Adult Foot and Ankle Disorders Flashcards
how has the big toe changed over time and why?
has become bigger and more vertical to allow weight bearing and ability to push off
where are the peroneal tendons and what do they do?
lateral foot
support the ankle (often affected by a sprain)
everts the foot
what are the most commonly affected structures in an ankle sprain?
CFL and ATFL
what is the acronym for the structures of the medial hindfoot?
Tom Dick and Harry
tp fdl fhl
what are the features of the medial and hindfoot?
medial malleolus anteromedial tibiotalar joint deltoid ligament PTT, FDL, FHL posterior tibial artery
what are the features of the lateral and hindfoot?
…
what are the features of the posterior ankle and hindfoot?
achilles tendon calcaneal insertion retrocalcaneal space peroneal tendons FHL
what are the features of the anterior ankle?
anterior ankle joint superficial peroneal nerve EHL EDL saphenous nerve
what are the 5 nerves of the foot?
saphenous superficial peroneal/fibular deep peroneal/fibular tibial (branches into 2) sural nerve
what are the features of the plantar surface of the foot?
heel pad 5th metatarsal base plantar fascia metatarsal heads Tib posterior insertion
what are the 3 rockers of gait?
1st = heel strike to flat foot 2nd = mid stance 3rd = heel rise
what is Thompson/simmons test and what doe sit show?
gentle squeeze on calf muscles should produce a slight movement of the toes
indicates achilles tendon rupture if no movement occurs
when does the arch in the foot normally appear?
6-7 years
is flat feet always abnormal?
no
usually normal unless asymmetrical
what does tibialis posterior dysfunction cause?
most common cause of acquired flatfoot syndrome in adults
can be present for years before diagnosis
what is the presenting symptom in tibialis posterior dysfunction?
cant push off properly when walking, can be difficult and painful (esp. on uneven ground)
usually in elderly
pain +/- swelling posterior to medial malleolus (very specific)
change in foot shape
noticeable hallux valgus
lateral wall impingement pain
midfoot and ankle pain
what is the course of tibialis posterior?
..
what are the risk factors for tibialis posterior dysfunction?
obese middle aged female age flat foot hypertension diabetes steroid injection seronegative arthropathies idiopathic tendonitis
how is TPD treated?
physio often enough if caught early with insole to support medial longitudinal arch steroid injections? orthoses to accommodate foot shape bespoke footwear surgery
what is pes cavus?
high arch??
what causes pes cavus?
mostly idiopathic
can be neurological (HSMN, CP, Polio, spina bifida, club foot)
what can pes cavus affect?
can cause clawing of toes
how is pes cavus treated?
surgery if complex
what are the symptoms of plantar fasciitis?
start up pain after rest
can be worse after exercise
…..
…..
what causes plantar fasciitis?
physical overload (exercise, weight etc) seronegative arthropathy diabetes abnormal foot shape improper foot shape
how is plantar fasciitis treated?
NSAIDs night splints taping heel cups/arch supports physiotherapy steroid injections ECSWL surgery rarely usually self limiting
what is a bunion?
deformity at first MTP joint
AKA hallux valgus
what are the risk factors for bunions?
age female some are familial shoes general joint laxity rheumatoid splayed forefoot
what causes pain in bunions?
medial nerve
from bursur
intrinsic pain in the joint (wear and tear as its not functioning properly)
big toe becomes non function so you load through the other 4 toes
how is hallux valgus treated?
non-surgical - shoes, padding etc
surgical - not always a great outcome
what problems can occur with hallux valgus?
transfer metatarsalgia
lesser toe impingement
pain, deformity, cosmesis
shoe difficulties
how is hallux valgus surgery performed?
scarf/akin procedure
break the bone and move the head laterally
what is hallux rigidus?
OA of the first MTP joint (big toe)
what causes hallux rigidus?
general wear and tear
how is hallux rigidus managed?
usually settles a bit with time
non-operative - footwear, support etc
operative - joint replacement and fusion of the joint
how does rheumatoid arthritis affect the foot?
90% of cases affect the feet
occurs early in disease
usually affects the forefoot
can deform the toes
describe the pathogenesis of rheumatoid foot?
synovitis > proteinases and collagenases > impaired integrity of joint capsules/ligaments > destruction of hyaline cartilage
what is charcots foot?
weakening of the bones in the foot in people with neuropathy (mainly diabetic)
how is charcots foot managed?
mainly conservative
surgery in some cases if conservative measures fail?
what can happen in charcots foot?
worsening deformity, ulceration, osteomyelitis
midfoot instability
what must be considered in charcots foot surgery?
optimise co-morbidities (diet etc)
soft tissue envelope from previous surgery
location of the deformity
timing
presence of infection or osteomyelitis (don’t operate if present)
what type of surgery is done in charcots foot?
fixation surgery
primary internal, primary external or combination of both
or staged reconstruction
when is external fixation used?
high risk patients with poor soft tissue envolope
what are the issues with external fixation?
metal scaffold is unpleasant and difficult for the patient
exposed to shear not axial forces
can injure other leg during sleep etc
what is mortons neuroma?
degenerative fibrosis of digital nerve near its bifurcation (between 3rd and 4th does)
what are the features of mortons neuroma?
forefoot pain (metatarsalgia) burning and tingling in the toes
who does mortons neuroma usually occur in?
middle aged females
how is mortons neuroma diagnosed?
examination - painful when squeezed
US
how is mortons neuroma managed?
non-surgical (insoles, injections)
surgical - excision
what is tendo-achilles tendinosis?
repetitive microtrauma, failure of collagen with loss of fibre alignment/structure
commonly causes by over training (running)
what are the features of tendo-achilles-tendinosis?
pain
morning stiffness
eases with heat and walking
how is tendo-achilles tendinosis treated?
…
