3- adult foot & ankle pathology Flashcards
what is hallux valgus?
when big toe sort of bends out = also known as bunions
what is common presentation of hallux valgus?
= bunion so will be able to see, often female and have flatfoot or RA too
- they will be unable to wear closed toe shoes (big toe on fire) often because bony bump on foot meaning bursa inflammation etc
- might have joint pain (which suggests have OA secondary to hallux valgus)
- might say feels like a pebble in shoe = transfer metatarsalgia (pain at metatarsal heads at ball of foot because of abnormal weight distribution due to big toe abnormality)
what is management of hallux valgus?
- if asymptomatic leave alone!
if symptoms:
1st start with conservative measures like analgesia, orthotic splints, toe spacers, low heel & wide fitting shoes, physio
2nd can go to operations but there’s lots options
what are 4 types of lesser toe deformities?
- claw toe = hyperextension of MTP joint
- mallet toes = flexion of DIP joint
- hammer toe = flexion of PIP
- curly toe = flexed at PIP & DIP joint
→they rub on shoes and get ulcers
what is hallux rigidus? how does it present?
it’s osteoarthritis of 1st MTP joint
presents as joint pain, loss of motion, transfer metatarsalgia
= presents in younger patients than osteoarthritis (usually 1st & earlier sign of OA)
what is management of hallux rigidus?
NSAIDs, activity modification, intra-articular joint injections, orthotics
(big toe OA)
what is pes planus? what causes it?
= flat foot
- a lot of people have flat foot, only care about if pain (it’s mostly caused by tibialis posterior dysfunction. tenosynovitis of posterior tibialis tendon leads to medial arch collapse)
what is tibialis posterior dysfunction?
- it’s when tibialis posterior muscle doesn’t work causing eversion of foot and drop of foot from arch weakness
*tibialis muscle usually causes inversion & supports arch
how does tibialis posterior dysfunction present?
= causes pain and swelling of posterior to medial malleolus
- diminished walking ability, difficulty on uneven surfaces, hallux valgus and lateral, midfoot & ankle pain (since more strain due to weak other parts of foot)
what is treatment of tibialis posterior dysfunction?
physio, insole to support, bespoke footwear, surgery
*NO STEROID INJECTIONS IN TENDONS THAT WEIGHT BEAR
what is pes cavus?
= high arch foot
- it’s idiopathic and often combines with other deformities like hindfoot varus, forefoot adduction
- can wear braces to treat (can get some surgery if super severe)
what is plantar fasciitis? how does it present?
= inflammation of plantar aponeurosis at it’s origin on calcaneus
- start up pain after worse
- worse after exercise
- fullness or swelling plantar medial aspect of heel
- tenderness over plantar aspect of heel
what is treatment of plantar fasciitis?
- night splints
- NSAIDs
- taping
- physio exercise (like holding feet back, stretching with whole calf on steps)
what is morton’s neuroma?
degenerative fibrosis of digital nerve near it’s bifurcation = thickening of nerve tissue (between toes)
how does morton’s neuroma present?
- Forefoot pain (metatarsalgia)
- Burning and tingling in toes
- usually age 40-50 and female
