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Musculoskeletal System > Common Foot and Ankle Problems > Flashcards

Common Foot and Ankle Problems Flashcards

1
Q

What is the other term commonly used for Hallux Valgus

A

Bunions

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2
Q

What are the risk factors for Hallux Valgus

A

Genetics, specific footwear, significant female preponderance

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3
Q

Symptoms of Hallux Valgus

A

Pressure symptoms from shoe wear, pain from crossing over of toes, metatarsalgia

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4
Q

Pathogenesis of Hallux Valgus

A

Occurs from lateral angulation of the great toe, the tendons then pull to lateral of centre of rotation of toes which then worsens the deformity. The sesamoid bones then sublux and less weight goes through the great toe.

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5
Q

Diagnosis of Hallux Valgus

A

Clinical, Xrays

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6
Q

Management of Hallux Valgus (non operative)

A

Foot wear modification, orthotics to offload the pressure and correct the deformity, activity modification, analgesia

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7
Q

Management of Hallux Valgus (non-operative)

A

Release lateral soft tissues

Osteotomy 1st metatarsal and the proximal phalanx

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8
Q

What is Hallux Rigidus

A

A stiff big toe, osteoarthritis of the 1st MTP joint, bimodal distribution of age

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9
Q

Aetiology of Hallux Rigidus

A

Possibly genetic, possibly multiple microtrauma

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10
Q

Symptoms of Hallux Rigidus

A

Pain at extreme dorsiflexion, limitation of range of movement

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11
Q

Diagnosis of Hallux Rigidus

A

Clinical or Xray

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12
Q

Hallux Rigidus Xray

A

complete loss of joint space bilaterally or dorsal osteophyte

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13
Q

Non operative management of hallux rigidus

A

Activity modification, shoe wear with rigid sole, analgesia

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14
Q

Surgery Hallux Rigidus

A

Cheilectomy, arthrodesis, arthroplasty

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15
Q

Cheilectomy

A

Removal of the dorsal impingement

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16
Q

Gold standard treatment of Hallux Rigidus

A

1st MTPJ fusion

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17
Q

Aetiology of Lesser Toe Deformities

A 
Imbalance between flexors/extensors
Shoe wear 
Neurological
Rheumatoid arthritis
Idiopathic
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18
Q

Symptoms of lesser toe deformities

A

Deformity, pain from the dorsum, pain from the plantar side

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19
Q

Different lesser toes deformities

A

Hammer Toe, Claw Toe, Mallet Toe

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20
Q

Non-operative management of lesser toe deformities

A

Activity modification
Shoe wear – flat shoes with high toe box to accommodate deformity
Orthotic insoles – metatarsal bar/dome support

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21
Q

Operative Treatment of lesser toe deformities

A

Flexor to extensor transfer
Fusion of interphalangeal joint
Release of metatarsophalangeal joint
Shortening osteotomy of metatarsal

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22
Q

What is Mortons Neuroma

A

Thickening of the tissue around the nerves at the base of the toes (usually the 3rd and 4th)

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23
Q

Causes of Mortons Neuroma

A

Mechanically induced degenerative neuropathy

Tends to affect females aged 40-60

Frequently associated with wearing high healed shoes

Common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear

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24
Q

Symptoms of Mortons Neuroma

A

Neuralgic burning pain into the toes and altered sensation in webspace

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25
Q

What webspace does Mortons Neuroma commonly effect

A

3rd followed by 2nd

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26
Q

Diagnosis of Mortons Neuroma

A

Clinical, Mulders Click, Ultrasound/MRI

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27
Q

Treatment of small Mortons Neuroma

A

Steroid Injection

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28
Q

Treatment of larger Mortons Neuroma

A

Excision of lesion including a section of normal nerve

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29
Q

Common effects of surgery of mortons neuroms

A

Numbness, recurrence, 30% have pain 1 year post surgery

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30
Q

Metatarsalgia

A

Pain and inflammation on the base and balls of the foot

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31
Q

Causes of Metatarsalgia

A

Synovitis, bursitits, arthritis, neuralgia, neuromata, Freiberg’s disease

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32
Q

Non operative treatment of rheumatoid forefoot

A

Shoewear, orthotics, activity modification

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33
Q

Operative management of rheumatoid forefoot

A

1st MTPJ arthrodesis and 2-5th toe excision arthroplasty

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34
Q

Ganglia

A

These tend to occur from arthritis of underlying tendon pathology

35
Q

Symptoms of ganglia

A

Pain from pressure

36
Q

Treatment of ganglia

A

Aspiration or excision (high rate of return (50%))

37
Q

Plantar Fibromatosis

A

Ledderhose disease, thickening of the foots deep connective tissue

38
Q

Symptoms of plantar fibromatosis

A

Usually asymptomatic unless very large on weightbearing area

39
Q

Non-operative management of plantar fibromatosis

A

Avoid pressure by changing foot wear or adding orthotics

40
Q

Other treatments of plantar fibromatosis

A

Operative excision, radiotherapy, combination radiotherapy/surgery

41
Q

Achilles Tendinosis

A

Degenerative overuse condition with little inflammation

42
Q

Insertional Achilles Tendinopathy

A

Within 2cm of insertion

43
Q

Non-insertional/ Mid-substance tendinopathy

A

2-7cm

44
Q

Bursitis achilles tendinopathy

A

Retrocalcaneal or superficial calcaneal

45
Q

Paratendinopathy

A

True inflammatroy problem showing paratendonitis histologically

46
Q

Aetiology of paratendonopathy

A

Common in athletic populations aged around 30-40 and occurs in males more than females (2:1)

