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Musculoskeletal > Adult food and ankle disorders > Flashcards

Adult food and ankle disorders Flashcards

1
Q

What are forefoot, midfoot and hindfoot?

A
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2
Q

3 main things in F&A examination?

A

Look
Feel
Move

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3
Q

what is hallux valgus?

A

Deformity of the great toe due to medial deviation of the 1st metatarsal and lateral deviation of the toe itself

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4
Q

what is the aetiology of hallux valgus?

A
  • Exact aetiology unknown
  • more in females
  • genetic predisposition
  • age related
  • common in RA
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5
Q

Clinical presentation of hallux valgus?

A
  • usually bilateral
  • May be painful due to joint incongruence ناهماهنگی
  • May be unable to wear closed shoes - bursa and/or nerve damage
  • A widened forefoot may cause rubbing of the foot with shoes resulting in an inflamed bursa over the medial 1st metatarsal head → bunion
  • Joint pain indicates OA
  • Transfer metatarsalgia or poor balance indicates defunctioned 1st ray (segment of the foot composed of the first metatarsal and first cuneiform bones)
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6
Q

what is the conservative Mx for hallux valgus?

A
  • Analgesia
  • wearing wider, low heel and deeper shoes to prevent bunions
  • the use of a spacer in the first web space to stop rubbing between the great and second toes,
  • physiotherapy for the tight one
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7
Q

Surgical Mx for hallux valgus?

A

Osteotomies to realign the bones and soft tissue procedures to tighten slack tissues and release tight tissues.
Nb=patients complain about pain and alteration in biomechanic of the foot.

*This managemeant is for only when these indications are present:
failure of conservative management, lesser toe deformities, lifestyle limitation, overlapping, functional limitation, ulceration *

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8
Q

what is Hallux Rigidus?

A

OA of the 1st MTPJ; can be primary (degenerative) or secondary to osteochondral injury

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9
Q

What is the clinical presentation for Hallux Rigidus?

A
  • Painful 1st MTP joint
  • Stiffness
  • Pain increases with activity/aggrevated by shoes
  • bone spur (bone lumps)
  • The interphalangeal joints (IPJ) hyperextension
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10
Q

Investigations for Hallux rigidus?

A

X-ray (AP/Lat and oblique)

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11
Q

Mx (both surgical and conservative) of hallux rigidus?

A

Conservative:
Analgesia, NSAIDs, activity modification, interarticular injection, orthotics (kafie kafsh k mamano man dasram that limit the MTPJ motion)

Surgery:
Fusion (arthrodesis)–gold standard
Replacement of the 1st MTP joint

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12
Q

About Rheumatoid foot?

A
  • Occurs early in Rh disease process
  • Surgery if affects the forefoot
  • Multi-joint disease
  • Systemic effect
  • Psychosocial
  • Often require multiple joint fusion
  • All three fore,hind, midfoot can get affected
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13
Q

About Pes Planus/Flat foot?

A
  • Familial
  • Associated ligamentous laxity
  • No treatment
  • Form an arch on tip toe
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14
Q

What is Tibialis Posterior Tendon Dysfunction?

A

Caused by attenuation and tenosynovitis of posterior tibialis tendon leading to media arch collapse

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15
Q

What is the aetiology of Tibalis posterior tendon dysfunction?

A
  • unknown
  • females
  • the most common cause of acquired flat foot in adults
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16
Q

Pahophysiology of Tibialis Posterior dysfunction?

A
  • The tendon is under repeated stress and particularly with degeneration can develop tendonitis, elongation and eventually rupture
  • Usually present for years prior to diagnosis
  • Elongation or rupture leads to loss of the medial arch with resulting valgus of the heel and flattening of the medial arch of the foot
17
Q

Clinical presentation of Tibialis Posterior dysfunction?

