which can include rest, stretching and the use of shoe inserts. Plantar fasciitis •The plantar fascia is a band of connective tissue deep to the fat pad on the plantar aspect of the foot. •Patients with plantar fascia complain of chronic pain symptoms that are often worse in the morning with walking. •The injection site is identified and marked on the medial side of the foot and betadine used. •Avoid injecting through the fat pad at the bottom of the foot to avoid fat atrophy. •The needle is inserted in a medial to lateral direction one finger breathe above the sole of the foot in a line that corresponds to the posterior aspect of the tibia. •The solution is injected past the midline of the width of the foot.
Views: 122432 nabil ebraheim
452 Foot Ankle Pathology Diagnosis Treatment
Presented by: Mary Lloyd Ireland Professor Dept. of Orthopaedic Surgery and Sports Medicine University of Kentucky Lexington KY www.marylloydireland.com 0:00 Introducdion 0:24 A good History and Physical is Key 0:39 Foot: Pronated Hand 0:58 Function •Propulsion •Support •Flexibility •Rigidity •Gait mechanics: ankle and foot motions 1:39 Ankle Axis 2:30 Ankle Axis: Opposite with foot fixed 3:38 Subtalar Joint 4:44 Windlass Mechanism 5:02 During gait: coupled motion between ankle and subtalar joints 8:08 Leg Movment 8:37 Ankle: Modified Hinge Joint 9:18 With complete history and physical and appropriate imaging, the diagnosis should be made and be specific 13:14 Summary of Findings From the National Collegiate Athletic Association 14:12 Basketball Injury Mechanism Video 14:47 EUA Gross instability, right ankle video 16:01 18 YO Female Gymnast •Right ankle injury •Landed awkwardly doing a back tuck •Immediate pain and swelling, right ankle 16:10 Initial X-rays 16:41 Stress tests, L & R ankles 17:12 Dx lateral talus fracture displaced 17:33 Physical Exam of the Foot and Ankle Video 18:32 Lateral Ankle Pain Soft Tissue 19:13 14 YO Female •Soccer athlete •Left ankle •Acute lateral talar dome fracture •Documented by plain films and bone •edema on MRI 19:16 Initial X-Rays 19:46 1 Month after Initial presentation 20:27 Talar Dome Fracture 20:45 Osteochondral Talar Lesions 21:11 Mechanism of injury of medial border of the dome of the talus. 22:08 Soft Tissue Lesion Location 24:32 Physical Exam of the Foot and Ankle Video 25:12 Think About Peroneal Tendon Involvement If: •Recurrent Ankle Complaints •Sprain Not Getting Better •Pain, Swelling Higher in Peroneal Tendon Sheath 25:37 In Acute Ankle Sprain, Assess Peroneal Function 25:58 17 YO WM High school Baseball/Football Player C/O Repeated Inversion Ankle Sprains 26:14 Peroneal Tendon Subluxing Video 27:42 Physical Exam of the Foot and Ankle Video 28:50 19 YO basketball player Os vesalianum bilateral feet. 29:20 Os peroneum 29:33 Medial Ankle Pain Differential Diagnosis 30:25 Posterior Tibial Tendon Dysfunction Stages 31:12 "Too Many Toes" Sign 34:16 18 YO Freshman Div. I basketball athlete 34:55 Navicular 37:06 Posterior Ankle Pain Differential Diagnosis 37:48 Bony Impingement of the Ankle Motion & Contact Areas 38:09 Anterior Tibiotalar Impingement Syndrome "Footballers" Ankle 38:32 FHL Tendinitis 39:19 Witherspoon MOI Video 40:27 Thompson Test Video 41:15 Achilles Tendon Video 43:20 Ankle Fracture Dislocations Video 44:40 Fractures Maisonneuve Fracture 48:46 Fracture blisters Leave alone. Do not lance unless they look infected. 49:33 Football athlete: Twists ankle on Astroturf Video 50:22 On-site Physical Treatment Video 52:38 Fractures Dislocation 53:19 Radiographs 54:08 14 YO Male •Left ankle •Tillaux fracture with displacement 54:44 Physical Exam Video 56:13 CT Scan 56:37 16 YO WM Basketball Athlete •Injury: Left Ankle •8 months prior to KSM visit •Continued ankle pain and swelling 56:55 Radiographs in ER post injury Casted for 3 months 57:35 2 weeks post injury 58:40 2 months post injury 59:13 Surgery – 9 months post injury 1:00:41 1 month post surgery 1:01:40 Don’t miss a Lisfranc midfoot fracture dislocation 1:02:56 Will require ORIF 1:03:43 Claw Toes Flex:ed PIPJ/DIPJ: Think Neurologic Involvement 1:04:29 Freiberg’s Infraction 1:05:16 Turf Toe: Football Athlete 1:05:56 Heel Pain 1:07:10 13 YO White Male •Right midfoot pain for 1 month •No specific injury •Baseball athlete •Rapid growth phase PE: •Tenderness over medial arch and midfoot •Stable normal ankle exam •Tenderness over posterior tibialis tendon 1:07:53 13 YO White MaleWorkup: •Plain xrays – negative •MRI scan – medial cuneiform stress fracture Treatment •Boot •Nonweightbearing 4 weeks •Full weightbearing 4 weeks •Improved •Cleared for return to baseball 1:08:26 Films in early summer 2009 1:09:44 Followup 1:10:08 RIGHT FOOT 1:10:29 RIGHT ANKLE 1:10:51 MRI Scan 1:11:29 Foot and Ankle Consult Recommended 1:12:19 1 Year Later 1:13:16 Diagnosis •Enthesistis Related Arthritis •HLAB 27 Positive •No clinical evidence of ankylosing spondylitis Treatment: •Medications: •Methotrexate, Naprosyn •Home Rehab program •Returned to baseball wearing AFO 1:14:41 15 YO Male •Right ankle •6 Months of Pain •Initial x-ray: 1:15:16 1 month followup 1:19:08 14 months post op 1:19:18 17 YO Male •Left ankle pain x3 weeks •Trying to get in shape, played more basketball than usual •Possible stress fracture of the medial malleolus 1:19:56 3 months after initial presentation 1:20:11 5 Months after initial presentation 1:20:53 7 months after initial presentation 1:21:13 Small Blue Cell Tumor 1:21:23 A good History and Physical is Key 1:22:07 Thank You
Views: 2115 UKyOrtho
Posterior Mini-Incision Approach for Total Hip Replacement
Full article/video: http://surgicaltechniques.jbjs.org/content/6/1/e5 We developed a modification of the posterior mini-incision for total hip arthroplasty, which was initially used by Sculco at The Hospital for Special Surgery, in response to the movement in the orthopaedic community to perform total hip arthroplasty with smaller incisions. Our approach preserves the piriformis and quadratus femoris muscles of the external rotators, uses three incisions into the capsule but does not excise the capsule, does not incise the tensor fascia/iliotibial band, and leaves intact the insertion of the gluteus maximus onto the femur. We have used this incision since 2004, and our published results and those of others show that the greatest advantage is cosmetic and patients’ perception of less violation of their body. It is a contributor to the same-day surgery program and rapid recovery protocol on which we have reported.
Views: 1772 JBJSmedia
Ankle Stabalization and Tendon Repair Surgery - Houston's Foot Doc
Watch Dr. Nagler perform a Ankle Stabilization and Tendon Repair.
Views: 55496 Nagler Foot Center

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