Adult Foot and Ankle Problems

Question 1

another name for hallux valgus

Answer 1

bunion

Question 2

what is hallux valgus?

Answer 2

there is medial deviation of the 1st metatarsal and lateral deviation of the toe with a bony lump appearing on the medial side

Question 3

risk factors for hallux valgus

Answer 3

FH
age
shoes
RA
neuromuscular diseases e.g. cerebral palsy

Question 4

presentation of hallux valgus

Answer 4

pain and skin breakdown due to rubbing on shoe leading to inflamed bursa
usually bilateral

Question 5

management of hallux valgus

Answer 5

shoes
use of spacer to prevent rubbing of toes and impingement
surgery for cosmetic reasons

Question 6

surgery options for hallux valgus (most dissatisfied)

Answer 6

Scarf/Akin osteotomy

Question 7

what is hallux rigidus?

Answer 7

first MTPJ OA

Question 8

what causes hallux rigidus?

Answer 8

degeneration

or secondary to injury

Question 9

management of hallux rigidus

Answer 9

stiff soled shoes to limit motion
removal of osteophytes
arthrodesis (GOLD STANDARD)
joint replacement

Question 10

what is primus varus?

Answer 10

first metatarsal bone is angled away from the second

Question 11

what is morton’s neuroma?

Answer 11

plantar interdigital nerve is subject to repeated trauma leading to inflammation, swelling and fibrosis forming a neuroma

Question 12

presentation of morton’s neuroma

Answer 12

metatarsalgia (inflamed ball of foot)

burning can radiate to affected toe

Question 13

diagnosis of morton’s neuroma

Answer 13

loss of sensation in affected web space (often 2nd or 3rd)
Mulder’s click test (compression of metatarsal head)
USS of swollen nerve

Question 14

management of morton’s neuroma

Answer 14

pad/insole
steroids and anaesthetic injections
surgical excision (small risk of reoccurrence)

Question 15

what causes Achilles tendonitis?

Answer 15

repetitive strain

OR degeneration

Question 16

risk factors for achilles tendonitis

Answer 16

quinolone antibiotics
RA
inflammatory arthropathies
gout

Question 17

presentation of achilles tendonitis

Answer 17

pain
morning stiffness
eases with heat/walking

Question 18

management of achilles tendonitis

Answer 18

rest
physiotherapy
heel raise to offload tendon
orthotic splint
boot

Question 19

what does achilles tendonitis predispose to?

Answer 19

rupture

Question 20

what should you never use with a tendon injury?

Answer 20

steroid injections

Question 21

what causes achilles tendon rupture?

Answer 21

sudden deceleration with resisted calf muscle contraction

Question 22

presentation of achilles tendon rupture

Answer 22

pain
difficulty bearing weight
palpable gap

Question 23

diagnosis of achilles tendon rupture

Answer 23

Simmond’s test

Question 24

what is a positive Simmond’s test result?

Answer 24

no plantarflexion of foot when squeezing calf

Question 25

management of achilles tendon rupture

Answer 25

surgery | casting in equinous position

Question 26

what is an ankle sprain?

Answer 26

injury to ligaments in the foot caused by twisting forces

Question 27

classification of ankle sprain

Answer 27

Graded 1-3 OR Weber's classification

Question 28

presentation of ankle sprain

Answer 28

pain bruising tenderness

Question 29

what is Ottowa's XR criteria?

Answer 29

criteria used to decide whether foot and ankle injuries need an XR

Question 30

management of ankle sprain

Answer 30

RICE | physiotherapy

Question 31

what is plantar fasciitis?

Answer 31

this is repetitive stress/overload/ degeneration to fascia on the sole of the foot

Question 32

risk factors for plantar fasciits

Answer 32

obesity DM frequent walking age (fat pad atrophies)

Question 33

presentation of plantar fasciitis

Answer 33

start-up pain after rest pain after exercise swelling of plantar medial aspect of heel with tenderness

Question 34

management of plantar fasciitis

Answer 34

``` NSAIDs and rest gel filled heel pad night splint stretching/physio steroid injections ```

Question 35

how long does it take plantar fasciitis to resolve?

Answer 35

2 years

Question 36

what does the tibialis posterior tendon support?

Answer 36

medial arch and plantar flexion of the foot

Question 37

what is a common cause of tibialis posterior tendon dysfunction?

Answer 37

pes planus (flat feet)

Question 38

presentation of tibialis posterior tendon dysfunction

Answer 38

pain swelling posterior to medial malleolus diminished walking ability/balance dislike of uneven surfaces

Question 39

management of tibialis posterior tendon dysfunction

Answer 39

``` physio insoles footwear splinting surgical decompression and tendon transfer ```

Question 40

can claw and hammer toes happen in fingers too?

Answer 40

yes

Question 41

what is a claw toe

Answer 41

hyperextension of MTPJ with hyperflexion at PIPJ and DIPJ

Question 42

what is a hammer toe?

Answer 42

hyperextension at DIPJ

Question 43

what is a mallet toe?

Answer 43

resisted extension

Question 44

presentation of abnormal toes

Answer 44

pain | skin breakdown due to rubbing

Question 45

management of abnormal toes

Answer 45

toe sleeves and plasters tendon surgery arthrodesis amputation