Ankle and Foot

Question 1

What is Hallux valgus?

Answer 1

Bunions- deformity of great toe due to medial deviation of the 1st metatarsal and lateral deviation of the toe itself- poorly understood aetiology.

Question 2

Treatment of Hallux Valgus?

Answer 2

Conservative treatment: wearing of wider and deeper shoes, use of space in the first web space
Loads of surgical options but none fully or always successful

Question 3

What is Hallux Rigidus?

Answer 3

OA of the first MTPJ

Question 4

What is Morton’s Neuroma?

Answer 4

Plantar interdigital nerves can become inflamed and swollen forming a neuroma due to repetitive trauma

Question 5

What do patients with Morton’s neuroma complain of?

Answer 5

Burning pain and tingling

Question 6

Exam of Mortons neuroma? Tests?

Answer 6

Loss of sensation in affected nerve space. Medic-Lateral compression of the metatarsal heads (exerted by squeezing forefoot with your hand) may reproduce symptoms or click (Mulders). USS shows swollen nerve.

Question 7

Metatarsal stress fractures are most commonly…

Answer 7

in 2nd MT followed by 3rd

Question 8

Patient with metatarsal stress fracture will complain of… why may it be difficult to diagnose?

Answer 8

Sudden, severe weight bearing pain. X-rays normal at first so need MRI or bone scan

Question 9

Causes of Metatarsal stress fractures?

Answer 9

Soldiers (prolonged marching), runners, unaccustomed walking, new shoes

Question 10

What can cause achilles tendonitis?

Answer 10

Repetitive strain from sports or due to degenerative process

Question 11

Treatment of achilles tendonitis?

Answer 11

Rest, physio, use of a heel raise to off load tendon and boot or splint

Question 12

Tendonitis predispose to …

Answer 12

tendon rupture

Question 13

In achilles tendonitis what should not be administered?

Answer 13

Steroid injections- this could cause rupture!!

Question 14

What will patient complain of in Achilles tendon rupture?

Answer 14

Sudden pain in the back of the leg and difficulty weight bearing.

Question 15

Examination of achilles tendon rupture?

Answer 15

Weakness of plantar flexion and a palpable gap in the tendon usually apparent

Question 16

What is plantar fasciitis?

Answer 16

Self limiting receptive stress/ overload or degenerative condition of the foot which causes inflammation of the plantar aponeurosis of the foot.

Question 17

Things that are thought to contribute to plantar fasciitis?

Answer 17

Diabetes, obesity, and frequent walking on hard floors with no cushioning as well as degeneration with age.

Question 18

Treatment of plantar fasciitis?

Answer 18

Rest, achilles and plantar fascia stretching may help. Steroid injections may help. Symptoms cantata up to 2 yrs to resolve. There are some surgeries but these are controversial.

Question 19

Where is the tibias posterior tendon and what does it do?

Answer 19

Inserts predominantly onto the medial navicular to serve the medial arch.

Question 20

Describe tibialis posterior tendon dysfunction

Answer 20

The tendon is under repeated stress and with degeneration can develop tendonitis, elongation and eventually rupture.
Will complain of pain and or swelling posterior to the medial malleolus, change in foot shape and diminished walking ability.
Treat: physio, insoles, orthoses, bespoke footwear and surgery.

Question 21

What is pes cavus? What causes it?

Answer 21

high arch of the foot

commonest is idiopathic but can be related to NM conditions

Question 22

What causes claw and hammer toes?

Answer 22

Occur due to acquired imbalance between flexor and extensor mechanism