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Musculoskeletal > Adult Foot and Ankle > Flashcards

Adult Foot and Ankle Flashcards

1
Q

What are important features of the lateral and hindfoot anatomy?

A

Distal fibula and fibular shaft, ankle lateral gutter and syndesmosis, lateral wall calcaneus, peronei, CFL and ATFL, sural nerve

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2
Q

What are important features of the medial and hindfoot topography?

A

Medial malleolus, anteromedial tibiotalar joint, deltoid ligament, PTT, FDL, FHL, posterior tibial artery

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3
Q

What are some features of the anatomy of the posterior ankle and hindfoot?

A

Achilles tendon, calcaneal insertion, retrocalcaneal space, peroneal tendons, FHL

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4
Q

What are some aspects of the anterior ankle topography?

A

Anterior ankle joint, superficial peroneal nerve, EHL, EDL, saphenous nerve

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5
Q

What are some important features of the plantar topography?

A

Heel pad, 5th metatarsal base, plantar fascia, metatarsal heads, tibialis posterior insertion

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6
Q

What are some features of pes planus (flat feet)?

A

Normal variant, occurs in 20% of population, familial, associated ligament laxity, when developmental its causes no problems and requires no treatment

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7
Q

What is a sign of flexible pes planus?

A

Flexible flat feet form an arch when patient tip toes

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8
Q

What is the most common cause of acquired flat feet in adults?

A

Tibialis posterior deformity (up to 10% of elderly women, usually present for years prior to diagnosis)

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9
Q

Where does the tibialis posterior pass?

A

Courses immediately posterior to medial malleolus

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10
Q

Where does the tibialis posterior attach?

A

Navicular tuberosity and plantar aspect of medial and middle cuneiforms

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11
Q

What are the functions of the tibialis posterior?

A

Primary dynamic stabiliser of medial longitudinal arch (elevates arch)
Invertor and plantar-flexor

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12
Q

What are the risk factors for tibialis posterior dysfunction?

A

Obese middle aged female, risk increase with age, flat foot, hypertension, diabetes, injected steroids, seronegative arthropathies, idiopathic tendonosis

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13
Q

What are some features of the pain caused by tibialis posterior dysfunction?

A

pain and/or swelling posterior to medial malleolus, lateral wall “impingement” pain, midfoot and ankle pain

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14
Q

What are some signs of tibialis posterior dysfunction?

A

Change in foot pain, diminished walking ability/balance, dislike of uneven surfaces, more noticeable hallux valgus, can’t single heel raise

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15
Q

What are the types of tibialis posterior dysfunction?

A

Type I = swelling, tenderness, slightly weak muscle power
Type II = planovalgus, midfoot abduction, passively correctable
Type III and IV = fixity and mortise signs

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16
Q

How are tibialis posterior dysfunctions treated?

A

Physio, insole to support medial arch, no injected steroids, orthoses to suit foot shape, bespoke footwear, surgery

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17
Q

What are the causes of pes cavus?

A

Most commonly idiopathic

Other causes mostly neurological = HSMN, cerebral palsy, polio, spina bifida, club foot

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18
Q

How does pes cavus present and how is it treated?

A

Often clawing of toes

Surgery complex if required = soft tissue releases, tendon transfers, calcaneal osteotomy, arthrodesis (fusion)

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19
Q

What are some features of the pain associated with plantar fasciitis?

A

Start-up pain after rest, may be worse after exercise

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20
Q

What are some signs of plantar fasciitis?

A

Fullness or swelling of plantarmedial aspect of heal, tenderness plantar aspect of heel and/or plantarmedial aspect of heel, Tinel’s test positive for Baxter’s nerve

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21
Q

What may cause plantar fasciitis?

A

Physical over-load = obesity, over-exercising

Seronegative arthropathy, diabetes, planovalgus or carovarus feet

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22
Q

What are some treatments of plantar fasciitis?

A

NSAIDs, night splints, taping, heel cups, medial arch supports, physio, steroid injections, ECSWL, surgery (50% success, better if acute onset)

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23
Q

How long does plantar fasciitis usually last for?

A

Usually self limiting over 18-24 months

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24
Q

What is the epidemiology of hallux valgus?

A

Increases with age, usually bilateral, 3 times more likely in men, adolescent subgroups exist

25
Q

What are some causes of hallux valgus?

A

Familial, shoes, general joint laxity, connective tissue disease, rheumatoid arthritis, splayed forefoot associated with loss of muscle tone and age

26
Q

What are some complications of hallux valgus?

A

Transfer metatarsalgia, lesser toe impingement, pain, deformity, cosmesis, shoe difficulties

27
Q

What are some supportive treatments for hallux valgus?

A

Shoe modifications and padding

28
Q

When is surgery indicated for hallux valgus?

A

Failure of conservative treatments, pain, lesser toe deformities, lifestyle limitations, overlapping ulceration, functional limitation

29
Q

What are the surgical options for hallux valgus?

A

Osteotomies (cutting bone) or Aiken technique (break bone and move head laterally)
Aim is to realign hallux and decrease HV angle

30
Q

What are some features of hallux rigidus?

