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-MSK Diseases > 16.1. Foot Problems - Forefoot Problems > Flashcards

16.1. Foot Problems - Forefoot Problems Flashcards

1
Q

What are the Pathological Groupings of Disease of the Foot?

A
  1. Vascular
  2. Infective
  3. Traumatic
  4. Autimmune
  5. Metabolic (Endocrine / Drugs)
  6. Inflammatory
  7. Inherited (Congenital)
  8. Neurological
  9. Neoplastic
  10. Degenerative
  11. Idiopathic
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2
Q

What are the Anatomical Groupings of Disease of the Foot?

A
  1. Forefoot Problems
  2. Midfoot PRoblems
  3. Hindfoot Problems
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3
Q

What are the major Forefoot Problems?

A
  1. Hallux Valgus
  2. Hallux Rigidus
  3. Lesser Toe Deformities
  4. Morton’s Neuroma
  5. Metatarsalgia
  6. Rheumatoid Forefoot
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4
Q

What is Hallux Valgus better known as?

A

Bunions

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5
Q

What is the Aetiology of Hallux Valgus (Bunions)?

A
  1. Genetic
  2. Footwear
  3. Being Female
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6
Q

What is the Pathogenesis of Hallux Valgus (Bunions)?

A
  1. Lateral Angulation of the Great Toe leads to Tendons being pulled
  2. They are then realigned to the Lateral Center of Rotation of worsening deformity
    Note - Vicious Cycle of Increased Pull causing Increased Deformity
  3. The Sesamoid Bones Sublux, due to the changes, and Less Weight goes through the Great Toe
  4. Abnormalities of the Lesser Toe occur as it progresses
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7
Q

What are the Symptoms of Hallux Valgus (Bunions)?

A
  1. Pressure Symptoms from Shoe-wear
  2. Pain from crossing over Toes
  3. Metetarsalgia
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8
Q

How is a Diagnosis of Hallux Valgus (Bunions) made?

A
  1. Clinical

2. X-Rays - Determine Severity of underlying bone deformity

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9
Q

What are the Non-Operative managements of Hallux Valgus (Bunions)?

A
  1. Shoe-wear Modification
  2. Orthotics to offload pressure
  3. Activity Modification
  4. Analgesia
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10
Q

What are the Operative managements of Hallux Valgus (Bunions)?

A
  1. Release Lateral Soft Tissue
  2. Osteotomy - 1st Metatarsal +/- Proximal Phalanx
    Note - Generally good outcome but recurrence inevitable
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11
Q

What is Hallux Rigidus?

A

Osteoarthritis of the 1st Metatarsophalangeal Joint

Note - This is also known as Hallux Limitus / Non-Extensus

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12
Q

What is the aetiology of Hallux Rigidus?

A

Unknown - possibly genetic

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13
Q

What are the Symptoms of Hallux Rigidus?

A
  1. Many are Assymptomatic
  2. Pain - Often at extreme Dorsiflexion
  3. Limitation of Range of Movement
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14
Q

How is a Diagnosis of Hallux Rigidus made?

A
  1. Clinically

2. With Radiographs

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15
Q

What are the Non-Operative managements of Hallux Rigidus?

A
  1. Activity Modification
  2. Shoe-Wear with Rigid Soles
  3. Analgesia
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16
Q

What are the Operative Managements of Hallux Rigidus?

A
  1. Cheilectomy
  2. Arthrodesis -Fusion of bones (Gold Standard)
  3. Arthroplasty - Better for Low Demand Patients (High Failure Rate but good Maintenance for ROM)
17
Q

What are the Lesser Toe Deformities?

A
  1. Claw Toes
  2. Hammer Toes
  3. Mallet Toes
18
Q

What is the Aetiology of the Lesser Toe Deformities?

A
  1. Imbalance between Flexors / Extensors
  2. Shoe-Wear
  3. Neurological
  4. Rheumatoid Arthritis
  5. Idiopathic
19
Q

What are the Symptoms of the Lesser Toe Deformities?

A
  1. Deformity
  2. Pain of the Dorsum of the Foot
  3. Pain from the Plantar Side of the Foot (Metatarsalgia)
20
Q

What are the Non-Operative Treatments of Lesser Toe Deformities?

A
  1. Activity Modification
  2. Shoe-Wear - Flat Shoes with High Toe Box
  3. Orthotic Insoles - Metatarsal Bar / Dome Support
21
Q

What are the Operative Treatments of Lesser Toe Deformities?

A
  1. Flexor to Extensor Transfer
  2. Fusion of Interphalangeal Joints
  3. Release Metatarsophalangeal Joint
  4. Shortening Osteotomy of Metatarsal
22
Q

What is Morton’s Neuroma also known as?

A

Interdigital Neuralgia

23
Q

What are the Symptoms of Morton’s Neuroma?

A
  1. Typically affects 3rd followed by 2nd Webspace / Toes
  2. Neuralgic Burning Pain in Toes
  3. Intermittent
  4. Altered Sensation in the Webspace
24
Q

How is Morton’s Neuroma Diagnosed?

A
  1. Clinically
  2. Mulder’s Click
  3. Ultrasound / MRI
25
Q

How is Morton’s Neuroma managed?

A
  1. Injection for Small Lesions
  2. Surgery - Excision of Lesion, including a section of normal nerve:
  3. a) Numbness
  4. b) Recurrence
  5. c) 30% have pain 1 year post surgery
26
Q

What is characteristic for Morton’s Neuroma?

A

If the pain is under the Metatarsal Head, then it is, in fact, a Morton’s Neuroma

27
Q

What is Metatarsalgia?

A 
A Symptom (Not a Diagnosis)
Pain of the Metatarsals
28
Q

What can cause Metatarsalgia?

A
  1. Synovitis
  2. Bursitis
  3. Arthritis
  4. Neuralgia
  5. Neuromata
  6. Freiberg’s Disease
  7. Tight Gastrcnemius
29
Q

What is the Treatment of Rheumatoid Forefoot?

A
  1. Non-Operative - Shoe-Wear / Orthotics / Activity etc.
  2. Operative:
  3. a) 1st Metatarsophalangeal Arthrodesis
  4. b) 2-5th Toe Excision Arthroplasty

-MSK Diseases (43 decks)

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