The Ankle and Foot

Lacerations to the ankle and foot may involve the underlying tendons and neurovascular structures ( Fig 4.0.-1.0.). Sensory function should be assessed before anesthesia (see Fig 40-2). After administering local or regional anesthesia, the ankle should be examined through complete range of motion, paying particular attention in the position of injury. Ihe function of the extensor hallucis longus (EHL), tibialis anterior (IA), and Achilles tendons should be assessed (see Fig 40-2).

Partial tendon lacerations may be missed if the wound is not inspected visually through the range of motion, since some tendon function will remain unless the tendon is completely lacerated. Ihe Achilles tendon is not the only tendon responsible for plantar flexion of the foot, and its individual function may be difficult to assess. Ihe Achilles tendon can be palpated for defects; if it is completely lacerated, there should be a conspicuous absence of the tendon at the posterior ankle. Ihe patient also can lie prone on the examination table with the foot dangling over the edge of the bed for the Ihompson test ( Fig 4.0.-11). Ihe bellies of the gastrocnemius and soleus muscles are squeezed by the examiner. Ihis should produce plantar flexion of the foot if the Achilles tendon is at least partially intact. Lacerations of the EHL, IA, and Achilles tendons require surgical consultation for repair because damage to these tendons can result in foot drop. Ihe skin should be closed with simple interrupted or horizontal mattress sutures using 4-0 nonabsorbable material, and the ankle should be splinted.

FIG. 40-10. Anatomy of the ankle and foot.

Lacerations to the sole of the foot should be inspected for a foreign body because they often result from stepping on a sharp object. Regional anesthesia is ideal for the sole of the foot (see Fig...40-2). Horizontal mattress sutures using 4-0 nonabsorbable material are recommended. The patient should be given crutches or a walking boot for comfort and to minimize trauma to the laceration while it heals.

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