Common Foot and Ankle Conditions Flashcards
Treatment options for foot and ankle conditions
Non-operative management
- Analgesia
- Shoe wear modification
- Activity modification
- Weight loss
- Physiotherapy
- Orthotics including insoles and bracing
Operative management
- The only indication for operative management is failure of non-operative management
Forefoot problems
- Hallux valgus
- Hallux rigidus
- Lesser toe deformities
- Morton’s neuroma
- Metatarsalgia
- Rheumatoid Forefoot
Hallux valgus definition and risk factors
- ‘Bunions’ - deformity at first metatarsophalangeal joint (MTPJ)
- Aetiology
- Female
- Connective tissue disorders
- Hypermobility syndromes
Hallax valgus symtoms
- Painful medial prominence - aggravated by walking, weight bearing or narrow toed shoes
- Pressure symptoms from shoe wear
Hallax valgus diagnosis
- Clinical
- X-ray
- Determine severity of underlying bony deformity
- Exclude associated degenerate change
Hallax valgus non-operative management
- Analgesia
- Shoe wear modification
- Orthotics to correct deformity (eg if flat footed)
- Physiotherapy
Hallax rigidus definition and aetiology
- stiff big toe
- osteoarthritis of 1st MTP joint
- aetiology
- possibly genetic
- possibly multiple microtrauma
Hallux rigidus symptoms
- Many asymptomatic
- Pain – often at extreme of dorsiflexion
- Limitation of range of movement
- Swelling around the joint
Hallax rigidus non-operative management
- Analgesia
- NSAIDs
- Shoe wear with rigid sole
Hallax rigidus operative management
- Cheilectomy - remove dorsal impingement
- Arthrodesis - 1st MTPJ fusion (gold standard)
- Arthroplasty - 1st MTPJ hemiarthroplasty
Morton’s neuroma
- mechanically induced degenerative neuropathy
- frequently associated with wearing high healed shoes – common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear
Morton’s neuroma symptoms
- Typically affects 3rd followed by 2nd webspace/toes
- Altered sensation in webspace
- Neuralgic burning pain into toes
- Intermittent
Interdigital Neuralgia = Morton’s Neuroma
Morton’s Neuroma Diagnosis
- Clinical
- Mulder’s Click
- Ultrasound best / MRI good
Morton’s Neuroma Management
- Injection for small lesions
- Surgery – excision of lesion including a section of normal nerve
- Numbness
- Recurrence
- Up to 30% have pain 1 year post surgery
- Nitrogen freezing
Hindfoot problems
- Achilles tendonitis/tendinosis
- Plantar fasciitis
- Ankle osteoarthitis
- Tibialis posterior dysfunction
- Cavovarus foot
Achilles tendinopathy aetiology
Paratendonopathy
- Commonest in athletic populations
- Age group 30-40
- Male:Female = 2:1
- Tendonopathy
- Commonest in non-athletic populations
- Unfit individual who has a sudden increase in exercise frequency
- Aged over 40
- Obesity
- Steroids
- Diabetes
Achilles Tendinopathy Symptoms
- Gradual onset of pain and stiffness in the posterior ankle, often worse with movement
- Tenderness over the tendon on palpation
Achilles tendinopathy diagnosis
- Clinical
- Tenderness
- Tests for rupture (Simmonds test)
- Investigations
- Ultrasound
Achilles Tendinopathy Non-operative Treatment
- RICE, NSAIDs
- Stop precipitation exercise
- Rehabilitaion and physiotherapy
Plantar fasciitis definition and risk factors
Inflammation of the plantar fascia
- Anatomical factors (high arches)
- Weak plantar flexors
- Prolonged standing or excessive running
- Unsuportive footwear
Plantar fasciitis symptoms
- Heel pain (stabbing)
- Worse with first few steps, before easing off
Plantar fasciitis diagnosis
- Mainly clinical
- Occasionally
- X-Ray
- MRI
Plantar fasciitis conservative management
- Activity moderation
- NSAIDs
- Footwear modification
- Physiotherapy
Plantar fasciitis surgical management
- Corticosteroid injections
- Plantar fasciotomy
