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Year 2- MSK > Ankle and foot > Flashcards

Ankle and foot Flashcards

1
Q

Red flag: Rheumatoid arthritis of the foot/ankle

A
  • Metacarpophalangeal mainly affected and can involve proximal interphalangeal joint
  • Swelling and stiffness
  • Nodules
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2
Q

Red flag: Psoriatic arthritis

A
  • Distal interphalangeal joints affected mainly
  • Dactylitis
  • Nail bed pitting
  • Nail bed separation
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3
Q

Red flag: Achilles tendon rupture

A
  • Audible snap during activity
  • Sudden significant pain in calf/ankle
  • Inability to continue with activity
  • Unable to single leg heel raise
  • Simmons triad - altered angle of declination, palpable gap and a positive thompson test
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4
Q

Red flag: Charcot foot

A

A disease which attacks the bones, joints and soft tissue in your feet
- Neuropathy
- Trauma history
- Hot, swollen foot
- Bounding pedal pulses in early stages
- May develop bone infection and/or inflammation of the joint membrane

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5
Q

Red flag: Navicular AVN

A
  • Midfoot pain over the dorsomedial aspect of the foot
  • Stiffness in hindfoot/midfoot
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6
Q

Red flag: Compartment syndrome

A

5 P’s
- Pain
- Pallor
- Paraesthesia
- Pulselessness
- Paralysis

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7
Q

Red flag: Lower limb DVT

A
  • Throbbing or cramping pain in affected leg
  • Usually in calf or thigh
  • Swelling
  • Swollen veins
  • Breathlessness or chest pain
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8
Q

Achilles tendinopathy: Pathophysiology

A
  1. Mid portion= non-insertional tendinopathy, approx 2-6cm above insertion. Due to poor vascular supply
  2. Insertional= tendinopathy of the insertion on the calcaneous
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9
Q

Achilles tendinopathy: Mid-portion risk factors

A
  • Certain drugs- e.g corticosteriods
  • Diabetes
  • History of injury
  • Factors associated with training
  • Increased cholesterol
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10
Q

Achilles tendinopathy: Insertional risk factors

A
  • Increasing age
  • RA
  • New exercise
  • Inappropriate footwear
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11
Q

Clinical presentation, signs and symptoms of Achilles tendinopathy

A
  • Pain either at mid portion or insertion on the calcaneous
  • Aggr factors: activity or direct pressure
  • Occur gradually
  • Some people can present with both
  • Stiffnes in morning and after prolonged rest
  • Mid portion= aching pain
  • Insertional= sharp pain in heel
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12
Q

Special tests/objective findings for Achilles tendinopathy

A
  • Antalgic gait
  • Haglunds deformity (lump on back of heel)
  • Pain reproduced with hopping and heel-raise endurance test
  • Most demonstrate full range with pain on active plantar flexion
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13
Q

Management of Achilles Tendinopathy

A
  • Education, symptom management and self management
  • Rest initially and gradually increase activity
  • Modifications of activities
  • PEACE & LOVE approach
  • Direct to GP
    If no improvement in 7-10 days:
  • Physio: eccentric exercise or a heavy load, slow-speed exercise programme
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14
Q

Achilles tendon tear/rupture: pathophysiology and risk factors

A

Most commonly seen within people aged between 37 and 43 year old approx.
The tear or rupture of the achilles tendon caused by overstretching of the heel during recreational sports; a forceful plantar flexion of the heel; or a fall from a height
Risks:
- Increasing age
- Achilles tendinopathy
- Poor vascular supply
- Certain drugs e.g corticosteriod
- Sports
- History of injury

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15
Q

Clinical presentation: signs and symptoms of achilles tendon rupture

A
  • Usually a traumatic onset usually during high velocity movement
  • Description of being ‘kicked or shot’ in the back of calf
  • Sudden pain in calf with an audible snap or pop
  • Weakness is a common symptom described particularly when pushing off with the affected foot
  • Inability to weight bear however may be able due to other plantar flexors helping with this movement
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16
Q

Special tests/ objective signs for Achilles rupture

A
  • Palpable gap if not too much swelling
  • Foot drop may be apparent in gait
  • Active plantarflexion may be completely or partially lost
  • Greater degree of dorsiflexion available on passive movement
  • Thompsons test usually positive with complete ruptures
  • Calf muscle atrophy
17
Q

Management of Achilles rupture

A

With suspected rupture refer to A+E

18
Q

Ankle OA: pathophysiology and risk factors

A

Is a chronic degenerative joint disease which leads to the breaking down of cartilage and other tissues about a joint
Can affect both talocrural and subtalar joints in the ankle
Risks:
- RA
- Obesity
- Intense physical exercise
- Knee OA
- Age

19
Q

Clinical presentation, signs and symptomsof ankle OA

A
  • Ankle joint pain
  • It most commonly affects one joint but can occur bilaterally
  • Aggravating factors: weight bearing particularly walking and prolonged standing
  • Ease: usually rest
  • Stiffness in the joint first thing but less than 30 minutes in duration
  • Crepitus in the ankle joint on movement with clicking and crunching being reported
  • More commonly seen in patients with manual labour jobs and in those who spend significant periods standing or walking
20
Q

Management of ankle OA

A
  • Education, symptom management and self management
  • Advise on lifestyle modifications
  • Direct to GP
  • Physio: manual therapy, mobility, strenghtening
  • Consider walking aids and CSI
    If persistent: referral for arthroplasty or fusion
21
Q

