Adult foot and ankle disorders Flashcards
What does a larger calcaneous allow us to do
Propel ourselves away
what are the anatomical structures in the lateral and hindfoot
distal fibula and fibula shaft ankle lateral gutter and syndesmosis lateral wall calcaneous perpnei CFL and ATFL sural nerve
What is the most commonly sprained ligament in the ankle
AFTL
What anatomical structures are in the medial and hindfoot
Medial malleolus Anteriomedial tibiotalar joint Deltoid ligament PTT (tom), FDL (dick), FHL (harry) Posterior tibial artery
What anatomical structures are found in the posterior ankle and hindfoot
Achilles tendon Calcaneal insertion Retrocalcaneal space Peroneal tendons FHL EDL Saphenous Nerve
What anatomical structures are located in the plantar topography
2nd MT Base 5th MT Base Tibialis P. Insertion Master knot of Henry Cuboid tunnel
How exposed should a patient be when examining the foot and ankle
Bare to the knee
What is Pes Planus more commonly known as
Flat Feet
Describe the Jack’s test
Push the child’s big toe up. If a nice arch is formed, the test is positive
What is the most common cause of acquired flatfoot deformity in adults
Tibialis Posterior Dysfunction
How do you test for Tibialis Posterior Dysfunction
Get the patient to go up on their tiptoes
Where does the tibialis posterior lie
Immediately posterior to the medial malleolus attaching on the navicular tuberosity and plantar aspect of medial and middle cuneiforms
What is the main function of tibialis posterior
To elevate the arch
What group of patients are a higher risk of developing tubialis posterior
Obese middle aged females
Increases with age
What is the common presentation of tibias posterior dysfunction
Pain and / or swelling posterior to medial malleolus
They may notice the foot has begun to change shape
What are some of the treatment options for TPD
Physiotherapy
Insole to support the arch
NO STEROID INJECTIONS
surgery
What is Pes Cavus more commonly known as
High arches
What is the common cause for Pes Cavus
Idiopathic
What is the best treatment for Pes Cavus
Surgery
What type of injuries are common in Pes Cavus
Ankle sprains
Describe the pain caused by plantar fasciitis
Pain after rest
Can be worse after exercise
Tenderness over the plantar aspect of heel
EXTREMELY PAINFUL
Plantar fasciitis has what test positive and what is this test for
Tinel’s test for Baxter’s nerve
What are some of the causes of plantar fasciitis
Physical overload excessive exercise or weight Seronegative arthropahy Diabetes Abnormal foot shape Improper foot wear
What is the treatment for plantar fasciitis
NSAIDS
Night splints
Taping/ resting
Usually self management
Describe Hallux Valgus
The great toe points laterally and has subsequent effects of the rest of the forefoot
Describe the incidence of Hallux Valgus
Increases with age
Usually bilateral
Females more than males
Adolescent subgroup
Describe the aetiology of Hallux Valgus
Some familial Shoes General joint laxity Rheumatoid Splayed forefoot associated with loss of muscle tone and age
What are the non-operative options for Hallux Valgus
shoe modification and padding
What is the aim in operating on Hallux Valgus
Aim to realign the hallux and decreased the HV angle
Correct any lesser toe deformities at same time
Describe the operation for Hallux Valgus
Break the bone and move the head laterally
What is Morton’s neuroma
Degenerative fibrosis of digital nerve near its bifurcation
Describe the presenting complaint from a patient with Morton’s neuroma
Burning and tingling in the toes
What is tendinosis
A tendonopathy
What is the management of Tendo-Achilles Tendinosis
Activity modifications/ analgesia NSAIDs Shockwave therapy Orthotics Physio Surgery
What age group are at a higher risk of Tendo-Achilles Rupture
Usually over 40s
Describe the clinical presentation of Tendo-Achilles Rupture
Unable to bear weight
Weak plantar flexion
Palpable painful gap
Positive calf squeeze (Simmonds) test)
Describe how the Simmonds test is performed
The patient kneels on a chair and you squeeze their calf. If the foot does not move this is a positive Simmonds test
What is the management for Tendo-Achilles Rupture
Operative
Non operative
Both involve an extended recovery/ cast time
Functional outcome normally good
What are the 4 different type of deformed toes that you can get
Hammer
Claw
Curly
Mallet
In all 4 toe deformities, what is the underlying problem
Slight hyperextension of PTJ
What are the common presentations of ankle sprains
Pain, bruising and tenderness
What is the management for a sprained ankle
Analgesia Rest Ice Compression Elevation
What does the Weber Classification show
The location of the fracture
What is the problem with the Weber Classification
It does not take the Malleolus into account
When do we operate on a Pilon Fracture
Rarely straight away - usually wait 1 week
