Adult Foot and Ankle Disorders Flashcards
What is the test to see how tight the gastrocneumius is?
Silverskiolds- dorsiflfexion with a straight leg and then with knee bent
What is the common name for pes planus?
flat feet
How can you tell flexible flat feet from inflexible?
flexible flat feet form an arch when the patient tip-toes
What is the most common cause of acquired flat feet in adults?
tibialis posterior dysfunction
What is the course of the tibialis posterior?
courses immediately posterior to medial malleolus and attaches on to the plantar aspect of medial and middle cuneiforms and navicular
What are the functions of tibialis posterior?
invertor; plantar-flexor; stabilises the medial longitudinal arch- elevates arch
Who is tibialis posterior dyfunction typically seen in ?
obese middle aged females (increases with age)
What are the conditions associated with tibialis posterior dysfunction?
hypertension; diabetes; seronegative arthropathies; tendinosis
What are the symtpons of tibialis posterior dysfunction?
pain and/or swelling posterior to medial malleolus; change in foot shape; diminshed walk ability/blanace and dislike of uneven surfaces; more noticeable hallux valgus; lateral wall “impingement” pain
What are the treatment options of tibialis posterior dysfunction?
PT; insoles to support medial longitudinal arch
What is pes cavus?
high arched feet
What are the causes of pes cavus?
mainly idiopathic but neurological- CP; polio; spina bifida
How does plantar fasciitis present?
start-up pain after rest:usually when wake-up; fullness or swelling and tenderness plantarmedial aspect of heel; sharp stabbing pain
What causes plantar fasciitis?
physical overload; seronegatvie arthropathy; diabetes; abonrmal foot shape; improper footwear
What are the treatments for plantar fasciitis?
NSAIDs; PT; heel cups or medial arch supports
What is the prognosis for plantar fasciitis?
usually self-limiting over 18-24 months
Why can hallux valgus be caused by flat feet?
if feet are always falling inwards, hallux tries to ocmpensate
Who gets hallux valgus?
increases ewith age; usually bilateral; females 3x more than males
What can cause hallux vlagus?
familial; shoes; general joint laxity; RA
What are the problems associated with hallux valgus?
transfer metersalgia;lesser toe impingement; pin; deformity; shoe difficulties
What is transfer metatarsalgia?
2nd toe has to take over main weight bearing and this causes pain
What is the management for hallux valgus?
shoe modificatiosn, padding etc; operative-osteotomy
What is hallux rigidus?
OA of 1st MTPJ
What are the operative options for hallux rigidus?
joint replacement and fusion
What is the pathogenesis of rheumatoid foot?
synovitis; proteinases and collagenases; impaired integrity of joint capsules/ligaments; destruction of hyaline cartilage
What is morton’s neuroma?
degenerative fibrosis of digital nerve near its bifurcation
What are the symptoms of mortons neuroma?
forefoot pain (metatarsalgia); burning and tingling in toes
Who gets mortons neuroma/
45-50 years; F>M
What occurs with tendo-achilles tendinosis?
repetitive microtrauma, failure of collagen repair with loss of fibre alignment/structure
What are the symptoms of achilles tendinosis?
pain; morning stiffness, eases with heat/ walking
What are implicated as causes for achilles tendinosis?
over-training, some drugs- ciprofloxacin, steroids;
What are the treatment options for achilles tendinosis?
activity modifications/analgesia/ NSAIDs; shockwave therapy; orthotics; PT; surgery
What is seen on presentation of an achilles rupture?
sudden decelration with resisted calf contraction; unable to weight bear; weak plantar flexion; palpable painful gap; positive calf squeeze- if foot fails to flex (simmonsds test)
Who gets an achilles rupture?
usually over 40s; pre-existing tendinosis
What causes claw, hammer and mallet toes?
an acquired imbalance between flexors and extensores
What happens with claw toes?
hyperextension; flexion; flexion
What happens with mallet toe?
flexion only at DIP
What happens with hammer toe?
hyperextension; flexion; normal
What is the management for claw, hammer and mallet toes?
surgery- tenonotomes tendon transger; fusion
What type of trauma causes an ankle sprain?
twisting forces- commonly inversion or twisting forces on a planted foot
What is the presentation of an ankle sprain?
pain; bruising and tenderness
What happens with an ankle sprain?
the elastic limit of ligaments is reached which causes a tear
What is the management for ankle sprains?
RICE- rest; ice; compression and elevation; PT
What are the classifications for ankle fractures?
Webers- A- below syndesmoses
B- around syndesmoses
C- above the syndesmoses
What is significant about Weber class C fractures?
unstable until proven otehrwise
What is a stable ankle fracture?
a distal fibula fracture with no medial malleolus fracture or deltoid ligament rupture
What causes an ankle fracture to be unstable?
medial malleolus fracture or deltoid ligament rupture, talar shift
What is a Pilon fracture?
A fracture involving the distal end of the tibia at its articulation at the ankle joint
What usually causes a 5th metatarsal fracture?
an inversion injury
What is a Lisfranc fracture?
an injury where one or more of the metatarsals are dislocated from the tarsal bones
What often causes a calcaneus fracture?
landing on heal when falling from a height
What is it important to do with a calcaneus fracture?
check for other injuries
