Common Foot and Ankle Conditions

Question 1

Aetiology of hallux valgus

Answer 1

Genetic
Footwear
Significant female proponderance

Question 2

Symptoms of hallux valgus

Answer 2

Pressure symptoms from shoe wear
Pain from crossing over of toes
Metatarsalgia

Question 3

Pathogenesis of hallux valgus

Answer 3

Lateral angulation of great toe, tendons pull realigned to lateral of centre of rotation worsening deformity
Viscous cycle
Sesamoid bones sublux - less weight goes through great toe
As deformity progresses abnormalities of lesser toe occur

Question 4

Diagnosis of hallux valgus

Answer 4

Clinical

X-rays(severity)

Question 5

Management of hallux valgus

Answer 5

Non operative - shoe wear modification, orthotics to offload pressure, activity modification, analgesia
Operative - release lateral soft tissues, oseotomy 1st metatarsal

Question 6

What is hallux rigidus

Answer 6

Stiff big toe - OA of 1st MTP joint
Many asymptomatic 
Pain
Limited ROM
Diagnosis - clinical or radiographs
Management - activity modification, shoe wear with rigid sole, analgesia, surgery

Question 7

Aetiologies of lesser toe deformities

Answer 7

Imbalance between flexors and extensors
Neurological
Rheumatoid arthritis
Idiopathic

Question 8

Symptoms of lesser toe deformities

Answer 8

Deformity
Pain from dorsum
Metatarsalgia

Question 9

Management lesser toe deformities

Answer 9

Non-op - activity modification, shoe wear, orthotic insoles

Op - flexor to extensor transfer, fusion of IP join, release MTP joint, shortening osteotomy of metatarsal

Question 10

Aetiology mortons neuroma

Answer 10

Mechanically induced degenerative neuropathy
Females 40-60
Wearing high heels
Common digital nerve relatively tethered to one metatarsal and movement in adjacents causing mechanical shear

Question 11

Symptoms mortons neuroma

Answer 11

Typically affects 3rd then 2nd webspace/toes
Neuralgic burning pain into toes
Intermittent
Altered sensation in webspace

Question 12

Diagnosis mortons neuroma

Answer 12

Clinical
Mulder’s click
US or MRI

Question 13

Management mortons neuroma

Answer 13

injection for small lesions

Surgery - excision of lesion including a section of normal nerve

Question 14

Treatment of rheumatoid forefoot

Answer 14

Non op - shoe wear, orhtotics, activity
Op - 1st MTPJ arthrodesis
2-5th toe excision arthroplasty

Question 15

Aetiology dorsal foot ganglion

Answer 15

Arise from joint or tendon sheath
Idiopathic
Underlying arthritis
Underlying tendon pathology

Question 16

Symptoms dorsal foot ganglion

Answer 16

pain from pressure from shoe wear

Pain from underlying problem

Question 17

Treatment dorsal foot ganglion

Answer 17

Non op - aspiration

Operative - excision

Question 18

Treatment mid foot arthritis

Answer 18

Non-op activity/shoewear/orthotics, injections

Op - fusion

Question 19

Plantar fibromatosis treatment

Answer 19

non op - avoid pressure
operative - excision
Radiotherapy

Question 20

Achilles tendinopathy aetiology

Answer 20

Paratendonopathy - athletic populations, 30-40, M>F

Tendonopathy - non athletic, > 40, obesity, steroids, DM

Question 21

Achilles tendinopathy symptoms

Answer 21

Pain during exercise
Pain following exercise
Recurrent episodes
Difficulty fitting shoes
Rupture

Question 22

Diagnosis achilles tendinopathy

Answer 22

Clinical - tenderness, tests for rupture

Investigations - US, MRI

Question 23

Treatment achilles tendinopathy

Answer 23

Non-op activity mod, weight loss, shoe wear mod, physio, extra-corporeal shock wave, immobilisation
Op - gastrocnemius recession, release and debridement of tendon

Question 24

Plantar fasciitis aetiology

Answer 24

Athletes with high intensity or rapid increase training
running poorly padded shoes
Obesity
occupations involving prolonged standing
Foot/lower limb deformities
tight gastro-soleus complex

Question 25

Plantar fasciitis symptoms

Answer 25

pain first thing in morning pain on weight bearing after rest pain located at origin of plantar fascia long lasting

Question 26

DDx plantar fasciitis

Answer 26

nerve entrapment syndrome Arthritis Calcaneal pathology

Question 27

Diagnosis plantar fasciitis

Answer 27

Mainly clinical | Occasionally x-rays, US, MRI

Question 28

Treatment plantar fasciitis

Answer 28

``` rest, change training stretching ice NSAIDs orthoses physio weight loss injections night splinting ```

Question 29

Newer/third line treatments of plantar fasciitis

Answer 29

``` extracorporeal shockwave therapy topaz plasma coblation nitric oxide platelet rich plasma endoscopic/open surgery ```

Question 30

Anke arthritis aetiology and symptoms

Answer 30

post traumatic idiopathic pain stiffness

Question 31

Ankle arthritis diagnosis

Answer 31

clinical radiographs CT scan

Question 32

Management ankle arthritis

Answer 32

``` weight loss activity modification analagesia physio steroid injections arthrodesis, joint replacement ```

Question 33

What is posterior tibial tendon dysfunction

Answer 33

``` acquired adult flat foot planovalgus common clinical diagnosis - double and single heel raise (valgus to varus) medial or lateral pain orthoses or surgery ```

Question 34

Aetiology diabetic foot ulcer

Answer 34

diabetic neuropathy diabetic autonomic neuropathy poor vascular supply lack of patient education

Question 35

Treatment diabetic foot ulcer

Answer 35

Prevention Modify main detriments ot healing - smoking, DM control, vascular supply, external pressure, internal pressure, infection, nutrition Surgical - improve vascular supply, decried ulcers and get deep samples for microbio, correct deformity, amputation

Question 36

Aetiology charcot neuroarthropathy

Answer 36

Any cause of neuropathy Diabetes commonest Presents with syphillis

Question 37

Features charcot neuroarthropathy

Answer 37

rapid bone destruction in 3 stages - fragmentation, coalescence, remodelling

Question 38

Diagnosis charcot neuroarthropathy

Answer 38

``` high index of suspicion consider in any diabetic with acute swollen erythematous foot frequently not painful radiographs MRI ```

Question 39

Management charcot neuroarthropathy

Answer 39

prevention immobilisation/non weight bearing correct deformity