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3rd Year - MSK Diseases > 16.3. Foot Problems - Hindfoot Problems > Flashcards

16.3. Foot Problems - Hindfoot Problems Flashcards

1
Q

What are the main Hindfoot Problems?

A
  1. Achilles Tendonitis / Tendinosis
  2. Plantar Fasciitis
  3. Ankle Arthritis
  4. Tibialis Posterior Tendon Dysfunction
  5. Diabetic Foot Ulcer
  6. Charcots Foot
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2
Q

What is Achilles Tendonitis / Tendinosis?

A

A Degenerative / Overuse condition with little inflammation

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3
Q

What is the definition of:

  1. Tendinosis?
  2. Tendinopathy?
A
  1. Histopathological Disease
  2. Term used to describe symptoms
    Note - “Tendonitis” Should be avoided
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4
Q

What can Achillies Tendinopathy refer to?

A

More than 1 Clinical Condition:

  1. Insertional Tendinopathy - within 2cm of insertion
  2. Non-Insertional / Mid-Substance Tendinopathy - 2-7cm of insertion
  3. Bursitis - Retrocalcaneal / Superficial Calcaneal
  4. Paratendinopathy - a true inflammatory problem
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5
Q

What is the Aetiology of Achilles Tendinopathy, caused by Paratendonopathy?

A
  1. Commonest in Athletic Populations
  2. Male (2:1)
  3. Ages 30-40
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6
Q

What is the Aetiology of Achilles Tendinopathy, caused by Tendonopathy?

A
  1. Commonest in Non-Athletic Populations
  2. Aged 40+
  3. Common in those with Obesity / Diabetes / Take Steroids
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7
Q

What symptoms occur in Achilles Tendinopathy?

A
  1. Pain During / Following Exercise
  2. Recurrent Episodes
  3. Difficulty Fitting Shoes (Insertional)
  4. Rupture - Don’t Miss This
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8
Q

How is Achilles Tendinopathy diagnosed?

A
  1. Clinically:
  2. a) Tenderness
  3. b) Tests for Rupture
  4. Investigations:
  5. a) Ultrasound
  6. b) MRI
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9
Q

What is the Achilles Rupture Test?

A
  1. Squeeze the Calf (Soleus) Muscle Gently
  2. If the Calf Squeeze Moves the foot then the Achilles Tendon is not fully Ruptured
  3. If the Calf Squeeze does not move the foot, then there is a Full Achilles Tendon Rupture
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10
Q

What is the Non-Operative Treatment for Achilles Tendinopathy?

A
  1. Activity Modification
  2. Weight Loss
  3. Shoe-Wear Modification - Slight Heel
  4. Physiotherapy - Eccentric Stretching
  5. Extra-Corporeal Shockwave Treatment
  6. Immobilisation (below the Knee Cast)
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11
Q

What is the Operative Treatment for Achilles Tendinopathy?

A
  1. Gastrocnemius Recession

2. Release and Debridement of Tendon

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12
Q

What is a better term for Fasciitis, in relation to Plantar Fasciitis?

A

Fasciosis

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13
Q

What is Fasciosis?

A

Chronic degenerative change, in which the patient can’t make the Extra-Cellular Matrix required for Repair / Remodelling, leading to:

  1. Fibroblast Hypertrophy
  2. Absence of Inflammatory Cells
  3. Disorganised and Dysfunctional Blood Vessels
  4. Disorganised and Dysfunctional Collagen
  5. Avascularity
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14
Q

What is the Aetiology of Plantar Fasciitis (Fasciosis)?

A
  1. Unknown
  2. Anything which puts increased pressure on the Foot
  3. Foot / Lower Limb Rotational Deformities
  4. Tight Gastro-Soleus Complex
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15
Q

What are the Symptoms of Plantar Fasciitis (Fasciosis)?

A
  1. Pain first thing in the Morning
  2. Post-Static Dyskinesia - Pain on weight bearing and after rest
  3. Pain located at origin of Plantar Fascia
  4. Frequently long-lasting (2 years +)
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16
Q

What is the Differential Diagnosis for Plantar Fasciitis (Fasciosis)?

A
  1. Nerve Entrapment Syndrome
  2. Arthritis
  3. Calcaneal Pathology
17
Q

How is Plantar Fasciitis (Fasciosis) Diagnosed?

A
  1. Clinically (Mainly)

2. Radiology - X-Rays / Ultrasound / MRI (Occasionally)

18
Q

What are the standard treatments of Plantar Fasciitis (Fasciosis)?

