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Year 3 MSK (JK) > Common foot and ankle conditions > Flashcards

Common foot and ankle conditions Flashcards

1
Q

List some non operative treatments

A

analgesia/shoewear modifications/weight loss/activity modification/physiotherapy/orthotics eg insoles

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2
Q

6 forefoot problems

A 
hallux valgus 
hallux rigidus 
lesser toe deformities 
mortons neuroma
metatarsalgia
rheumatoid forefoot
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3
Q

Aetiology of hallux valgus

A

genetic. female, footwear

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4
Q

Symptoms of hallux valgus

A

pressure symptoms from shoe wear
pain from toes crossing over
metatarsalgia

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5
Q

Metatarsalgia

A

pain in ball of foot

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6
Q

describe in 5 steps the pathogenesis of hallux valgus

A

lateral angulation of great toe
tendon pull realigned to lateral of toe
vicious cycle of increase pull and deformity
sesamoid bone sublux - less weight through big toe
deformities of lesser toes occur

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7
Q

Diagnosis of hallux valgus

A

clinical

x-rays show severity of bone deformity

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8
Q

non operative - hallux valgus

A

shoes - wide and increase toe box
orthotics to offload pressure and correct deformity
activity modification and analgesia

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9
Q

Operative - hallux valgus

A

release lateral soft tissue

osteotomy - 1st MT +/- proximal phalanx`

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10
Q

What is hallux rigidus

A

OA of 1st MTP joint

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11
Q

Aetiology of hallux rigidus

A

unknown, genetic, multiple microtrauma

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12
Q

Symptoms of hallux rigidus

A

many asymptomatic

can be decreased ROM and pain at extreme dorsiflexion

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13
Q

Diagnosis of hallux rigidus

A

clinical and radiographs

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14
Q

non op - hallux rigidus

A

activity/shoe with rigid sole/analgesia

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15
Q

op - hallux rigidus

A

cheilectomy, arthrodesis and arthroplasty

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16
Q

Gold standard of for hallux rigidus

A

1st MTP joint fusion

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17
Q

When is 1st MTPJ hemiarthroplasty a good option for hallux rigidus?

A

retain ROM and in low demand patients

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18
Q

3 lesser toe deformities and briefly describe appearance

A

claw - flexed PIP and DIP
hammer - flexed PIP and extended DIP
mallet - DIP flexion

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19
Q

Aetiology of lesser toe deformities

A 
imbalance between flexors/extensors 
shoe wear 
RA 
neurological 
idiopathic
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20
Q

symptoms of lesser toe deformities

A

deformity, pain from dorsum and plantar side

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21
Q

3 non op - lesser toe deformities

A

activity
shoe wear - flat with high toe box
orthotic insoles

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22
Q

4 op - lesser toe deformities

A

flexor –> extensor transfer
IPJ fusion
release metatarsophalangeal joint
shortening osteotomy of metatarsal

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23
Q

aetiology of mortons neuroma

A

mechanically induced degenerative neuropathy
females age 40-60
high heeled shoes

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24
Q

mortons neuroma symptoms

A

3rd followed by 2nd webspace with burning pain

intermittent and sensation in webspace altered

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25
Q

Diagnosis of mortons neuroma - name of clinical sign

A

mulders click

USS/MRI

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26
Q

Management of mortons neuroma

A

injection for small lesions

excise lesion and some of normal nerve

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27
Q

If no known cause of metatarsalgia what should you consider?

A

tight gastrocnemius

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28
Q

non op management of RA forefoot

A

shoewear, orthotics and activity

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29
Q

op - RA forefoot

A

1st MTPJ arthrodesis is gold standard

2-5th toe excision arthroplasty

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30
Q

3 midfoot problems

A

ganglia

OA and plantar fibromatosis

31
Q

Where do dorsal foot ganglia arise from?

A

tendon sheath or joint

32
Q

aetiology of dorsal foot ganglia

A

idiopathic
underlying arthritis
underlying tendon pathology

33
Q

symptoms of ganglia

A

pain from shoe wear pressure or underlying problem

34
Q

Treatment of ganglia

A

aspirate or family bible

excise

35
Q

% return rate of ganglia excision

A

50

36
Q

3 types of midfoot arthritis

A

post traumatic, OA, RA

37
Q

3 treatments of arthritis in midfoot

A

non op = activity/shoes/orthotics
x-ray guided injections
fusion

38
Q

When is plantar fibromatosis symptomatic?

