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MSK clinical > Common foot problems > Flashcards

Common foot problems Flashcards

1
Q

what are the non-operative managements for foot problems?

A 
orthotics i.e. insoles & bracing 
shoe wear modification 
analgesia
weight loss 
physiotherapy
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2
Q

what are common forefoot problems?

A 
hallux valgus
hallux rigidus 
lesser toe deformities (claw, hammer and mallet toes)
mortons neuroma
metatarsalgia 
rheumatoid forefoot
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3
Q

what is the aetiology of hallux valgus?

A

genetic
female predisposition
foot wear can precipitate hallux vallus in a susceptible individual

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4
Q

describe the pathogenesis of hallux valgus.

A

lateral angulation of the big toe
the tendons pulls lateral to the centre of rotation to realign the toe but this worsens the deformity
the sesamoid bone sublux - therefore less weight is put on the big toe
as it progresses abnormalities of the lesser toes occur

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5
Q

what are the treatment options for hallux valgus?

A

non-operative

surgery: osteotomy of 1st metatarsal +/- proximal phalanx

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6
Q

what is hallux rigidus and what age groups is is most common?

A

stiff big toe

bimodal age distribution: 20s/30s and 40s

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7
Q

what is the presentation of hallux rigidus?

A

stiff big toe

often pain at the extremes of dorsiflexion

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8
Q

what are the treatment options for hallux rigidus?

A 
non-operative 
surgery:
- cheilectomy (remove osteophyte to relive nerve impingement) 
- arthrodesis (gold standard) 
- arthroplasty
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9
Q

what are the 3 lesser toe deformities?

A

claw toes:

  • hyperextension of MTP joint
  • flexion at the distal and proximal interphalangeal joints

hammer toe:
- hyperextension of the MTP joint

mallet toe:
- fixed extension of the distal interphalangeal joint

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10
Q

what is the aetiology of lesser toe deformities?

A 
imbalance between flexors and extensors
shoe wear
neurological
rheumatoid arthritis
idiopathic
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11
Q

what is morton’s neuroma?

A

interdigital neuralgia caused by inflammation at the site where the common digital nerve splits to supply adjacent toes
the common digital nerve is tethered to one metatarsal but is also involved in movement in adjacent metatarsal causing mechanical shear

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12
Q

what is the aetiology of mortons neuroma?

A

mechanically induced degenerative neuropathy

commonly associated with wearing high heels

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13
Q

what is the presentation of morton’s neuroma?

A

neuralgic burning pain into toes
intermittent
altered sensation in webspace

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14
Q

how is morton’s neuroma diagnosed?

A

clinical
examination: Mulder’s click
USS

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15
Q

what is the treatment for Morton’s neuroma/ interdigital neuralgia?

A

steroid injection

surgery: excision of lesion (not usually done)

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16
Q

what is metatarsalgia?

A

pain and inflammation in the forefoot - metatarsal head/ the ball of the foot
it is a symptom rather than a diagnosis

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17
Q

what could be the cause of metatarsalgia if there is no identifiable cause?

A

a high gastrocnemius muscle

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18
Q

what deformity is found in rheumatoid forefoot?

A

hallux valgus with degenerative change

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19
Q

what is the treatment for rheumatoid forefoot?

A

non-operative
1st MTP joint arthrodesis (union)
2nd to 5th toe excision arthroplasty

20
Q

what are common conditions of the mid foot?

A

ganglion
osteoarthritis
plantar fibromatosis

21
Q

where does a dorsal foot ganglion arise from and what causes it?

A

arises from the joint or tendon sheath
idiopathic
may have underlying arthritis or tendon pathology

22
Q

what is the treatment for a dorsal foot ganglion?

A

aspiration

excision

23
Q

what are the aetiologies of mid foot arthritis?

A

post trauma
rheumatoid arthritis
osteoarthritis

24
Q

what is the management of mid foot arthritis?

A

non-operative
steroid injections
surgery: fusion

25
Q

what is plantar fibromatosis?

A

thickening of the deep connective tissue or fascia

26
Q

what is the presentation of fibromatosis?

