adult foot and ankle disorders Flashcards
What is pes planus?
flat feet
What is pes cavus?
high arched feet
The older we get the feet get flatter T/F
T
What is the most common cause of acquired flatfoot deformity in adults?
Tibialis posterior dysfunction
Where does the tibialis posterior tendon run
courses immediately posterior to medial malleolus
Attaches to navicular tuber sty and plantar aspect of medial and middle cuneiform
What is the function of the tibias posterior tendon?
primary dynamic stabiliser of medial longitudinal arch-elevates arch
What are RF for tibias posterior dysfunction?
obese middle aged women increase with age flat foot hypertension diabetes steroid injetion seronegative antibodies idiopathic tendonosis
What does Tibias posterior dysfunction look like?
pain and/or swelling posterior to medial malleolus-very specific change in foot shape diminished walking ability/balance mid foot and ankle pain lateral wall "impingement" pain
What is the treatment for arthritic joints in foot?
fuse it
high arch, clawing taws, stiff, tight
think neurology esp if asymmetric, new and progressive
What is the treatment for TPD?
physio
insole to support medial longitudinal arch
orthoses to accommodate foot shape
NO steroid injecitons- the tendon will just rupture
surgery
Plantar fasciitis cause
physical overload seronegative arthropathy diabeted abnoraml foot shape improper footwear
plantar fasciitis treatments
NSAIDS night splints taping heel cups or medial arch supports physio steroid injection Surgery- only 50% success
Plantar fasciitis is self-limiting
True - lasts 18-24 months
What are the causes of pes cavus
idiopathic commonest
variety of other causes - HSMN,CP,Polio,Spina bifida, club foot
Bunion(Hallux valgus) background
familial background
but inappropriate footwear such as heel can make it worse
general joint laxity/CTDs
What is plantar fasciitis?
fullness or swelling plantar medial aspect of heel
(tenderness over plantar aspect of heel and/or plantar medial aspect of heel)
Tinel’s test positive for Baxter’s nerve
Incidence of hallux valgus
increases with age
usually bilateral
3F>1M
adolescent subgroup
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
They get forefoot pain and burning and tinging in toes
What is the management of Morton’s neuroma
Non -op (insoles, injections)
Operative (excise)
What is tendon-achilles tendinosis?
Repetitive microtrauma,failure of collagen repair with loss of fibre alignment/structure
pain, morning stiffness, eases with heat/walking
What is the management of tendon-achilles tendonosis?
Activity modification/analgesia NSAIDs shockwave therapy orthotics physio surgery
Who does tend-achilles rupture occur in?
usually over 40s
often pre-existing tendinosis
sudden declaration with resisted calf contraction
patients often think somebody had hit them
What does tend-achilles rupture look like clinically?
unable to bear weight
weak plantar flexion
palpable painful gap
positive calf squeeze (Simmonds) test
What is Hammer toe?
PIP joint flexing
What is curly toes?
The whole thing flexing
What is claw toe?
a toe that is contracted at the PIP and DIP joints
What is mallet toe?
joint at the end of the toe cannot straighten
What is ankle sprain?
elastic limit of ligaments
longer to resolve than fracture
typically lateral ligaments
pain, bruising and tenderness
What is the surgery of claw hammer and mallet toes?
tenotomies ( division of tendons), tendon transfer, fusions (PIP) or amputation
What is the management of ankle sprain?
Non-operative
- RICE
- Physiotherpay- strength, stability,proprioception
Operative
-Brostrum Gould
What is the Weber classification?
The commonest classification for ankle fractures
Weber a- fractures affecting just the tip of the lateral malleolus
Weber b- goes through the syndesmoses (communication between tibia and fibula)
Weber c-above the level of the ankle joint
