Common Foot and Ankle Conditions

Question 1

What is the aetiology of hallux valgus?

Answer 1

Bunions

• genetics
• footware
• F > M

Question 2

What is the pathogenesis of hallux valgus?

Answer 2

• lateral angulation of great toe
• tendons pull realigned to lateral of centre of rotation of toe worsening deformity
• vicious cycle of inc. pull -> inc. deformity
• sesamoid bone sublux- less weight goes through great toe
• abnormalities of lesser toes occur

Question 3

What are the symptoms of hallux valgus?

Answer 3

• pressure from footware
• pain from crossing over of toes
• metatarsalgia

Question 4

What are the investigations for hallux valgus?

Answer 4

• clinical diagnosis
• XR

Question 5

What is the management for hallux valgus?

Answer 5

• shoe wear modification
• orthotics
• offload pressure
• correct deformity
• activity modification
• analgesia
• surgery
• release lateral soft tissues
• osteotomy 1st metatarsal, promimal phalanx

Question 6

What is the aetiology and symptoms of hallux rigidus?

Answer 6

Stiff big toe

• ? genetics
• ? multimicrotrauma
• asymptomatic
• pain
• limited range of movement

Question 7

What are the investigations and treatment for hallux rigidus?

Answer 7

• clinical diagnosis
• XR

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Question 8

What is the causes and symptoms of lesser toe deformities?

Answer 8

Hammer toe, claw toe, mallet toe

• imbalance between flexors + extensors
• shoe wear
• neurological
• rheumatoid arthritis
• idiopathic
• deformity
• pain from dorsum
• pain from plantar side (metatarsalgia)

Question 9

What is the treatment for lesser toe deformities?

Answer 9

• activity modification
• flat shoes with high toe box
• orthotic insoles (metatarsal bar/dome support)
• surgery
• flexor to extensor transfer
• fusion of interphalangeal joint
• release metatarsophalangeal joint
• shortening osteotomy of metatarsal

Question 10

What is the aetiology and symptoms of interdigital n neuralgia (Mortons neuroma)?

Answer 10

• mechanically induced degenerative neuropathy
• common digital nerve relatively tethered to one metatarsal, movement in adjacent metatarsal cause mechanical sheer
• associated with high heels (F, 40-60 yrs)
• usually affects 3rd then 2nd webspace/toes
• neuralgic burning pain in toes
• intermittent
• altered sensation in webspace

Question 11

What are the investigations and treatment for interdigital neuralgia (Mortons neuroma)?

Answer 11

• clinical diagnosis
• Mulders click
• US/MRI
• injection (small lesions)
• excision of lesion + section of normal nerve

Question 12

What is the treatment for rheumatoid forefoot?

Answer 12

• shoe wear
• orthotics
• activity modification
• 1st MTPJ arthrodesis
• 2-5th toe excision arthroplasty

Question 13

What is the aetiology and symptoms of dorsal foot ganglia?

Answer 13

• arise from joint or tendon sheath
• iodiopathic
• underlying arthritis
• underlying tendon pathology
• pain from pressure of shoe wear
• pain from underlying problem

Question 14

What is the treatment for dorsal foot ganglia?

Answer 14

• aspiration
• ‘bible’
• excision
• 50% rate of return

Question 15

What is the aetiology and treatment for midfoot arthritis?

Answer 15

• post-traumatic arthritis
• osteoarthritis
• rheumatoid arthritis
• activity modification
• shoe wear, orthotics
• injections- XR guided
• fusion surgery

Question 16

What are the signs and treatment for plantar fibromatosis?

Answer 16

• ‘Dupuytren’s of the foot’
• progressive
• asymptomatic- unless large/weightbearing area
• shoe wear, orthotics
• excision
• 80% reccurance
• radiotherapy

Question 17

What is the aetiology of achilles tendinopathy?

Answer 17

• paratendonopathy
• athletic
• 30-40 yrs
• M:F = 2:1
• tendonopathy
• non-athletic
• > 40 yrs
• obese
• steroids
• diabetes

Question 18

What are the symptoms of achilles tendonopathy?

Answer 18

• pain during exercise
• pain following exercise
• recurrent episodes
• difficuly fitting shoes
• rupture
• tenderness

Question 19

What are the investigations for achilles tendonopathy?

Answer 19

• clinical diagnosis
• test for rupture
• US
• MRI

Question 20

What is the treatment of achilles tendonopathy?

Answer 20

• activity modification
• weight loss
• shoe wear with slight heel
• physiotherapy
• extra-corporeal shockwave treatment
• immobilisation (below knee cast)
• gastrocnemius recession
• release and debridement of tendon

Question 21

What is the aetiology of plantar fasciitis?

Answer 21

• not known
• athletes- high intensity/rapid inc. in training
• running- poorly padded soles/hard surfaces
• obesity
• occupation- prolonged standing
• foot/lower limb rotational deformities
• tight gastro-soleus complex

Question 22

What does fasciosis mean?

Answer 22

• chronic degenerative change
• fibroblast hypertrophy
• absence inflammatory cells
• disorganised + dysfunctional blood vessels and collagen
• avascularity
• cant make extr-cellular matrix for repair + remodelling
• microtears

Question 23

What are the symptoms of plantar fasciitis?

Answer 23

• morning pain
• weight-bearing pain, after exercise (post-static dyskinesia)
• pain located at origin of plantar fascia
• frequently long lasting

Question 24

What are the investigations for plantar faciitis?

Answer 24

• clinical diagnosis
• XR
• US
• MRI

Question 25

What is the treatment for plantar fasciitis?

Answer 25

• rest/change training
• stretching
• ice
• NSAIDs
• orthoses- heel pad
• physiotherapy
• weight loss
• corticosteroid injections
• good in short term, may make it worse in long term
• night splinting

Question 26

What is tibialis posterior tendon dysfunction?

Answer 26

• aquired adult flat foot planovalgus
• double and single raised heel
• medial/lateral pain
• heel swings from valgus to varus on rising

Question 27

What are the investigations and treatment for tibialis posterior tendon dysfunction?

Answer 27

• clincal diagnosis
• MRI
• orthotics- medial arch support
• reconstruction of tendon (tendon transfer)
• triple fusion (subtalar, talonavicular, calcaneocuboid)