Adult Foot Disorders Flashcards
What are bunions?
fluid filled bursae around bony prominences - they form as a natural response to pressure
what are corns?
painful areas of thickened excess skin in response to high pressure
How are corns and bunions treated?
removal of the underlying cause
What is hallux valgus?
turning away of the phalanges of the big toe from the mid-line.
What is hallux rigidus?
osteoarthritis of the big toe
How is HR treated in adolescents?
it is thought to be caused by osteochondral fracture - a metatarsal bar is used conservatively but young people do not like this cosmetically so surgery is needed
How is HR treated in adults?
it can present at any age and commonly alongside HV. conservative methods in adults rarely work and surgery is required
What is involved in HR surgery?
Surgical removal of the osteophytes with an osteotomy of the proximal phalanx is often sufficient for minor cases. Surgical fusion in a neutral position is most reliable and despite the folklore this rarely gives women problems with shoe heel height. Inter- position arthroplasty with a silicone plastic (silastic) spacer is an alternative which gives mixed results.
How is HV treated?
realignment o the first metatarsal to a more lateral position and excision of any bony prominence can give satisfactory results.
Keller’s procedure if this is ineffective
What is Keller’s Procedure?
excision of the 1st MTP joint
In what combination of conditions is Keller’s arthroplasty useful?
HV and HR
What is claw foot?
Wasting of the muscles of the feet make the bones and nails more prominent so they appear like claws
What are hammer toes?
abnormalities of the foot that lead to prolapse of metatarsal heads and disruption of the MTP joints
How is surgery for hammer toes done?
fusion of the ITP joints in a straight position - often unsatisfactory
good comfortable shoes is usually all that is required
What is a neuroma?
cutaneous nerves between the toes become trapped or irritated and give rise to a neuroma. receptive trauma is the cause
What is the pain like in neuromas?
dull and throbbing
Is surgery a good option in neuromas?
No - commonly leaves a sensory deficit and recurrence is very common.
What is the cure for ingrown toenails?
careful nail care and straight cutting
it may be necessary to remove the nail to clear chronic infection
What is the plantar fascia?
a tough layer of fibrous tissue which connects the toe bases to the heel
What is plantar fasciitis and how is it caused?
it is pain, commonly on the instep of the foot caused by inflammation of the PF
it is caused by repetitive strain/injury e.g. long distance runners
How is PF treated?
it is self-limiting
NSAIDs
rest
local steroid injection
surgery is unpredictable and is done by stripping the fascia from the os calcis.
What condition can cause neuropathic feet?
Diabetes
How does achilles tendinitis occur in young athletes?
over-use
the area may be tender or swollen
surgical decompression
steroid injection - NOT INTO THE TENDON A THIS MAY CAUSE RUPTURE
How does achilles tendon rupture occur in middle-aged men?
a period of discomfort may precede this - degeneration of the tendinous tissue.
Blood supply is poor to the lower achille tendon and is vulnerable in people still active into middle age
How is achilles rupture treated?
the ankle is kept in equinous paster for 8 weeks minimum.
The tendon is sutured either closed or open (more risky)
What is the risk of re-rupture of the achilles tendon after repair?
high risk