11f. foot and ankle

Question 1

risk factors for achilles tendon rupture

Answer 1

quinolone use (e.g. ciprofloxacin) is associated with tendon disorders

hypercholesterolaemia (predisposes to tendon xanthomata)

Question 2

Presentation achilles teninopathy

Answer 2

gradual onset of posterior heel pain that is worse following activity
morning pain and stiffness are common

Question 3

management achilles tendinopathy

Answer 3

simple analgesia
reduction in precipitating activities
calf muscle eccentric exercises: this may be self-directed or under the guidance of physiotherapy

Question 4

presentationa chilles tendon rupture

Answer 4

‘pop’ whilst doing an actvity –> sudden onset significant pain in the calf or ankle or the inability to walk or continue the sport.

Question 5

o/e achilles tendon rupture

Answer 5

simmonds triad

• gap
• abnormal angle of declination
• calf squeeze

Question 6

what should you do to assess for achilles tendon rupture

Answer 6

simmonds triad

ask pt to lie prone on bed with feet hanging off

look for triad of:
- gap
- abnormal angle of declination
- calf squeeze

Question 7

investigations for achilles tendon rupture

Answer 7

USS

Question 8

management achilles tendon rupture

Answer 8

<2w since rupture
First: 2 weeks of immobilisatuon with the ankle splinted in a plaster in full equinus. cruches, not allowed to weight bear

Second: 4 weeks of semi-equinas

Thirs: normal position 4 weeks

> 2w since rupture or cases of re-rupture require surgical fixation with an end-to-end tendon repair.

Question 9

most common cause of heel pain in adults

Answer 9

plantar fascitis

Question 10

risk fatcors plantar fasciits

Answer 10

Anatomical factors, such as excessive pronation or pes cavus (high arches)
Weak plantar flexors or tight gastrocnemius or soleus
Prolonged standing or excessive running
Leg length discrepancy
Obesity
Unsupportive footwear

Question 11

Presentation plantar fasciitis

Answer 11

heel pain, especially over medial aspect of calcaneal tuberosity

worst with the first few steps of the day or after periods of inactivity, before easing off.

Question 12

Management plantar fasciitis

Answer 12

Conservative:
- rest the feet where possible
- wear shoes with good arch support and cushioned heels, insoles and heel pads may be helpful
- NSAIDs

• physiotherapy
• steroid inj
• surgical: plantar fasciotomy

Question 13

ddx heel pain

Answer 13

plantar fasciitis
fat pad atrophy

Question 14

what should you assess pt for o/e ?heel pain

Answer 14

plantar fasciitis:
assess for evidence of over-pronation, high arches, leg length discrepancy, or femoral anteversion (all of which can predispose to the plantar fasciitis).
The infracalcaneal region is commonly tender on palpation and palpating the medial calcaneal tubercle can reproduce the symptoms.

fat pad atrophy: assess fat pad of the heel

Question 15

what is mortons neuroma

Answer 15

thickening of the tissue around one of the nerves leading to your toes. This can cause a sharp, burning pain in the ball of your foot. You may have stinging, burning or numbness in the affected toes.