A
  1. Rest / Change Training
  2. Stretching
  3. Ice
  4. NSAID’s
  5. Orthoses - Heel Pads
  6. Physiotherapy
  7. Weight Loss
  8. Corticosteroid Injections
  9. Night Splinting
19
Q

What are the new treatments of Plantar Fasciitis (Fasciosis)?

A
  1. Extracorporeal Shockwave Therapy
  2. Topaz Plasma Coblation
  3. Nitric Oxide
  4. Platelet Rich Plasma
  5. Endoscopic / Open Surgery
20
Q

What is the Aetiology of Ankle Arthritis?

A
  1. Mean age of presentation is 46 years old
  2. Commonly Post-traumatic
  3. Idiopathic
21
Q

What are the Symptoms of Ankle Arthritis?

A
  1. Pain

2. Stiffness

22
Q

How is Ankle Arthritis diagnosed?

A
  1. Clinically

2. Radiographs - CT Scan to exclude adjacent Joint Arthritis

23
Q

What is the Non-Operative Management of Ankle Arthritis?

A
  1. Weight Loss
  2. Activity Modification
  3. Analgesia
  4. Physiotherapy
  5. Steroid Injections
24
Q

What is the Operative Management of Ankle Arthritis?

A
  1. Open / Arthroscopic Arthrodesis
  2. Joint Replacement
  3. Arhtroscopic Anterior Debridement - If symptoms are exclusively anterior
25
Q

What is Tibialis Posterior Tendon Dysfunction?

A

Acquired Adult Flat Foot Planovalgus.

It is relitively common but under-recognised.

26
Q

What are the Symptoms of Tibialis Posterior Tendon Dysfunction?

A

Medial / Lateral Pain

Note - There are 4 stages

27
Q

How is Tibialis Posterior Tendon Dysfunction Diagnosed?

A
  1. Clinically - Double & Single Limb Heel Raise

2. MRI to Assess Tendon

28
Q

How is Tibialis Posterior Tendon Dysfunction managed?

A
  1. Orthotics - Medial Arch Support
  2. Reconstruction of Tendon (Tendon Transfer)
  3. Triple Fusion (Subtalar, Talonavicular, and Calcaneocuboid)
29
Q

What is the Aetiology of Diabetic Foot Ulcers?

A
  1. Diabetic Neruopathy
  2. Diabetic Autonomic Neuropathy
  3. Poor Vascular Supply
  4. Lack of Patient Education
30
Q

What are the Non-Operative treatments of Diabetic Foot Ulcers?

A
  1. Prevention
  2. Modifying the main detriments to Healing:
  3. a) Diabetic Control / Nutrition
  4. b) Smoking
  5. c) Vascular Supply
  6. d) External Pressure (Splints / Shoes / Weight Bearing)
  7. e) Internal Pressure (Deformity)
  8. f) Infection
31
Q

What are the Surgical treatments of Diabetic Foot Ulcers?

A
  1. Improve Vascular Supply
  2. Debride Ulcers and get Deep Samples for Microbiology
  3. Correct and Deformity to Offload Area
  4. Amputation
32
Q

What is the prognosis of Diabetic Foot Ulcers?

A
  1. 15% of Diabetics will develop Ulceration
  2. 85% of amputations for Diabetes are preceded by ulceration
  3. 25% with Diabetic Ulcers go onto amputation
33
Q

What is the aetiology of Charcot Neuropathy?

A

Any cause of Neuropathy:

  1. Diabetes
  2. Syphillis
34
Q

What are the 2 Theories of the Pathophysiology of Charcot Neuropathy?

A
  1. Neurotraumatic - Lack of Proprioception and Protective Pain Sensation
  2. Neurovascular - Abnormal Autonomic Nerve System results in Increased Vascular Supply and Bone Resorption
35
Q

What is Charcot Neuropathy characterised by?

A

Rapid Bone Destruction in 3 stages:

  1. Fragmentation
  2. Coalescence
  3. Remodelling
36
Q

How is Charcot Neuropathy diagnosed?

A
  1. Clinically - Consider any diabetic with an acutely swollen erythematous foot
  2. Radiologically - X-Rays / MRI Scnas
37
Q

How is Charcot Neuropathy managed?

A
  1. Prevention
  2. Immobilisation / Non-Weight Bearing until acute Fragmentation Resolved
  3. Correct Deformity = Deformity - Ulceration - Infection - Amputation

3rd Year - MSK Diseases (43 decks)

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