Ankle & Foot Flashcards
What is hallux valgus?
Deformity of the great toe due to MEDIAL deviation of the 1st metatarsal and LATERAL deviation of the toe itself
Name 2 types of conditions that increase an individuals risk of hallux valgus
- RA or other inflammatory arthropathies
- Certain neuromuscular conditions such as MS & cerebral palsy
Rubbing of the greater toe against shoes in hallux valgus can lead to what condition?
Bunion - An inflamed bursa over the medial 1st metatarsal
In hallux valgus, the great toe and second toe may rub against each other, What can this lead to?
Ulceration & skin breakdown
In severe cases of hallux valgus what might happen?
The great toe may override the second toe
Hallux valgus initial management
CONSERVATIVE MANAGEMENT
- Wider footwear to prevent bunions
- Spacers in the first web space to prevent rubbing between toes
Name some indications for surgical management with hallux valgus
- Failure of conservative management
- lesser toe deformities
- lifestyle or functional limitation
- overlapping of great toe & second toe
NOT cosmetic reasons alone
Surgical management of hallux valgus
- Osteotomies to realign bones
- Soft tissue procedures to tighten or release tissue
What do some patients complain of after hallux valgus surgery?
Metatarsalgia - pain in the metatarsal heads
What is hallux rigidus?
OA of the first MTPJ
Hallux rigidus clinical presentation
- Painful, stiff first MTPJ
- Pain worse on activity/ wearing shoes
- Dorsal exostosis (bone spur)
- Reduced MTPJ movement, especially dorsiflexion
- Therefore, IPJ hyperextension
Describe the difference in ROM of the great toe IPJ in Hallux rigidus
Hyperextension
Hallux rigidus investigations
- Clinical diagnosis
- X-ray
Hallux rigidus conservative management
- Weight loss
- Analgesia
- Stiff soled shoe to limit motion
Possible surgical option for hallux rigidus in early stages with dorsal osteophyte impingement
Osteophyte removal (cheilectomy)
Hallux rigidus gold standard treatment
Arthrodesis
(Note - women will no longer be able to wear heels)
What is a Morton’s neuroma
Inflamed plantar interdigital nerves forming a neuroma
Morton’s neuroma clinical presentation
- Burning pain
- Tingling radiating into toes
- Exacerbated - footwear, relieved - massaging foot
- Loss of sensation in affected web space
- Positive mulder’s click test
Describe the clinical test used to test for Morton’s neuroma
Mulder’s click test - squeezing the forefoot with your hands, compressing the metatarsal heads to reproduce symptoms &/ a characteristic ‘click’
Morton’s neuroma investigations
- Mulder’s click test
- X-ray to rule out MSK pathology
- Diagnostic US to demonstrate swollen nerve (low specificity)
Morton’s neuroma risk factors
- Age
- Obesity
- Female
- High heels
Morton’s neuroma management
- Conservative - RICE, weight loss, offloading insole, calf muscle stretching
- Symptom relief - steroid & local anaesthetic injections
- Persistent, resistant symptoms - surgical excision
Metatarsal stress fracture risk factors & clinical presentation. Which MT is most commonly affected?
- Runners, soldiers, dancers etc (repeated stress/injury)
- Pain & inability to weight bear
- 2nd MT most commonly affected
Metatarsal stress fracture investigations
- X-ray - to rule out other pathology.
- NOTE - takes around 3 weeks (when callus forms) for a stress fracture to be seen on an X-Ray.
- Therefore, bone scan may be useful to confirm diagnosis