Common Foot and Ankle Conditions Flashcards
1
Q
Treatment options for foot and ankle conditions
A
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
2
Q
Forefoot problems
A
- Hallux valgus
- Hallux rigidus
- Lesser toe deformities
- Morton’s neuroma
- Metatarsalgia
- Rheumatoid Forefoot
3
Q
Hallux valgus definition and risk factors
A
- ‘Bunions’ - deformity at first metatarsophalangeal joint (MTPJ)
- Aetiology
- Female
- Connective tissue disorders
- Hypermobility syndromes
4
Q
Hallax valgus symtoms
A
- Painful medial prominence - aggravated by walking, weight bearing or narrow toed shoes
- Pressure symptoms from shoe wear
5
Q
Hallax valgus diagnosis
A
- Clinical
- X-ray
- Determine severity of underlying bony deformity
- Exclude associated degenerate change
6
Q
Hallax valgus non-operative management
A
- Analgesia
- Shoe wear modification
- Orthotics to correct deformity (eg if flat footed)
- Physiotherapy
7
Q
Hallax rigidus definition and aetiology
A
- stiff big toe
- osteoarthritis of 1st MTP joint
- aetiology
- possibly genetic
- possibly multiple microtrauma
8
Q
Hallux rigidus symptoms
A
- Many asymptomatic
- Pain – often at extreme of dorsiflexion
- Limitation of range of movement
- Swelling around the joint
9
Q
Hallax rigidus non-operative management
A
- Analgesia
- NSAIDs
- Shoe wear with rigid sole
10
Q
Hallax rigidus operative management
A
- Cheilectomy - remove dorsal impingement
- Arthrodesis - 1st MTPJ fusion (gold standard)
- Arthroplasty - 1st MTPJ hemiarthroplasty
11
Q
Morton’s neuroma
A
- 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
12
Q
Morton’s neuroma symptoms
A
- Typically affects 3rd followed by 2nd webspace/toes
- Altered sensation in webspace
- Neuralgic burning pain into toes
- Intermittent
Interdigital Neuralgia = Morton’s Neuroma
13
Q
Morton’s Neuroma Diagnosis
A
- Clinical
- Mulder’s Click
- Ultrasound best / MRI good
14
Q
Morton’s Neuroma Management
A
- 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
15
Q
Hindfoot problems
A
- Achilles tendonitis/tendinosis
- Plantar fasciitis
- Ankle osteoarthitis
- Tibialis posterior dysfunction
- Cavovarus foot
