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MSK > Common Foot and Ankle Conditions > Flashcards

Common Foot and Ankle Conditions Flashcards

1
Q

What are some forefoot problems?

A

Hallux valgus, hallux rigidus, lesser toe deformities, Morton’s neuroma, Metatarsalgia, and rheumatoid forefoot

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2
Q

What is the aetiology of hallux valgus (bunions)?

A

Genetics, foot wear and significant female preponderance

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3
Q

What are the symptoms of hallux valgus?

A

Pressure symptoms from shoe wear, pain from crossing over of toes and metatarsalgia

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4
Q

What is the pathogenesis of hallux valgus?

A

Lateral angulation of great toe
Tendons pull realigned lateral to centre of toe worsening deformity
Vicious cycle of increased pull causing deformity
Sesamoid bones sublux medially
Then abnormalities of lesser toes occur as less pressure on big toe

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5
Q

What angles are changed in hallux valgus?

A

First metatarsophalangeal angle and intermetatarsal angle

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6
Q

How is hallux valgus diagnosed?

A

Clinical
X-ray - determine severity and exclude degenerative change

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7
Q

What is the non-operative management of hallux valgus?

A

Shoe wear modification
Orthotics to offload pressure and correct deformity
Activity modification
Analgesia

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8
Q

What is the operative management for hallux valgus?

A

Release lateral soft tissues
Osteotomy 1st metatarsal and possible proximal phalanx
Generally good outcome but recurrence is inevitable
Scarf and basal osteotomy

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9
Q

What is hallux rigidus?

A

Stiff big toe
OA of 1st metatarsal-phalangeal joint
Bimodal distribution of age

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10
Q

What is the aetiology of hallux rigidus?

A

Not known
Possibly genetic
Possible multiple micro-trauma

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11
Q

What is the symptoms and diagnosis for hallux rigidus?

A

Many asymptomatic, pain often at extreme dorsiflexion and limitation of range of movement
Diagnosis - clinical and radiographs

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12
Q

What are the features of hallux rigidus on radiographs?

A

Features of OA
Narrowing and irregularity at MTP joint
Osteophytes seen
Sclerosis of margins
Angle is normal

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13
Q

What is the management of hallux rigidus?

A

Non-operative - activity modification, shoe wear with rigid insole and analgesia
Surgery - cheilectomy (remove dorsal impingement), arthrodesis, and arthroplasty

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14
Q

What is the gold standard treatment for hallux rigidus?

A

1st MTPJ fusion
Is permanent

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15
Q

Describe 1st MTPJ hemiarthroplasty

A

Good option to maintain range of movement
High failure rate
Probably better for low demand patients

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16
Q

What are some lesser toe deformities?

A

Claw toes
Hammer toes
Mallet toes

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17
Q

What is the differences between claw, hammer and mallet toes?

A

Claw - flexion at proximal and distal interphalangeal joints
Hammer - flexion of proximal interphalangeal joints and dorsiflexion at MTP joint
Mallet - flexion at distal interphalangeal joint

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18
Q

What is the aetiology of lesser toes deformities?

A

Imbalance between flexors/ extensors, shoe wear, neurological, RA and idiopathic

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19
Q

What are the symptoms of lesser toes deformities?

A

Deformity, pain from dorsum and pain from planter side (metatarsalgia)

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20
Q

What is the non-operative treatment for lesser toe deformities?

A

Activity modification, shoe wear (flat shoes with high toe box), and orthotic insoles (metatarsal bar/ dome support)

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21
Q

What is the operative treatment for lesser toe deformities?

A

Flexor to extensor transfer
Fusion of interphalangeal joint
Release metatarsophalangeal joint
Shortening osteotomy of metatarsal

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22
Q

What is Morton’s neuroma?

A

Inflammation with severe pain and numbness on plantar side of foot
Interdigital neuroma

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23
Q

What is the aetiology of Morton’s neuroma?