Morton’s neuroma: pathophysiology and risk factors

A

Inflammation or thickening of the nerves between the metatarsal bones
- The thickening of the nerve is usually secondary to pressure or repetitive irritation
Risk factors:
- Female
- Associated with tight or high heeled shoes
- Common in runners
- Foot or hallux deformity

22
Q

Clinical presentation, signs and symptoms of Morton’s neuroma

A
  • Paraesthesia (tingling, prickling, burning sensation) within the affected digital nerve with pain apparent in the corresponding intermetatarsal space (third more commonly than the second)
  • Burning and tingling sensation in the third or second intertarsal space
  • Feeling of a ‘stone in their shoe’
  • Aggr factors: walking, wearing tight shoes, high heels and running
  • Ease factors: resting the foot, removing shoes
23
Q

Special tests/objective signs for Morton’s neuroma

A
  • Thumb index finger squeeze test- positive sign being referred to as a Mulder’s click
  • Observation of any plantar calloses around the second and third metatarsal heads can also predispose to this complaint
24
Q

Management of Morton’s neuroma

A
  • Patient education
  • Rest
  • Advise for wider fitting shoe is the first line of management
  • Orthotics
  • Glucocorticosteroid injection
    If ineffective:
  • Surgery to remove the neuroma
25
Q

What are the common first MTP joint pathologies?

A
  • OA
  • Hallux Valgus (bunion)
  • Hallux rigidus (restriction in flexion and extension leading to OA)
26
Q

Risk factors for pathologies of the MTP joint

A
  • Increased age
  • Female
  • Arthritis - commonly RA
  • Neuromuscular disorders
  • Acute and repetitive articular trauma
27
Q

Clinical presentation, signs and symptoms of first MTP joint pathologies

A
  • Stiffness and pain within first MTP
  • Aggr factors: that require dorsiflexion of MTP joint and walking
  • Localised pain, stiffness and enlargement of MTP joint
  • Ease factors: rest
  • Palpation is painful
28
Q

Special tests/ objective signs on examination for first MTP joint pathologies

A
  • Antalgic gait
  • Crepitus
  • AROM and PROM may be restricted particularly into extension
  • Wasting of the intrinsic muscles of the foot
29
Q

Management of first MTP joint pathologies

A
  • Education, symptom management and self management
  • Advise on lifestyle modifications
  • Direct to GP
  • Physio: joint mobs, strengthening and gait re-education
  • Referral to podiatry for orthoses
  • CSI
    If no improvement: Surgical management
30
Q

Ankle ligament injuries: pathophysiology and risk factors

A

A sprain or tear to the lateral or medial ligament complex
Lateral: ATFL, CFL, PTFL. Caused by inversion, rapid shift of body weight over the affected ankle followed by rolling outwards casuing excessive inversion and plantarflexion
Medial: PTTL, TCL, TNL and ATTL
Caused by: eversion, ankle rolls inwards causing excessive eversion
Lateral sprains are more common
Risks:
- History
- Increased weight
- Participation in sports
- Foot anatomy

31
Q

Clinical presentation, signs and symptoms for ankle injuries

A
  • Unable to weight bear
  • Tenderness, swelling and bruising (depending on side)
  • Bony tenderness can sometimes be apparent and fracture should be potentially suspected if the tenderness is within the areas identified within the OTTAWA rules
  • Pain restricted ROM
  • A soft or springy end feel is usually apparent
  • Tenderness over affected ligament
32
Q

Special tests/objective signs for Ankle ligament injuries

A
  • Anterior draw test and talar tilt- pain and laxity
  • Syndesmosis squeeze
  • Poor balance, proprioception and weakness in gluteals
33
Q

Management of ankle ligament injuries

A
  • Education, symptom management and self management
  • PEACE and LOVE
  • Advice continuing activities within pain limits
  • Direct to GP
  • Physio: mobility, manual therapy, strengthening
    No improvement and significant laxity: Surgical reconstruction
34
Q

Plantar fasciopathy: pathophysiology and risk factors

A

Thickening and degeneration of tissue affecting the plantar fascia at the bottom of your foot, usually felt at the heel.
Multifactoral: poor or delayed healing and abnormal biomechanics
Risks:
- Age (40-60)
- Female
- Excessive foot pronation
- High arches
- Tight achilles or gastroc
- Overweight
- Running

35
Q

Signs and symptoms of Plantar fasciopathy

A
  • Pain in the medial plantar heel region
  • Pain worsens throughout the day
  • Gradual onset (if sudden onset with trauma can be ruptured)
  • Aggr factors: prolonged weight bearing
  • Restricted dorsiflexion
36
Q

Special tests/Objective signs for Plantar Fasciopathy

A
  • Positive Windlass test
  • Antalgic gait
  • Restricted dorsiflexion
37
Q

Management of plantar fasciopathy

A
  • Education, symp management
  • Advise on activity modifications, good foot wear, insoles and heel pads
  • Advise on weight loss
  • GP
  • Ice application
  • Self stretches
    If persistent:
  • Physio - for tendon loading
  • Referral to podiatry
  • Glucocorticosteroid injection
    Failure from conservative:
  • Ortho or podiatry for SWT
    If tried for 6-12 months:
  • Surgery

Year 2- MSK (10 decks)

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