A

Osteoarthritis of 1st MTP joint, non-operative management or surgery (joint replacement or fusion)

31
Q

What are some features of rheumatoid foot?

A

Affects feet in 90% of rheumatoid patients, occurs early in disease, most common reason for surgery of the forefoot

32
Q

What are some features of the pathogenesis of rheumatoid foot?

A

Synovitis, proteinases and collagenases, impaired integrity of joint capsule/ligaments, destruction of hyaline cartilage

33
Q

What are some challenges associated with rheumatoid foot?

A

Multi-joint disease = disability, slower rehab, use of crutches
Systemic effects = vasculitis, ischaemia, ulceration, neuropathy, anaemia, immunosuppression
Psychosocial

34
Q

What are some features of rheumatoid of the hindfoot?

A

Talocalcaneal interosseous ligament, unstable subtalar joint (calcaneus drifts into valgus), medial arch collapses (flat feet), often require multiple joint fusions

35
Q

What is Morton’s neuroma?

A

Degenerative fibrosis of digital nerve near it’s bifurcation

36
Q

What are some features of Morton’s neuroma?

A

Get forefoot pain = metatarsalgia, burning and tingling in toes
Mean age 45-50, more common in females, investigated with USS, can be given insoles or injections, can be excised operatively

37
Q

What are some features of tendo-Achilles tendinosis?

A

Repetitive microtrauma, failure of collagen repair with loss of fibre alignment/structure, hypovascular region 2-6cm proximal to insertion, can be mid-substance or distal

38
Q

What are some risk factors of tendo-Achilles tendinosis?

A

Over-training, steroids, ciprofloxacin, connective tissue diseases

39
Q

How can tendo-Achilles tendinosis present and how can it be diagnosed?

A

Pain, morning stiffness, eases with heat or walking

Diagnosis = USS, MRI

40
Q

What are some management options of tendo-Achilles tendinosis?

A

No steroid injections, activity modifications, analgesia, NSAIDs, shockwave therapy, orthotics, physio, surgery

41
Q

What are some features tendo-Achilles rupture?

A

Usually aged >40, often pre-existing tendinosis, caused by deceleration with resisted calf contraction, people often think someone has hit them

42
Q

What are the signs of tendo-Achilles ruptures?

A

Unable to weight-bear, weak plantar flexion, palpable painful gap, positive Simmond’s (calf squeeze) test

43
Q

How are tendo-Achilles ruptures treated?

A

Operative or non-operative, both involve an extended recovery/cast time, functional outcome normally good

44
Q

What are some features of claw, hammer and mallet toes?

A

Acquired imbalance between flexors and extensors, can cause painful callus/corns with skin breakdown

45
Q

What are some surgical techniques used to treat claw, hammer and mallet toes?

A

Tenotomies (division of tendons), tendon transfer, fusion (PIP), amputation

46
Q

What causes ankle sprains?

A

Twisting forces = commonly inversion/twisting on planted foot
Due to elastic limit of ligaments, typically lateral ligaments (ATFL, CFL)

47
Q

What are some features of ankle sprains?

A

Longer to resolve than fractures, pain, bruising, tenderness, graded 1-3 (grade 3 is complete rupture)

48
Q

What are some treatments for ankle sprains?

A 
Non-operative = RICE, physio (strength, stability, proprioception)
Operative = Brostrom Gould (improves stability be repairing lateral ligaments), Chrisman Snook (long recovery and often causes post-operative stiff ankle)
49
Q

What causes ankle fractures?

A

Caused by twisting forces (common injury)

50
Q

What are some ways to classify ankle fractures?

A

Weber classification = A-C

Lauge Hansen = based on foot position and force applied

51
Q

What is a stable ankle fracture?

A

Distal fibula fracture with no medial malleolus fracture or deltoid ligament rupture

52
Q

What is an unstable ankle fracture?

A

Distal fibula fracture with medial malleolus fracture or deltoid ligament rupture

53
Q

What is a Pilon fracture of the ankle?

A

High energy injury, significant soft tissue problem, often have other injuries, damage to joint may lead to osteoarthritis, may need amputation

54
Q

What cause 5th metatarsal fractures?

A

Inversion injury, very common injury

55
Q

What are some examples of 5th metatarsal fractures?

A

Avulsion by peroneus brevis tendon = heal predictably in moonboot
Jones fracture = poor blood supply, 25% risk of non-union
Proximal shaft = common site for stress fracture

56
Q

What are some features of a Lisfranc injury to the foot?

A

Tarsometatarsal fracture dislocation, high energy, require fixation, risk of osteoarthritis, often subtle on imaging

57
Q

What are some features of a calcaneus fracture?

A

Fall from height, often also have spinal injury, often intra-articular, significant swelling, risk of compartment syndrome

58
Q

What are some features of a talus fracture?

A

Caused by forced dorsiflexion/rapid deceleration, talus has reversed blood supply, risk of avascular necrosis and osteoarthritis

Musculoskeletal (57 decks)

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