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Trauma + Orthopaedics > 2: Joint Disorders Of The Ankle > Flashcards

2: Joint Disorders Of The Ankle Flashcards

1
Q

What is another term for hallus valgus

A

Bunions

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2
Q

What are bunions

A

Lateral deviation of the first phalangeal (big toe) often with medial deviation of the first metatarsal

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3
Q

What is the most common foot deformity

A

hallus valgus (bunions)

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4
Q

In which gender is halls valgus more common

A

females

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5
Q

What are 5 causes of bunions

A
  • Biomechanical instability
  • Poor fitting footwear
  • Rheumatoid arthritis
  • Ehlers-Danos
  • Multiple Sclerosis
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6
Q

How may hallus valgus present

A
  • Lateral deviation of the big toe with medial deviation of the first metatarsal
  • Pain
  • Inflammation
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7
Q

what is a complication of haluls valgus

A

Secondary OA

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8
Q

how is hallus valgus diagnosed

A

Inflammation

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9
Q

what is first-line management of bunions

A

NSAIDs and orthoses

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10
Q

what is second-line management of bunions

A

Osteotomy (Scarf or Chevor)

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11
Q

what is plantar fasciitis

A

Inflammation of plantar fascia at its aponeurosis on the calcaneus

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12
Q

what is the most common cause of heel pain in adults

A

Plantar fasciitis

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13
Q

What is the peak incidence of plantar fascitis

A

30-50y

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14
Q

Explain the aetiology of plantar fasciitis

A

Chronic over-use causes micro tears in the plantar fascia which leads to recurrent inflammation and periostitis

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15
Q

What are 5 risk factors for plantar fascitis

A
  • Obesity
  • High arches
  • Tight calves
  • Repetitive impact activity
  • Features of ankylosing spondylitis
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16
Q

How will plantar fasciitis present clinically

A
  • Gradual onset
  • Sharp heel pain
  • Worse in the morning or after rest
  • Typically bilateral
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17
Q

How is plantar fasciitis investigated

A
  • Clinical diagnosis

- If surgery is planned perform an MRI

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18
Q

What is first-line management of plantar fasciitis

A

Conservative approaches

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19
Q

What conservative management can be offered for plantar fasciitis

A

Rest
Orthoses
Stretching programmes
Analgesia

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20
Q

What orthoses can be offered for plantar fasciitis

A
  • Cushioned heel inserts
  • Short leg cast for 8-10W
  • Night splint where ankle is held in dorsiflexion
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21
Q

What is second-line for plantar fasciitis

A

Shockwave treatment

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22
Q

What are indications of shock wave treatment

A

Pain present for >6m

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23
Q

What is surgical management of plantar fasciitis

A

Plantar fasciotomy

24
Q

When is plantar fasciotomy indicated

A

If pain is present for more than 9m and conservative measures have failed

25
What is Achille's tendonitis
Inflammation and thickening at the insertion of the achilles tendon
26
In which age group is Achille's tendonitis more common
Middle-age | Elderly patients
27
What causes Achille's tendonitis
Repetitive trauma causes inflammation. Heals by cartilaginous formation and then bony metaplasia
28
What are risk factors for Achille's tendonitis
- Age - Poor footwear when running - Biomechanical instability
29
How will achilles tendonitis present
Gradual onset posterior heel pain and STIFFNESS. Worse following activity
30
What is a sign of achilles tendonitis
Thickening | Crepitus
31
What is the achilles tendon
Provides attachment of the gastrocnemius and soleus to the calcaneus
32
How is achilles tendonitis diagnosed
Clinically
33
What is first-line management of achilles tendonitis
Conservative: rest, NSAIDs, physio, orthoses, weight loss
34
What is second-line management of achilles tenonditis
Surgical
35
What is a complication of achilles tendonitis
Achille's tendon rupture
36
What is the most common cause of posterior heel pain
Achilles tendonitis
37
What are two risk factors for achilles tendon disorders
- Quinolones - cause tendon disorders | - Hypercholesterolaemia - causes tendon xanthomas
38
What is the clinical presentation of achilles tendonitis
Gradual onset pain in the posterior heel which is worse following activity. May present with a degree of morning stiffness
39
How does achilles tendon rupture present
Audible pop when playing sport and an inability to continue playing
40
What test can be used to identify achilles tendon rupture
Simmond's test
41
In achilles tendon rupture, how will Simmonds test present
Foot will stay in neutral when calf is squeezed
42
If suspecting rupture of the achilles tendon, what should be done
Immediate referral to orthopaedic specialist
43
What is a Morton's neuroma
Formation of a benign fibrotic thickening affecting the intermetatarsal plantar nerve
44
What is the inter-metatarsal plantar nerve found
3rd intermetatarsal space
45
Why does a Mortons neuroma often form in the 3rd inter-metatarsal space
As the metatarsal heads compress the inter-metatarsal plantar nerve
46
In which gender is a Morton's neuroma more commonly found
Female (4:1)
47
What is the plantar inter metatarsal nerve compressed on
Intermetatarsal transverse ligament
48
How may Morton's neuroma present
- Pain over 3rd intermetatarsal space. - Fore-foot, burning pain - Worse on walking or in boxed high heel shows - Loss of sensation in distal toes
49
What sign indicates a Morton's neuroma
Mudler's click
50
What is a mulder's click
- One hand tries to isolate the neuroma - One hand squeezes metatarsal heads together - A click may be heard
51
What is the investigation of Morton's neuroma
Clinical diagnosis
52
How can Morton's neuroma be managed
Avoid high heels Metatarsal pad Surgical excision
53
What is used to determine if someone requires an x-ray of their foot or ankle
Ottawa Ankle Rules
54
What are the Ottawa ankle rules
An x-ray of the ankle is only required if their is pain over the malleolar zone and one of the following 1. Tenderness at posterior edge or tip of the lateral malleolus 2. Tenderness at the posterior edge or tip of the medial malleolus 3. Inability to weight bear immediately and in emergency department for 4h
55
what investigation is used to diagnose achilles tendon rupture
USS

Trauma + Orthopaedics (11 decks)

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