Causes of Foot and Ankle Pain

Question 1

Disease of the epiphysis that starts with necrosis (osteonecrosis) and fragmentation followed by repair and regeneration

(mostly in children)

Answer 1

Osteochondritis

Question 2

3 types of Osteochondritis

Answer 2

Kohler disease

Freiberg disease

Sever disease

Question 3

Osteonecrosis of the tarsal navicular bone

Begins about the 4-5 years old

Answer 3

Kohler’s disease

Question 4

Trauma can be a contributory factor

Unknown

Answer 4

Etiology of Kohler’s disease

Question 5

Limp

Tenderness and thickening over the affected navicular

Answer 5

Symptoms of Kohler’s disease

Question 6

Radiograph – small bone, dense and of irregular outline

Answer 6

Dx of Kohler’s Disease

Question 7

Protection of diseased bone from excessive traumatization

Support of longitudinal arch

Immobilize foot in slight inversion through a plastic cast

Answer 7

Treatment of Kohler’s disease

Question 8

Avascular necrosis most commonly of the second metatarsal head in which a portion or all of the metatarsal head loses its structural integrity

blood supply to part of the bone of the metatarsal head for whatever reason is diminished or cut off

also called Freiberg’s infraction

is more common in adults

Answer 8

Freiberg’s disease

Question 9

Unilateral pain worse with activity
ROM with limitation
Most common sight is over 2nd metatarsal
+ tenderness

Answer 9

Signs and symptoms of Freiberg’s disease

Question 10

self limiting

Answer 10

Treatment of Freiberg’s disease

Question 11

Osteonecrosis of the calcaneal apophysis

common cause of heel pain (in children)

thought to be an overuse injury of the calcaneal apophysis in a growing child

Answer 11

Sever’s disease

Question 12

commonly seen in immature athletes participating in running & jumping sports

frequently seen just before or during peak growth

Answer 12

Epidemiology

Question 13

pain in the area of the calcaneal apophysis in an immature athlete

pain increased with activity or impact

stretch of the triceps surae exacerbates heel pain

can display warmth, erythema, & swelling

Answer 13

Symptoms of Sever’s disease

Question 14

tight Achilles tendon

positive squeeze test (pain with medial-lateral compression over the tuberosity of the calcaneus)

pain over the calcaneal apophysis

Answer 14

Physical exam of Sever’s disease

Question 15

self-limiting entity that resolves with maturation and the closure of the apophysis

Avoid too much activity until the closure of the epiphysis

Answer 15

Treatment of Sever’s disease

Question 16

accumulation of uric acid in the joint.

Deposition of uric acid crystal

Answer 16

Gout

Question 17

byproduct of protein, the more we eat protein/meat,the higher our uric acid becomes

Answer 17

Uric acid

Question 18

60% of initial attack of gout involves the

Answer 18

1st MTP or great toe

Question 19

what you call gout affecting the 1st MTP

Answer 19

Podagra

Question 20

severe excruciating pain in the foot(unable to walk or put on shoes), swelling, warmth, redness

Answer 20

Signs of gout

Question 21

Incidence of gout

Answer 21

Very common in middle aged men. (Hereditary)

Question 22

Characterized by sudden attacks of sharp pain well localized affecting the web space between 3rd and 4th followed by 2nd and 3rd

Answer 22

Interdigital Neuroma (Morton’s Toe)

Question 23

thickening of the common digital nerve at its bifurcation in the web space;

Repeated trauma to the nerve by metatarsal head

Answer 23

cause of morton’s toe

Question 24

Metatarsal arch support (metatarsal pads)

Stretching

Answer 24

Conservative treatment of Morton’s toe

Question 25

Surgery for excision of enlarged segment of nerve

Answer 25

If morton's toe is not relieved by conservative management

Question 26

Called march or fatigue fracture Fracture of metatarsal shaft usually 2nd or 3rd due to repeated stress from unaccustomed amount of walk Pain on the area increasing in a week or more as callus forms Common in army recruits during basic training Can also involved other bones as calcaneus, femur, tibial or fibula

Answer 26

Stress Fracture

Question 27

Dx of Stress fracture

Answer 27

x-ray

Question 28

Rest Adhesive strapping Use of anterior arch pad and metatarsal pad

Answer 28

Treatment of stress fracture

Question 29

Lateral angulation of the great toes at the MTP Associated with enlargement of the medial side of the head of the first metatarsal (bunion) Medial deviation of the first metatarsal bone and lateral deviation of the great toe

Answer 29

Hallux Valgus

Question 30

Causes hereditary, contracture of the flexor and extensor hallucis longus; Pointed shoe + tiptoe= forcing big toe to go laterally

Answer 30

Hallux Valgus

Question 31

proper fitted shoes and repeated over correction of stretching

Answer 31

treatment for mild hallux valgus

Question 32

excision of the bursa

Answer 32

surgical treatment of hallux valgus

Question 33

elongation of the ligaments on the medial side on the medial side of EHL

Answer 33

Silver operation

Question 34

resection of the proximal half of the first phalanx; procedure of choice

Answer 34

Keller or Schanz operation

Question 35

reset the bone to return to straight position

Answer 35

Osteotomy

Question 36

Medial angulation of the great toe at the MTP

Answer 36

Hallux Varus

Question 37

Causes trauma, infection, muscle imbalance, paralysis of adductor hallucis, insertion of the adductor hallucis tendon have been relead may also be cause of hallux varus

