2: Joint Disorders Of The Ankle Flashcards
What is another term for hallus valgus
Bunions
What are bunions
Lateral deviation of the first phalangeal (big toe) often with medial deviation of the first metatarsal
What is the most common foot deformity
hallus valgus (bunions)
In which gender is halls valgus more common
females
What are 5 causes of bunions
- Biomechanical instability
- Poor fitting footwear
- Rheumatoid arthritis
- Ehlers-Danos
- Multiple Sclerosis
How may hallus valgus present
- Lateral deviation of the big toe with medial deviation of the first metatarsal
- Pain
- Inflammation
what is a complication of haluls valgus
Secondary OA
how is hallus valgus diagnosed
Inflammation
what is first-line management of bunions
NSAIDs and orthoses
what is second-line management of bunions
Osteotomy (Scarf or Chevor)
what is plantar fasciitis
Inflammation of plantar fascia at its aponeurosis on the calcaneus
what is the most common cause of heel pain in adults
Plantar fasciitis
What is the peak incidence of plantar fascitis
30-50y
Explain the aetiology of plantar fasciitis
Chronic over-use causes micro tears in the plantar fascia which leads to recurrent inflammation and periostitis
What are 5 risk factors for plantar fascitis
- Obesity
- High arches
- Tight calves
- Repetitive impact activity
- Features of ankylosing spondylitis
How will plantar fasciitis present clinically
- Gradual onset
- Sharp heel pain
- Worse in the morning or after rest
- Typically bilateral
How is plantar fasciitis investigated
- Clinical diagnosis
- If surgery is planned perform an MRI
What is first-line management of plantar fasciitis
Conservative approaches
What conservative management can be offered for plantar fasciitis
Rest
Orthoses
Stretching programmes
Analgesia
What orthoses can be offered for plantar fasciitis
- Cushioned heel inserts
- Short leg cast for 8-10W
- Night splint where ankle is held in dorsiflexion
What is second-line for plantar fasciitis
Shockwave treatment
What are indications of shock wave treatment
Pain present for >6m
What is surgical management of plantar fasciitis
Plantar fasciotomy
When is plantar fasciotomy indicated
If pain is present for more than 9m and conservative measures have failed
What is Achille’s tendonitis
Inflammation and thickening at the insertion of the achilles tendon
In which age group is Achille’s tendonitis more common
Middle-age
Elderly patients
What causes Achille’s tendonitis
Repetitive trauma causes inflammation. Heals by cartilaginous formation and then bony metaplasia
What are risk factors for Achille’s tendonitis
- Age
- Poor footwear when running
- Biomechanical instability
How will achilles tendonitis present
Gradual onset posterior heel pain and STIFFNESS. Worse following activity
What is a sign of achilles tendonitis
Thickening
Crepitus
What is the achilles tendon
Provides attachment of the gastrocnemius and soleus to the calcaneus
How is achilles tendonitis diagnosed
Clinically
What is first-line management of achilles tendonitis
Conservative: rest, NSAIDs, physio, orthoses, weight loss
What is second-line management of achilles tenonditis
Surgical
What is a complication of achilles tendonitis
Achille’s tendon rupture
What is the most common cause of posterior heel pain
Achilles tendonitis
What are two risk factors for achilles tendon disorders
- Quinolones - cause tendon disorders
- Hypercholesterolaemia - causes tendon xanthomas
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
How does achilles tendon rupture present
Audible pop when playing sport and an inability to continue playing
What test can be used to identify achilles tendon rupture
Simmond’s test
In achilles tendon rupture, how will Simmonds test present
Foot will stay in neutral when calf is squeezed
If suspecting rupture of the achilles tendon, what should be done
Immediate referral to orthopaedic specialist
What is a Morton’s neuroma
Formation of a benign fibrotic thickening affecting the intermetatarsal plantar nerve
What is the inter-metatarsal plantar nerve found
3rd intermetatarsal space
Why does a Mortons neuroma often form in the 3rd inter-metatarsal space
As the metatarsal heads compress the inter-metatarsal plantar nerve
In which gender is a Morton’s neuroma more commonly found
Female (4:1)
What is the plantar inter metatarsal nerve compressed on
Intermetatarsal transverse ligament
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
What sign indicates a Morton’s neuroma
Mudler’s click
What is a mulder’s click
- One hand tries to isolate the neuroma
- One hand squeezes metatarsal heads together
- A click may be heard
What is the investigation of Morton’s neuroma
Clinical diagnosis
How can Morton’s neuroma be managed
Avoid high heels
Metatarsal pad
Surgical excision
What is used to determine if someone requires an x-ray of their foot or ankle
Ottawa Ankle Rules
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
- Tenderness at posterior edge or tip of the lateral malleolus
- Tenderness at the posterior edge or tip of the medial malleolus
- Inability to weight bear immediately and in emergency department for 4h
what investigation is used to diagnose achilles tendon rupture
USS
