Adult Foot and Ankle Problems Flashcards
another name for hallux valgus
bunion
what is hallux valgus?
there is medial deviation of the 1st metatarsal and lateral deviation of the toe with a bony lump appearing on the medial side
risk factors for hallux valgus
FH age shoes RA neuromuscular diseases e.g. cerebral palsy
presentation of hallux valgus
pain and skin breakdown due to rubbing on shoe leading to inflamed bursa
usually bilateral
management of hallux valgus
shoes
use of spacer to prevent rubbing of toes and impingement
surgery for cosmetic reasons
surgery options for hallux valgus (most dissatisfied)
Scarf/Akin osteotomy
what is hallux rigidus?
first MTPJ OA
what causes hallux rigidus?
degeneration
or secondary to injury
management of hallux rigidus
stiff soled shoes to limit motion
removal of osteophytes
arthrodesis (GOLD STANDARD)
joint replacement
what is primus varus?
first metatarsal bone is angled away from the second
what is morton’s neuroma?
plantar interdigital nerve is subject to repeated trauma leading to inflammation, swelling and fibrosis forming a neuroma
presentation of morton’s neuroma
metatarsalgia (inflamed ball of foot)
burning can radiate to affected toe
diagnosis of morton’s neuroma
loss of sensation in affected web space (often 2nd or 3rd)
Mulder’s click test (compression of metatarsal head)
USS of swollen nerve
management of morton’s neuroma
pad/insole
steroids and anaesthetic injections
surgical excision (small risk of reoccurrence)
what causes Achilles tendonitis?
repetitive strain
OR degeneration
risk factors for achilles tendonitis
quinolone antibiotics
RA
inflammatory arthropathies
gout
presentation of achilles tendonitis
pain
morning stiffness
eases with heat/walking
management of achilles tendonitis
rest physiotherapy heel raise to offload tendon orthotic splint boot
what does achilles tendonitis predispose to?
rupture
what should you never use with a tendon injury?
steroid injections
what causes achilles tendon rupture?
sudden deceleration with resisted calf muscle contraction
presentation of achilles tendon rupture
pain
difficulty bearing weight
palpable gap
diagnosis of achilles tendon rupture
Simmond’s test
what is a positive Simmond’s test result?
no plantarflexion of foot when squeezing calf
management of achilles tendon rupture
surgery
casting in equinous position
what is an ankle sprain?
injury to ligaments in the foot caused by twisting forces
classification of ankle sprain
Graded 1-3 OR Weber’s classification
presentation of ankle sprain
pain
bruising
tenderness
what is Ottowa’s XR criteria?
criteria used to decide whether foot and ankle injuries need an XR
management of ankle sprain
RICE
physiotherapy
what is plantar fasciitis?
this is repetitive stress/overload/ degeneration to fascia on the sole of the foot
risk factors for plantar fasciits
obesity
DM
frequent walking
age (fat pad atrophies)
presentation of plantar fasciitis
start-up pain after rest
pain after exercise
swelling of plantar medial aspect of heel with tenderness
management of plantar fasciitis
NSAIDs and rest gel filled heel pad night splint stretching/physio steroid injections
how long does it take plantar fasciitis to resolve?
2 years
what does the tibialis posterior tendon support?
medial arch and plantar flexion of the foot
what is a common cause of tibialis posterior tendon dysfunction?
pes planus (flat feet)
presentation of tibialis posterior tendon dysfunction
pain
swelling posterior to medial malleolus
diminished walking ability/balance
dislike of uneven surfaces
management of tibialis posterior tendon dysfunction
physio insoles footwear splinting surgical decompression and tendon transfer
can claw and hammer toes happen in fingers too?
yes
what is a claw toe
hyperextension of MTPJ with hyperflexion at PIPJ and DIPJ
what is a hammer toe?
hyperextension at DIPJ
what is a mallet toe?
resisted extension
presentation of abnormal toes
pain
skin breakdown due to rubbing
management of abnormal toes
toe sleeves and plasters
tendon surgery
arthrodesis
amputation
