4- Foot and Ankle

Question 1

How can you treat ankle OA

Answer 1

Removal of osteophytes
Arthrodesis - fusion
Ankle replacement - severe cases only

Question 2

What can increase your chance of get

Answer 2

Older age 
Familial tendency 
Footwear 
RA & other inflammatory arthropathy 
Neuromuscular diseases

Question 3

What are the conservative treatments for Hallux rigidus

Answer 3

Wearing stiff soled shoes to limit motion
Inserts for shoes
Removal of osteophytes if impinging

Question 4

Which sex is most commonly affected by Morton’s neuroma

Answer 4

Women

High heels have been implicated

Question 5

Describe the conservative management for Morton’s neuroma

Answer 5

Metatarsal pad or offloading insole

Steroid and LA injections can relieve symptoms

Question 6

A neuroma cannot be excised - true or false

Answer 6

FALSE

they can be excised but there is a chance of recurrence

Question 7

How do you manage a metatarsal stress fracture

Answer 7

Prolonged rest in a rigid soled boot for 6-12 weeks

This allows it to heal

Question 8

How do you treat Achilles tendonitis

Answer 8

Rest
Physio
Use of a heel raise
Splint or boot

Resistant cases may get tendon decompression

Question 9

Describe how Achilles tendon rupture usually occurs

Answer 9

Can be due to degenerative changes or recent tendonitis

Sudden deceleration with a tensed calf causes the rupture

Question 10

What are the symptoms and signs of an Achilles rupture

Answer 10

Sudden pain
Difficulty weight bearing
Weak plantar flexion
Palpable gap in tendon

Question 11

How do you treat an Achilles tendon rupture

Answer 11

Some will repair surgically with sutures and then protect with casts

Many just go for a series of casts that put foot in best healing position

Question 12

How does plantar fasciitis present

Answer 12

Pain on instep when walking

Localised tenderness on palpation

Question 13

Where does the plantar aponeurosis insert

Answer 13

Distal plantar aspect of calcaneal tuberosity

Question 14

How do you treat plantar fasciitis

Answer 14

Rest
Stretches for Achilles and plantar fascia
Gel heel pad
Steroid injections

Question 15

Can flat feet be normal?

Answer 15

Yes

affects up to 20%

Question 16

What does being flat footed increase your risk of

Answer 16

Tendonitis of tibialis posterior

Question 17

What can lead to acquired flat feet

Answer 17

Tibialis posterior tendon stretch or rupture
RA
Diabetes with charcot foot

Question 18

What is Charcot foot

Answer 18

Neuropathic joint destruction

Question 19

How do you treat tendonitis of tibialis posterior

Answer 19

Splint with medial arch support to avoid rupture

If this fails then may need surgery to stop rupture - decompression or tenosynovectomy

Question 20

What can cause pes cavus

Answer 20

Idiopathic

Neuromuscular conditions - e.g. cerebral palsy, spina bifida

Question 21

How can you treat pes cavus

Answer 21

Pain can be treated with soft tissue release and tendon transfer
Severe cases may need arthrodesis

Question 22

What causes claw and hammer toes

Answer 22

Acquired imbalance between flexor and extensor tendons

Question 23

How do you treat claw and hammer toes

Answer 23

Toe sleeves to stop skin problems

Surgery - tenotomy, tendon transfer, arthrodesis or amputation