A

Mechanically induced degenerative neuropathy
Tends to affect females aged 40-60
Associated with wearing high heels
Common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical tear

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24
Q

What are the symptoms of Morton’s neuroma?

A

Typically affects 3rd followed by 2nd web spaces
Neuralgic burning pain into toes
Intermittent
Altered sensation in web space

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25
Q

How is Morton’s neuroma diagnosed?

A

Clinical
Mulder’s click - if press on lump and squeeze on metatarsal heads, it causes painful click
US best and MRI good

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26
Q

What is the management of Morton’s neuroma?

A

Injection for small lesions - steroids
Surgery - excision of lesion including a section of normal nerve (can cause numbness and recurrence)

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27
Q

What is metatarsalgia?

A

A symptom
Any pain coming from forefoot
Careful examination should localise pain
If no obvious cause then consider tight gastrocnemius

28
Q

What is the treatment for rheumatoid forefoot?

A

Non-operative - shoe wear, orthotics and activity
Operative - many techniques
Current gold standard is 1st MTPJ arthrodesis and 2-5th toe excision arthroplasty

29
Q

What are some midfoot problems?

A

Ganglia, OA and plantar fibromatosis

30
Q

What is the aetiology of dorsal foot ganglia?

A

Arises from joint or tendon sheath
Idiopathic, underlying arthritis and underlying tendon pathology

31
Q

What are the symptoms of dorsal foot ganglia?

A

Pain from pressure from shoe wear
Pain from underlying problem

32
Q

What is the treatment and prognosis of dorsal foot ganglia?

A

Non-operative - aspiration and ‘family bible’
Operative - excision
High rate of return - 50%

33
Q

What can cause midfoot arthritis?

A

Post-traumatic arthritis, osteoarthritis and rheumatoid arthritis

34
Q

What is the treatment for midfoot arthritis?

A

Non-operative - activity/ shoe wear/ orthotics
Injections - X-ray guided
Operative - fusion

35
Q

Describe plantar fibromatosis

A

Ledderhose disease
Dupuytren’s of the foot
Progressive
Usually asymptomatic unless very large or on weight bearing area
Lumps on sole of foot

36
Q

What is the treatment of plantar fibromatosis?

A

Non-operative - avoid pressure (shoe wear and orthotics)
Operative - excision (80% risk of recurrence)
RT - similar recurrence as operation
Combination RT and surgery (low risk of recurrence but high risk complications)

37
Q

What are some hindfoot problems?

A

Achilles tendonitis/ tendinosis
Plantar fasciitis
Ankle OA
Tibialis posterior dysfunction
Cavovarus foot

38
Q

What is Achilles tendonitis/ tendinosis?

A

Degenerative/ overuse condition with little inflammation
Tendinosis histopathological
Tendinopathy term to describe symptoms

39
Q

What are the types of Achilles tendinopathy?

A

Insertional tendinopathy - within 2cm of insertion
Non-insertional - 2-7cm of insertion
Bursitis - retrocalcaneal and superficial calcaneal
Para tendinopathy is true inflammatory problem - para-tendonitis histologically

40
Q

What is the aetiology of Achilles tendinopathy?

A

Para-tendinopathy - commonest in athletic population, age 30-40 and more males (2:1)
Tendinopathy - commonest in non-athletes, aged over 40, obesity, steroids and diabetes

41
Q

What are the symptoms of Achilles tendinopathy?

A

Pain during exercise, pain following exercise, recurrent episodes, difficulty fitting shoes (insertional) and rupture

42
Q

How is Achilles tendinopathy diagnosed?

A

Clinical - tenderness and tests for rupture
Simmonds test - squeeze calf gently and if foot moves then not fully ruptured
Angle of the Dangle and Matles
Investigations - US and MRI

43
Q

What is the non-operative treatment for Achilles tendinopathy?

