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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
Q

What is Achille’s tendonitis

A

Inflammation and thickening at the insertion of the achilles tendon

26
Q

In which age group is Achille’s tendonitis more common

A

Middle-age

Elderly patients

27
Q

What causes Achille’s tendonitis

A

Repetitive trauma causes inflammation. Heals by cartilaginous formation and then bony metaplasia

28
Q

What are risk factors for Achille’s tendonitis

A
  • Age
  • Poor footwear when running
  • Biomechanical instability
29
Q

How will achilles tendonitis present

A

Gradual onset posterior heel pain and STIFFNESS. Worse following activity

30
Q

What is a sign of achilles tendonitis

A

Thickening

Crepitus

31
Q

What is the achilles tendon

A

Provides attachment of the gastrocnemius and soleus to the calcaneus

32
Q

How is achilles tendonitis diagnosed

A

Clinically

33
Q

What is first-line management of achilles tendonitis

A

Conservative: rest, NSAIDs, physio, orthoses, weight loss

34
Q

What is second-line management of achilles tenonditis

A

Surgical

35
Q

What is a complication of achilles tendonitis

A

Achille’s tendon rupture

36
Q

What is the most common cause of posterior heel pain

A

Achilles tendonitis

37
Q

What are two risk factors for achilles tendon disorders

A
  • Quinolones - cause tendon disorders

- Hypercholesterolaemia - causes tendon xanthomas

38
Q

What is the clinical presentation of achilles tendonitis

A

Gradual onset pain in the posterior heel which is worse following activity. May present with a degree of morning stiffness

39
Q

How does achilles tendon rupture present

A

Audible pop when playing sport and an inability to continue playing

40
Q

What test can be used to identify achilles tendon rupture

A

Simmond’s test

41
Q

In achilles tendon rupture, how will Simmonds test present

A

Foot will stay in neutral when calf is squeezed

42
Q

If suspecting rupture of the achilles tendon, what should be done

A

Immediate referral to orthopaedic specialist

43
Q

What is a Morton’s neuroma

A

Formation of a benign fibrotic thickening affecting the intermetatarsal plantar nerve

44
Q

What is the inter-metatarsal plantar nerve found

A

3rd intermetatarsal space

45
Q

Why does a Mortons neuroma often form in the 3rd inter-metatarsal space

A

As the metatarsal heads compress the inter-metatarsal plantar nerve

46
Q

In which gender is a Morton’s neuroma more commonly found

A

Female (4:1)

47
Q

What is the plantar inter metatarsal nerve compressed on

A

Intermetatarsal transverse ligament

48
Q

How may Morton’s neuroma present

A
  • 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
Q

What sign indicates a Morton’s neuroma

A

Mudler’s click

50
Q

What is a mulder’s click

A
  • One hand tries to isolate the neuroma
  • One hand squeezes metatarsal heads together
  • A click may be heard
51
Q

What is the investigation of Morton’s neuroma

A

Clinical diagnosis

52
Q

How can Morton’s neuroma be managed

A

Avoid high heels
Metatarsal pad
Surgical excision

53
Q

What is used to determine if someone requires an x-ray of their foot or ankle

A

Ottawa Ankle Rules

54
Q

What are the Ottawa ankle rules

A

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
Q

what investigation is used to diagnose achilles tendon rupture

A

USS

Trauma + Orthopaedics (11 decks)

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