A
  • Pain and/or swelling posterior to medial malleolus - very specific
  • Change in foot shape
  • Diminished walking ability/balance
  • Dislike of uneven surfaces
  • More noticable hallux valgus
  • Lateral wall ‘impingement’ pain
  • Midfoot and ankle pain
18
Q

TPD Examination/classifications?

A

Stage 1– swelling, tenderness, slightly weak muscle power
Stage 2 – flatfoot, midfoot abduction (planovalgus), “too many toes” sign, deformity is passively correctable
Stage 3-flatfoot and rigid forefoot and hindfoot deformities
Stage 4 – Fixity and mortise signs

19
Q

What does TBD’s classification look like in xray?

A

Xrays:
stage1-normal
stage 2-arch collapsed
stage 3-arch collapsed+subtalar arthritis
stage 4-arch collapse+subtalar and talar tilt in ankle mortise

20
Q

What is TBD Mx?

A
  • Physiotherapy
  • Insole to support medial longitudinal arch
  • Orthoses to accommodate foot shape, Orthoses footwear
  • If this fails to settle symptoms, surgical decompression and tenosynovectomy may prevent rupture
  • DO NOT use steriod injections
21
Q

What is Pes Cavus?

A

Abnormally high arch of the foot
-Often combined with other deformities: hindfoot varus, Forefoot adduction, clawing of toes

22
Q

Aetiology of Pes Cavus?

A

idiopathic but is often related to neuromuscular conditions including Hereditary Senory and Motor Neuropathy (HSMN), cerebral palsy, polio(unilateral) and spinal cord tethering from spina bifida occulta

23
Q

Pes Cavus Mx?

A
  • Soft tissue releases and tendon transfer if supple, or calcaneal osteotomy if more rigid
  • Severe cases may require arthrodesis
24
Q

Planter Fasciitis?

A

Degenerative condition and inflammation of the plantar fascia (plantar aponeurosis) at its origin on the calcaneus. this causes sharp pain on the bottom of the foot pain

25
Q

Aetiology and risk factors of plantar fasciitis?

A
  • Repetitive stress/overload or degenerative condition

Risk factors
- Physical overload - excessive exercise, excessive weight (obesity)
- Diabetes
- Age - the cushioning heel fat pad atrophies with age
- Abnormal foot shape - splanovalgus or cavovarus
- Frequent walking on hard floors with poor cushioning in shoes

26
Q

Clinical presentation of Plantar fasciitis?

A

Start-up pain after rest
Can be worse after exercise
Fullness or swelling plantarmedial aspect of heel
Tenderness over plantar aspect of heel and/or plantarmedial aspect of heel

27
Q

Mx of plantar fasciitis?

A
  • Rest, NSAIDs
  • Night splints, taping, heel cups or medial arch supports
  • Physiotherapy - achilles and plantar fascia stretching exercises
  • Corticosteroid injection may alleviate symptoms
  • Surgical release of the plantar fascia risks injury to the plantar nerves and it is unclear whether there is an actual benefit
  • ECSWL*- not supported by NICE guidelines

Extracorporeal Shock Wave Lithotripsy–ECSWL

28
Q

What is Morton’s Neuroma?

A

Degenerative fibrosis of digital nerve near its bifurcation. Most common in 2nd and 3rd space.

29
Q

What is the aetiology of Morton’s Neuroma?

A
  • Mean age 45-50
  • F>M
  • Obesity
30
Q

Clinical presentation of Morton’s Neuroma?

A
  • Burning and tingling in toes
  • Loss of sensation in the affected webspace
31
Q

Investigation of Morton’s Neuroma?

A
  • X-ray (AP/LAT/oblique WB) to rule out MSK pathology
  • Diagnostic US - swollen nerve (poor specificity if <6mm in diameter - risk of false positive)
32
Q

Mx of Morton’s Neuroma?

A

Non-op:
-insoles
-Steroid and local anaesthetic injections
Operative:
-neuromas* can be excised

neuroma a disorganized growth of nerve cells where is a nerve injury

Musculoskeletal (9 decks)

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