Common Foot and Ankle Conditions Flashcards
What is the aetiology of hallux valgus?
Bunions
- genetics
- footware
- F > M
What is the pathogenesis of hallux valgus?
- 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
What are the symptoms of hallux valgus?
- pressure from footware
- pain from crossing over of toes
- metatarsalgia
What are the investigations for hallux valgus?
- clinical diagnosis
- XR
What is the management for hallux valgus?
- shoe wear modification
- orthotics
- offload pressure
- correct deformity
- activity modification
- analgesia
- surgery
- release lateral soft tissues
- osteotomy 1st metatarsal, promimal phalanx
What is the aetiology and symptoms of hallux rigidus?
Stiff big toe
- ? genetics
- ? multimicrotrauma
- asymptomatic
- pain
- limited range of movement
What are the investigations and treatment for hallux rigidus?
- clinical diagnosis
- XR
*
What is the causes and symptoms of lesser toe deformities?
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)
What is the treatment for lesser toe deformities?
- 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
What is the aetiology and symptoms of interdigital n neuralgia (Mortons neuroma)?
- 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
What are the investigations and treatment for interdigital neuralgia (Mortons neuroma)?
- clinical diagnosis
- Mulders click
- US/MRI
- injection (small lesions)
- excision of lesion + section of normal nerve
What is the treatment for rheumatoid forefoot?
- shoe wear
- orthotics
- activity modification
- 1st MTPJ arthrodesis
- 2-5th toe excision arthroplasty
What is the aetiology and symptoms of dorsal foot ganglia?
- arise from joint or tendon sheath
- iodiopathic
- underlying arthritis
- underlying tendon pathology
- pain from pressure of shoe wear
- pain from underlying problem
What is the treatment for dorsal foot ganglia?
- aspiration
- ‘bible’
- excision
- 50% rate of return
What is the aetiology and treatment for midfoot arthritis?
- post-traumatic arthritis
- osteoarthritis
- rheumatoid arthritis
- activity modification
- shoe wear, orthotics
- injections- XR guided
- fusion surgery
What are the signs and treatment for plantar fibromatosis?
- ‘Dupuytren’s of the foot’
- progressive
- asymptomatic- unless large/weightbearing area
- shoe wear, orthotics
- excision
- 80% reccurance
- radiotherapy
What is the aetiology of achilles tendinopathy?
- paratendonopathy
- athletic
- 30-40 yrs
- M:F = 2:1
- tendonopathy
- non-athletic
- > 40 yrs
- obese
- steroids
- diabetes
What are the symptoms of achilles tendonopathy?
- pain during exercise
- pain following exercise
- recurrent episodes
- difficuly fitting shoes
- rupture
- tenderness
What are the investigations for achilles tendonopathy?
- clinical diagnosis
- test for rupture
- US
- MRI
What is the treatment of achilles tendonopathy?
- 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
What is the aetiology of plantar fasciitis?
- 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
What does fasciosis mean?
- chronic degenerative change
- fibroblast hypertrophy
- absence inflammatory cells
- disorganised + dysfunctional blood vessels and collagen
- avascularity
- cant make extr-cellular matrix for repair + remodelling
- microtears
What are the symptoms of plantar fasciitis?
- morning pain
- weight-bearing pain, after exercise (post-static dyskinesia)
- pain located at origin of plantar fascia
- frequently long lasting
What are the investigations for plantar faciitis?
- clinical diagnosis
- XR
- US
- MRI
What is the treatment for plantar fasciitis?
- 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
What is tibialis posterior tendon dysfunction?
- aquired adult flat foot planovalgus
- double and single raised heel
- medial/lateral pain
- heel swings from valgus to varus on rising
What are the investigations and treatment for tibialis posterior tendon dysfunction?
- clincal diagnosis
- MRI
- orthotics- medial arch support
- reconstruction of tendon (tendon transfer)
- triple fusion (subtalar, talonavicular, calcaneocuboid)
