Adult Foot & Ankle disorders Flashcards
Describe the deltoid ligament of the ankle.
fans from medial malleolus & attacks distally to talus, calcaneus and navicular via 4 parts; tibionavicular anterior tibiotalartibiotalar tibiocalcaneal posterior
Describe the lateral ligaments of the ankle.
anterior talofibular
calcaneofibular
posterior talofibular
What is pes planus?
a normal variant in 20% of population - flexible flat feet that form an arch when the patient tiptoes.
What is the most common cause of acquired flat foot? And what are the risk factors for developing this?
tibialis posterior dysfunction obese middle aged female increases with age hypertension/diabetes/steroid injection seronegative arthropathies
Describe the course and function of tibias posterior.
courses immediately posterior to medial malleolus; attaches to navicular tuberosity & plantar aspect of medial and middle cuneiforms.
primary dynamic stabiliser of medial longitudinal arch - elevates arch.
investor and plantar flexor
What are the clinical signs of acquired flat foot and how do you treat it?
** pain ± swelling posterior to medial malleolus - very specific **
diminished walking ability/balance, dislikes uneven surfaces, more noticeable hallux valgus, midfoot & ankle pain
“too many toes”, cannot single heel raise
DO NOT GIVE STEROID INJECTION
tendonitis -> split & medial arch support to avoid rupture
surgical decompression if this fails; orthoses, physio
What is pes cavus? And how is it managed?
An abnormally high arched foot - clawing of toes often accompanies it - idiopathic commonest cause
pain -> soft tissue release & tendon transfer (lateral transfer of tibias anterior)
A basketball player that trains 5x a week presents with pain worse on his toes, on walking upstairs and is worse after exercise. What test would you do and what is your diagnosis?
Tinel’s test +ve for Baxter’s nerve = Plantar fasciitis
Tenderness localised over plantar aspect of heel (where aponeurosis attaches proximally to the medial tubercle of calcaneus)
Baxter’s nerve is the 1st branch of the lateral planter nerve - from tibial nerve
What are some clinical signs of Plantar fasciitis? And what is the treatment?
start-up pain after rest e.g. in the morning - relieved after short time
“heel spurs” protruding from calcaneus - “heel pad pain syndrome”
physical exercise/excessive wight, improper footwear
self-limiting but can use NSAIDs, night splints, taping, medial arch supports, physio, steroid injections
What is hallux valgus?
“bunions”
A deformity of the great toe due to medial deviation of the 1st metatarsal + lateral deviation of the toe itself.
What are the treatment options for an elderly lady with bilateral bunions, made worse after long walks?
wider shoes / spacer in 1st web space
operational management aims to realign hallux & reduce the HV angle (can correct any lesser deformities at same time).
What is a sign of a serve case of hallux valgus?
hallux overrides 2nd toe
What is hallux rigidus and what is the gold standard treatment?
OA of the 1st MTP joint -> arthrodesis (fusion); small sacrifice of no motion but alleviates pain
A 45 y/o lady present with a burning/tingling sensation between her 3rd and 4th toes. What is your diagnosis, investigations & treatment options?
Morton’s neuroma - degenerative fibrosis of interdigital nerves near its bifurcation (medial & lateral plantar nerves)
Squeeze forefoot with hand - can reproduce symptoms or give a ‘click’ = Mulder’s click test
USS for diagnosis - swollen nerve
non-op -> offloading insoles, steroid injections
op -> excise neuroma
Describe the pathogenesis of tends-achilles tendonitis & which section of the tendon as at most risk and way?
Repetive micro-trauma, failure of collagen repair with loss of fibre alignment/structure
hypo vascular region 2-6cm proximal to insertion -> midsection of tendon at increased risk
