Adult Foot and Ankle Flashcards
what region of the foot does the meidal malleolus lie in?
medial hindfoot
what region of the foot does the deltoid ligament lie in?
medial hindfoot
what region of the foot does the sural nerve lie in?
lateral hindfoot
another name for flat feet?
pes planus
most common cause of acquired flat foot deformity in adults?
tibialis posterior dysfunction
what does the tibialis posterior muscle run behind in the foot?
medial malleolus
where does the tibialis posterior insert
navicular tuberosity
plantar aspect of medial and middle cuneiforms
what does the tibialis posterior do
stabilises medial longitudinal arch
inversion
plantarflexion
who tends to get tibialis posterior dysfunction?
obese middle aged women
causes of tibialis posterior dysfunction?
hypertension diabetes steroid injection seronegative arthropathies idiopathic tendonosis
clinical presentation of tibialis posterior dysfunction?
pain +/- swelling posterior to medial malleolus with: change in foot shape struggling to walk noticeable hallux valgus midfoot/ankle pain
what would you see on examination of someone with type 1 TPD?
swelling
tenderness
slightly weak muscle power
what would you see on examination of someone with type 2 TPD?
planovalgus
midfoot abduction
treatment for TPD?
physiotherapy
NO steroids
orthoses
surgery
commonest cause of pes cavus?
idiopathic
other causes of pes cavus?
HSMN CP polio spina bifida club foot
clinical presentation of pes cavus?
high arched foot with clawed toes
clinical presentation of plantar fasciitis?
pain after rest that is exacerbated by exercise
swelling on plantarmedial aspect of heel
positive tinel’s test for baxter’s nerve
causes of plantar fasciitis
physical overload eg exercise, obesity
seronegative arthritis
diabetes
planovalgus/cavovalgus
treatment for plantar fasciitis?
NSAIDs night splints taping physio steroid injection
does hallux valgus commonly present bilaterally or unilaterally?
bilaterally
is hallux valgus more common in men or women?
women
causes of hallux valgus?
familial shoes joint laxity connective tissue disease rheumatoid
treatment for hallux valgus?
shoe modifications (non-op) operative
when would you consider surgery in someone with hallux valgus?
failure of other treatment pain lesser toe deformities lifestyle limititation overlapping ulceration
how is the surgery for hallux valgus done?
osteotomy to break the bone and then move the head laterally
what is hallux rigidus?
OA of 1st MTPJ
surgical management of hallux rigidus?
joint replacement
fusion
what causes rheumatoid foot?
synovitis increases proteinases and collagenases which impairs integrity of joint capsules and ligaments by destructing hyaline cartilage
systemic effects of rheumatoid foot?
vasculitis ischaemia ulceration neuropathy immunosuppression anaemia
why do you get flat feet in rheumatoid foot?
unstable subtalar joint causes the calcaneus to become valgus, this causes medial arch to collapse
what is morton’s neuroma?
degenerative fibrosis of digital nerve near it’s bifurcation
clinical presentation of mortons neuroma?
forefoot pain
burning and tingling in toes in middle aged people
non surgical treatment of mortons neuroma?
insoles
injections
surgical treatment of mortons neuroma?
excise
how is mortons neuroma diagnosed?
USS
XR
what happens when you excise the digital nerve?
no sensation in between toes
what happens in achilles tendinosis?
repetitive microtrauma causes failure of collagen repair
what drugs predispose you to achilles tendinosis?
ciprofloxacin
steroids
clinical presentation of achilles tendinosis?
pain, morning stiffness, eases with heat/walking
investigations for achilles tendinosis?
USS
MRI
management for achilles tendinosis?
analgesia NSAIDs NO steroids orthotics physio maybe surgery
what is the minimum age that you tend to see a tendo-achilles rupture in?
40
most common cause of a tendo-achilles rupture?
pre-existing tendinosis
sudden deceleration with resisted calf contraction
clinical presentation of a tendo-achilles rupture?
unable to bear weight weak plantar flexion palpable painful gap \+ve simmond's test think someone has hit them
what is simmond’s test?
test for achilles tendonitis by squeezing calf
name the types of surgery conducted on claw, hammer and mallet toes?
tenotomy
tendon transfer
fusion
amputation
most common movement causing an ankle sprain?
inversion on a planted foot
does an ankle sprain or fracture take longer to heal?
sprain
what ligaments are commonly affected in ankle sprain?
anterior talofibular (ATFL) calcaneofibular (CFL) lateral ligaments
non-operative management for ankle sprain?
RICE
physio
operative management for ankle sprain?
brostrum gould
chrisman snook
when is an ankle fracture classed as unstable?
if it includes a medial malleolus fracture or deltoid ligament fracture
treatment for an unstable fracture?
surgery
treatment for a stable fracture?
cast and boot
where does a pilon fracture happen?
distal tibia
most common cause of a pilon fracture?
high energy fall/crash
most common injury to the 5th metatarsal?
inversion