A

Activity modification, weight loss, shoe wear, physio, extra-corporeal shockwave treatment and immobilisation

44
Q

What is the operative treatment for Achilles tendinopathy?

A

Gastrocnemius recession
Release and debridement of tendon

45
Q

Describe plantar fasciitis

A

Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen - fasciosis
Cant make extracellular matric required for repair and remodelling

46
Q

What is aetiology of plantar fasciitis?

A

Not known, athletes associated with high intensity, running with poorly padded shoes/ hard surfaces, obesity, occupations of long standing, foot/ limb rotational deformities and tight gastro-soleus complex

47
Q

What are the symptoms of plantar fasciitis?

A

Pain first thing in morning, pain on weight bearing after rest, pain localised at origin of plantar fascia and frequently long lasting (2 years or more)

48
Q

What is the differential diagnosis for plantar fasciitis?

A

Nerve entrapment syndrome, arthritis and calcaneal pathology

49
Q

How is plantar fasciitis diagnosed?

A

Mainly clinical
Occasionally x-rays, US and MRI

50
Q

What is the treatments for plantar fasciitis?

A

Rest, change training, stretching, ice, NSAIDs, orthoses, physio, weight loss, injection (corticosteroids) and night splinting

51
Q

What are newer/ 3rd line treatments for plantar fasciitis?

A

Extracorporeal shockwave therapy
Topaz plasma coblation
Nitric oxide
Platelet rich plasma
Endoscopic/ open surgery

52
Q

What is the aetiology of ankle arthritis?

A

Mean age is 46 years
Commonly post-traumatic
Idiopathic

53
Q

What are the symptoms and diagnosis of ankle arthritis?

A

Pain and stiffness
Clinical, radiographs and CT scan

54
Q

What is the non-operative management of ankle arthritis?

A

Weight loss, activity modification, analgesia, physio and steroid injections

55
Q

What is the operative management for ankle arthritis?

A

If anterior symptoms - arthroscopic anterior debridement
Arthrodesis - open or arthroscopic (gold standard) - fusion
Joint replacement

56
Q

Describe tibialis posterior tendon dysfunction

A

Acquired adult flat foot planovalgus (heels are valgus and medial arch collapse)
Relatively common and under-recognised
4 stages
Clinical diagnosis - double and single heel raise
Medial or lateral pain

57
Q

What is the treatment for tibialis posterior tendon dysfunction?

A

Orthoses or surgery

58
Q

What is the normal double and single limb heel raise?

A

Heels should swing from valgus to varus as heel rises

59
Q

What is the diagnosis and management of tibialis posterior tendon dysfunction?

A

Diagnosis - clinical and MRI to assess tendon
Management - orthotics, reconstruction of tendon and triple fusion

60
Q

What is aetiology of diabetic foot ulcer?

A

Diabetic neurology and autonomic neuropathy (lack of sweating, dry skin and sensitive to trauma)
Poor vascular supply
Lack of patient education

61
Q

What is the treatment for diabetic foot ulcer?

A

Prevention and modify main detriments to healing (control of diabetes, smoking, vascular supply and external pressure)
Surgical - vascular supply, debride ulcers, correct deformity and amputation

62
Q

What is the aetiology and pathophysiology of Charcot neuroarthropathy?

A

Any cause of neuropathy - diabetes most commo
Can be lack of proprioception and protective pain sensation
Abnormal autonomic nervous system so increased vascular supply and bone resorption

63
Q

What are the 3 stages of Charcot neuroarthropathy?

A

Fragmentation
Coalescence
Remodelling

64
Q

How is Charcot neuroarthropathy diagnosed?

A

High index of suspicion
Greater than 3 degrees difference between limbs
Frequently not painful
Radiographs
MRI scan

65
Q

What is the management of Charcot neuroarthropathy?

A

Prevention, immobilisation and correct deformity - as leads to infection then amputation

MSK (39 decks)

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