Answer 37

Hallux Varus

Question 38

Surgical release the contracture structure on the medial side of toe Other – osteotomy of metatarsal head and use of the 2nd extensor hallucis brevis in the presence correct alignment

Answer 38

Treatment for Hallux varus

Question 39

dorsiflexion of the MTP and plantar flexion contracture of the IP; most common affected is 2nd toe; due to overactivity or tightness or due to use of a narrow she at the end of the second toe

Answer 39

Hammer Toe

Question 40

hyperextension of the metatarsophalangeal joint and flexion contracture of both the proximal and distal interphalangeal joint

Answer 40

Claw Toe

Question 41

simple flexion contracture of the DIP

Answer 41

Mallet Toe

Question 42

Sprain on the first metatarsophalangeal joint secondary to forceful dorsiflexion or sometimes forceful plantarflexion Involves the plantar capsule and ligament

Answer 42

Turf Toe

Question 43

Pain and tenderness with swelling of the 1st MTP Pain is worse with movement of joint Persistent symptoms lead to decrease ROM

Answer 43

Signs and symptoms of Turf's toe

Question 44

Radiograph to r/o bony injury

Answer 44

Dx of turf's toe

Question 45

RICE (rest, ice, compress, elevate) - Sometimes PRICE (protect, rest, ice, compress, elevate) Taping to limit motion of the joint Use stiff soled shoes

Answer 45

Treatment of turf's toe

Question 46

Fracture of the diaphysis of the 5th metatarsal bone Due to inversion – plantarflexion injury or due to stress fracture of the area Common in sprinters and jumpers

Answer 46

Jone’s Fracture

Question 47

Pain on the lateral aspect of the forefoot + tenderness localized at proximal 5th metatarsal bone

Answer 47

Clinical picture of Jone's fracture

Question 48

NSAID for pain management Cast immobilize until pain and swelling subsides (6-8 weeks) Screw fixation so patient can return to work

Answer 48

Treatment of turf's toe

Question 49

fibrous band on the bottom of the foot that connects the heel bone to each of the toes

Answer 49

plantar fascia

Question 50

Four plantar foot muscles originate from the volar calcaneus

Answer 50

Adductor hallucis Quadratus plantae Flexor digitorum brevis Abductor digiti minimi

Question 51

Overload of these muscles can cause enthesopathy at the calcaneus causing heel pain and lateral inflammation and pain in the plantar fascia the plantar fascia becomes irritated and inflamed. This causes pain in the heel and arch of the foot

Answer 51

Plantar Fasciitis

Question 52

epidemiology of plantar fascitis

Answer 52

affects men and women equally

Question 53

obesity (high BMI) decreased ankle dorsiflexion in a nonathletic population (tightness of the foot and calf musculature) weight bearing endurance activity (dancing, running)

Answer 53

risk factors of plantar fascitis

Question 54

Non operative treatment of Plantar fascitis

Answer 54

Pain control, splinting & therapy (stretching) programs

Question 55

first line treatment of plantar fascitis

Answer 55

Modalities

Question 56

plantar fascia-specific stretching and Achilles tendon stretching anti-inflammatories or cortisone injections - corticosteroid injections can lead to fat pad atrophy or plantar fascia rupture foot orthosis - examples include cushioned heel inserts, prefabricated shoe inserts, night splints, walking casts - short leg casts can be used for 8-10 weeks

Answer 56

Modalities– first line treatment of Plantar Fascitis

Question 57

Second line of treatment Chronic heel pain lasting longer than 6 months when other treatments have failed

Answer 57

Shock wave treatment

Question 58

A compressive neuropathy caused by compression of the tibial nerve Counterpart of the carpal tunnel in the hand

Answer 58

Tarsal Tunnel Syndrome

Question 59

Posterior tarsal tunnel formed by

Answer 59

flexor retinaculum calcaneus (medial) talus (medial) abductor hallucis (inferior)

Question 60

contents include (Tom, Dick And Very Nervous Harry)

Answer 60

tibial nerve posterior tibial artery and vein FHL tendon FDL tendon tibialis posterior tendon

Question 61

types of impingement

Answer 61

intrinsic, extrinsic

Question 62

ganglion cyst tendinopathy tenosynovitis lipoma/tumor perineural fibrosis Osteophytes

Answer 62

Intrinsic impingement

Question 63

shoes trauma anatomic deformity (tarsal coalition, valgus hindfoot) post-surgical scarring systemic inflammatory disease edema of the lower extremity

Answer 63

Extrinsic impingement

Question 64

Pain with prolonged standing or walking often vague and misleading medial foot pain sharp, burning pains in the foot

Answer 64

Symptpms of TTS

Question 65

intermittent paresthesias and numbness in the plantar foot tingling/burning sensation

Answer 65

Numbness of TTS

Question 66

posterior tibial tendon deficiency (adult-acquired flatfoot), plantar fasciitis, tarsal tunnel syndrome believed to be due to loss of static and dynamic stabilizers of the medial arch and subsequent traction neuropathy on the tibial nerve

Answer 66

heel pain triad

Question 67

medications -anti-inflammatory medications -SSRIs have been used bracing -orthosis or foot wear changes to address alignment of hindfoot -can try a period of short-leg cast

Answer 67

conservative treatment of TTS

Question 68

surgical release of tarsal tunnel

Answer 68

Operative treatment for TTS

Question 69

after 3-6 months of failed conservative management and compressive mass (ganglion cyst) identified positive EMG reproducible physical findings

Answer 69

Indications for TTS surgery