A

usually asymptomatic unless very heavy large or at a weight bearing area

27
Q

what are the treatment options for planet fibromatosis?

A

non-operative
excision
radiotherapy
combination of radiotherapy & surgery

28
Q

what are examples of hind foot problems?

A 
chillies tendonosis 
plantar fasciitis 
ankle osteoarthritis
tibialis posterior dysfunctiion
cavovarus foot
29
Q

what is achillies tendinosis?

A

degenerative / overuse condition with little inflammation

30
Q

what is the difference in the prevalence of achillies paratendinopathy and tendinopathy?

A

paratendinopathy occurs in athletic populations

  • 30s & 40s
  • male: female 2:1

tendinopathy commonest in non-athletic populations:

  • diabetics
  • age > 40 yrs
  • obesity
  • steroids

paratendinopathy is inflammation of a thin membrane that surrounds the chillies tendon whereas tendinopathy is inflammation of the tendon itself

31
Q

what is the presentation of achillies tendinopathy?

A 
pain on exercise
pain after exercise
recurrent episodes
difficulty fitting shoes 
rupture
32
Q

how would you diagnose achillies tendonopathy?

A

history pattern

clinical: tenderness, tests for rupture
investigations: MRI, USS

33
Q

what clinical tests is used to diagnose an achillies tendon rupture?

A

Simmonds test;
- Lie patient on their front and let feet hand from the bed
squeeze the calf and it the foot doesn’t move then their is a full rupture

Angle of dangle / Matles;
- Lie patient supine on their front and ask to bend their knees. if their is a tear then there will be excessive dorsiflexion in the ruptured side
also can do it by asking them to dangle feet from edge of the bed whilst lying on their frontand observe from their

34
Q

what is the management for achillies tendinopathy?

A

non-operative:

  • activity modification
  • weight loss
  • physiotherapy
  • shoe wear modification
  • extracorporeal shock wave therapy
  • immobilisation with cast

surgery:
- gastrocnemius recession
- release and debridement of tendon

35
Q

what is plantar fasciitis?

A

chronic degenerative change with fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen, vascularity
can’t make extracellular matrix required for repair and remodelling

36
Q

what is the aetiology of plantar fasciitis?

A 
idiopathic 
athletes - high intensiting, rapid increase in training
exercise with poorly padded shoes
obesity
foot/lower limb rotational deformities
tight gastro-soleus complex
37
Q

what is the presentation of plantar fasciitis?

A

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

38
Q

how is plantar fasciitis diagnosed?

A

clinical diagnosis

MRI, x-rays, USS may be useful

39
Q

what are the treatments for plantar fasciitis?

A 
rest
stretching 
NSAIDS
ice 
orthotics i.e. heel pads, insoles
weight loss
steroid injections
night splinting

3rd line:

  • extracorporeal shockwave therapy
  • endoscopic open surgery
40
Q

what is the presentation of ankle arthritis and at what age does it common present?

A

mean age is 46 yrs
commonly post traumatic or idiopathic
symptoms: pain and stiffness

41
Q

what is the treatment for ankle arthritis?

A

non-operative
surgery: arthrodesis, arthroplasty
if symptoms are exclusively anterior then treat with arthroscopic anterior debridement

42
Q

what is tibialis posterior tendon dysfunction?

A

acquired adult flat foot planovalgus

43
Q

what does tibialis posterior tendon dysfunction present with?

A

medial or lateral pain

acquired flat feet (in adults)

44
Q

how can you diagnose tibialis posterior tendon dysfunction?

A

double and single limb heel raise test:

they can rise on their heels if they do both at a time but they can’t do a heel rise on one foot

MRI to assess tendon

45
Q

what is the treatment for tibialis posterior tendon dysfunction?

A

orthotics to support arch
reconstruction of tendon (tendon transfer)
tripple fusion

46
Q

how does charcot’s foot develop? (neuroarthropathy)

A

neurotraumatic:
- lack of proprioception and protective pain sensation

neurovascular:
- abnormal autonomic nervous system results in increased vascular supply and bone resorption

47
Q

what are the 3 stages involved in bone destruction in charcots foot?

A

fragmentation
coalescence
remodelling

MSK clinical (25 decks)

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