A

very large or weightbearing area

39
Q

non op - plantar fibromatosis

A

avoid pressure - shoes/orthotics

40
Q

other treatments of pantar fibromatosis

A

excise
radiotherapy
radiotherapy and surgery

41
Q

5 hindfoot problems

A 
ankle osteoarthritis 
cavovarus foot 
achilles tendinosis 
plantar fasciitis 
tibialis posterior dysfunction
42
Q

Describe achilles tendinosis

A

degenerative/overuse condition with little inflammation

43
Q

Who does paratendonopathy affect?

A

athletes, 30-40, males

44
Q

Who does tendonopathy affect?

A

non athlete, obese, over 40, steroids, DM

45
Q

Symptoms of achilles tendinopathy

A

pain on exercise or after exercise

recurrent and difficulty fitting shoes

46
Q

Diagnosis of achilles tendinopathy and the name of tests

A

clinical = Simmonds squeeze test and matles angle of dangle

USS/MRI

47
Q

non op - achilles tendinopathy

A

activity/weight loss/shoes - slight heel/physio/ECST/immobilise

48
Q

op - achilles tendinopathy

A

gastrocnemius recession

release and debridement of tendon

49
Q

Describe fasciosis

A

chronic degenerative change with disorganised blood vessels, no inflammatory cells and fibroblast hypertrophy
cannot make ECM needed for remodelling

50
Q

Aetiology of plantar fasciitis

A

unknown/obese/athletes/standing/poorly padded shoes/foot and lower limb deformities/tight gastrosoleus

51
Q

4 symptoms of plantar fasciitis

A

pain in morning or after rest
pain at origin of plantar fascia
2 years + duration

52
Q

differential diagnosis of plantar fasciitis

A

arthritis
calcaneal pathology
nerve entrapment syndrome

53
Q

Diagnosis of plantar fasciitis

A

mainly clinical

x-rays, USS, MRI

54
Q

9 treatments of plantar fasciitis

A 
NSAIDS 
ice 
physiotherapy 
CCS injections
orthoses - heel pads 
stretching 
rest 
night splinting 
weight loss
55
Q

5 newer treatments for plantar fasciitis

A 
extracorpeal shockwave therapy 
Nitric oxide 
endoscopic/open surgery 
platelet rich plasma 
topaz plasma coblation
56
Q

aetiology of ankle arthritis

A

46 years, post trauma, idiopathic

57
Q

Symptoms of ankle arthritis

A

pain and stiffness

58
Q

diagnosis of ankle arthritis

A

clinical, radiographs and CT

59
Q

non op - ankle arthritis

A

weight loss/activity/analgesia/physio/steroid injections

60
Q

op - ankle arthritis

A

anterior symptoms - arthroscopic anterior debridement
arthrodesis is the gold standard
joint replacement

61
Q

Clinical diagnosis of posterior tibial tendon dysfunction

A

double and single heel raise

62
Q

What Is posterior tibial tendon dysfunction a common cause of?

A

acquired flat feet

63
Q

3 managements of posterior tibial tendon dysfunction

A

orthotics - medial arch support
reconstruct tendon
triple fusion

64
Q

Diagnosing posterior tibial tendon dysfunction

A

clinical or MRI

65
Q

Why does diabetic foot ulcers occur?

A

peripheral neuropathy
lack of patient education
poor blood supply
ANS dysfunction - less sweating - dry cracked skin

66
Q

Treatment of diabetic foot ulcer

A

prevention

modify –> smoking, DM control, vascular supply, shoes, deformity, infection, nutrition

67
Q

Surgery for diabetic foot ulcer

A

improve vascular supply
amputate
debride ulcers
correct deformity

68
Q

prognosis for diabetic foot ulcer statistics

A

15% diabetics develop
50% 5ys
85% diabetic amputations due to this
25% –> amputation

69
Q

aetiology of charcot neuropathy

A

neuropathy causes
diabetes
syphilis

70
Q

2 types of charcot foot

A

neurotraumatic - lack of proprioception and protective pain sensation
neurovascular - abnormal ANS leads to increased blood supply and bone resorption

71
Q

3 stages of charcots foot

A

fragmentation
coalescence
remodelling

72
Q

diagnosing charcots foot

A

acute erythematous foot in DM and neuropathy
more than 3 degrees difference in limbs
non painful
radiograph, MRI

73
Q

Managing charcots foot

A

prevention
immobilisation
correct deformity before amputation

Year 3 MSK (JK) (30 decks)

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