47
Q

Aetiology of tendonopathy

A

Common in non-athletic populations, usually aged over 40

48
Q

Risk factors for tendonopathy

A

Obesity, steroids and diabetes

49
Q

Symptoms of Achilles Tendinopathy

A

Pain during exercise
Pain following exercise
Recurrent episodes
Difficulty fitting shoes

50
Q

How is achilles tendinopathy usually diagnosed

A

Tenderness, tests for rupture, ultrasound scan or MRI

51
Q

Simmonds Test

A

If the calf squeeze does not move the foot then the achilles tendon is ruptured

52
Q

Non-operative treatment of achilles tendinopathy

A 
Activity modification 
Weight loss
Shoe wear modification 
Physiotherapy - eccentric stretching 
Extra-corporeal shockwave treatment
Immobilisation in below the knee cast
53
Q

Operative treatment of achilles tendinopathy

A

Gastrocnemius recession

Release and debridement of tendon

54
Q

Plantar Fasciitis/Fasciosis

A

Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen and avasularity

55
Q

Causes of Plantar Fasciitis

A

Athletes associated with high intensity or marked increase in training
Running with poorly padded shoes
Obesity
Occupations involving long periods of standing
Foot/lower limb rotational deformities
Tight gastro-soleus compex

56
Q

Symptoms of plantar fasciitis

A

Pain first think in the morning, pain on weight bearing after rest (post-static dyskinesia), pain located at the origin of plantar fascia, frequently long lasting - 2 years or more

57
Q

Differential diagnosis plantar fasciitis

A

Nerve entrapment syndrome
Arthritis
Calcaneal Pathology

58
Q

Diagnosis of Plantar Fasciits

A

Mainly clinical, can use X-rays, Ultrasounds and MRI

59
Q

Treatments of plantar fasciitis

A 
Rest
Stretching
Ice
NSAIDs
Orthoses
Physiotherapy
Weight loss
Corticosteroid injections
Night spinting
60
Q

Newer treatments of plantar fasciitis

A 
Extracorporeal Shockwave therapy
Topaz Plasma Coblation
Nitric Oxide
Platelet Rich Plasma
Endoscopic / Open Surgery
61
Q

Ankle Arthritis mean age of presentation

A

46

62
Q

Symptoms of Ankle arthritis

A

Pain and stiffness in the ankle joint

63
Q

Diagnosis of Ankle Arthritis

A

Clinical, X-ray, CT scan - exclude adjacent joint arthritis

64
Q

Non-operative management of Ankle Arthritis

A

Weight loss, activity modification, analgesia, physiotherapy, steroid injections

65
Q

Operative Managment of Ankle Arthritis (exclusively anterior symptoms)

A

Arthroscopic anterior debridement

66
Q

Operative management of ankle arthritis

A

Arthrodesis, joint replacement

67
Q

Gold standard treatment for ankle arthritis

A

Arthrodesis

68
Q

Tibialis posterior tendon dysfunction

A

Acquired adult flat foot planovalgus

69
Q

Diagnosis of tibialis posterior tendon dysfunction

A

Double and single heel raise test (valgus to varus)

70
Q

Symptoms of tibialis posterior tendon dysfunction

A

Medial or lateral pain

71
Q

Treatment of tibialis posterior tendon dysfunction

A

Orthoses (medial arch support) or surgery (reconstruction of tendon or triple fusion of subtalar, talnoavicular and calcaneocuboid)

72
Q

Aetiology of diabetic foot ulcer

A

Occurs due to diabetic neuropathy resulting in the patient being unaware of the trauma occuring to their foot.

There is also autonomic neuropathy resulting in a alack of sweating and normal sebum production, therefore there is dry cracked skin and it is more sensitive to trauma

Poor vascular supply

73
Q

Treatment of diabetic foot ulcer (modification the main detriments to healing)

A 
Diabetic control
Smoking
Vascular supply
External pressure (splints/shoes/weight bearing)
Internal pressure (deformity)
Infection
Nutrition
74
Q

Surgical treatment of diabetic foot ulcer

A

Improvement of vascular supply
Debridement of ulcers and get deep samples for microbiology
Amputation

75
Q

Percentage of diabetic patients who get foot ulcers

A

15%

76
Q

Percentage of patients with diabetic foot ulcers that go on to have amputation

A

25%

77
Q

5 year mortality of diabetic foot ulcers

A

50%

78
Q

Aetiology of Charcot Neuroarthropathy

A

Any cause of neuropathy to the foot, mostly diabetic neuropathy

79
Q

Neurotraumatic theory of the pathophysiology of Charcot Neuroarthropathy

A

Lack of proprioception and protective pain sensation

80
Q

Neurovascular pathophysiology of Charcot

A

Abnormal autonomic nervous system results in increased vascular supply and bone resorption

81
Q

3 stages of bone destruction in Charcot

A

Fragmentation
Coalescence
Remodelling

82
Q

Diagnosis of Charcot

A

Consider in any diabetic with acutely swollen erythematous foot
X-ray
MRI scan

83
Q

Management of Charcot

A

Prevention
Immobilisation
Correction of the deformity

Musculoskeletal System (34 decks)

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