Common Foot and Ankle Conditions Flashcards
Aetiology of hallux valgus
Genetic
Footwear
Significant female proponderance
Symptoms of hallux valgus
Pressure symptoms from shoe wear
Pain from crossing over of toes
Metatarsalgia
Pathogenesis of hallux valgus
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
Diagnosis of hallux valgus
Clinical
X-rays(severity)
Management of hallux valgus
Non operative - shoe wear modification, orthotics to offload pressure, activity modification, analgesia
Operative - release lateral soft tissues, oseotomy 1st metatarsal
What is hallux rigidus
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
Aetiologies of lesser toe deformities
Imbalance between flexors and extensors
Neurological
Rheumatoid arthritis
Idiopathic
Symptoms of lesser toe deformities
Deformity
Pain from dorsum
Metatarsalgia
Management lesser toe deformities
Non-op - activity modification, shoe wear, orthotic insoles
Op - flexor to extensor transfer, fusion of IP join, release MTP joint, shortening osteotomy of metatarsal
Aetiology mortons neuroma
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
Symptoms mortons neuroma
Typically affects 3rd then 2nd webspace/toes
Neuralgic burning pain into toes
Intermittent
Altered sensation in webspace
Diagnosis mortons neuroma
Clinical
Mulder’s click
US or MRI
Management mortons neuroma
injection for small lesions
Surgery - excision of lesion including a section of normal nerve
Treatment of rheumatoid forefoot
Non op - shoe wear, orhtotics, activity
Op - 1st MTPJ arthrodesis
2-5th toe excision arthroplasty
Aetiology dorsal foot ganglion
Arise from joint or tendon sheath
Idiopathic
Underlying arthritis
Underlying tendon pathology
Symptoms dorsal foot ganglion
pain from pressure from shoe wear
Pain from underlying problem
Treatment dorsal foot ganglion
Non op - aspiration
Operative - excision
Treatment mid foot arthritis
Non-op activity/shoewear/orthotics, injections
Op - fusion
Plantar fibromatosis treatment
non op - avoid pressure
operative - excision
Radiotherapy
Achilles tendinopathy aetiology
Paratendonopathy - athletic populations, 30-40, M>F
Tendonopathy - non athletic, > 40, obesity, steroids, DM
Achilles tendinopathy symptoms
Pain during exercise Pain following exercise Recurrent episodes Difficulty fitting shoes Rupture
Diagnosis achilles tendinopathy
Clinical - tenderness, tests for rupture
Investigations - US, MRI
Treatment achilles tendinopathy
Non-op activity mod, weight loss, shoe wear mod, physio, extra-corporeal shock wave, immobilisation
Op - gastrocnemius recession, release and debridement of tendon
Plantar fasciitis aetiology
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
Plantar fasciitis symptoms
pain first thing in morning
pain on weight bearing after rest
pain located at origin of plantar fascia
long lasting
DDx plantar fasciitis
nerve entrapment syndrome
Arthritis
Calcaneal pathology
Diagnosis plantar fasciitis
Mainly clinical
Occasionally x-rays, US, MRI
Treatment plantar fasciitis
rest, change training stretching ice NSAIDs orthoses physio weight loss injections night splinting
Newer/third line treatments of plantar fasciitis
extracorporeal shockwave therapy topaz plasma coblation nitric oxide platelet rich plasma endoscopic/open surgery
Anke arthritis aetiology and symptoms
post traumatic
idiopathic
pain
stiffness
Ankle arthritis diagnosis
clinical
radiographs
CT scan
Management ankle arthritis
weight loss activity modification analagesia physio steroid injections arthrodesis, joint replacement
What is posterior tibial tendon dysfunction
acquired adult flat foot planovalgus common clinical diagnosis - double and single heel raise (valgus to varus) medial or lateral pain orthoses or surgery
Aetiology diabetic foot ulcer
diabetic neuropathy
diabetic autonomic neuropathy
poor vascular supply
lack of patient education
Treatment diabetic foot ulcer
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
Aetiology charcot neuroarthropathy
Any cause of neuropathy
Diabetes commonest
Presents with syphillis
Features charcot neuroarthropathy
rapid bone destruction in 3 stages - fragmentation, coalescence, remodelling
Diagnosis charcot neuroarthropathy
high index of suspicion consider in any diabetic with acute swollen erythematous foot frequently not painful radiographs MRI
Management charcot neuroarthropathy
prevention
immobilisation/non weight bearing
correct deformity
