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Orthopedics > Common Musculoskeletal Problems: Foot and Heel > Flashcards

Common Musculoskeletal Problems: Foot and Heel Flashcards

1
Q

What are the 2 common types of foot deformity?

A
  1. Flat feet
    - Pronation/eversion
    - Stresses the ankle
    - Hind foot valgus
    - Rigid and inflexible
  2. High arched feet
    - Supination/inversion
    - Pressure on lateral border and ball of foot
    - Hind foot varus
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2
Q

List 8 causes of pain in the foot and heel

A
  1. Structural
    - Flat or high-arches foot
  2. Hallux valgus/rigidus
    +/- OA
  3. Metatarsalgia
  4. Stress fracture
  5. Inflammatory arthritides
    - Mono (gout), poly (RA), oligo (spondlyo)
  6. Tarsal tunnel syndrome
  7. Heel pain
    - Plantar fasciitis
    - Plantar spur
    - Calcaneal bursitis
    - Achilles tendonitis/bursitis
    - Sever’s disease
  8. Arthritis of ankle/subtaloid joint
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3
Q

True or false: flat foot is a pronation deformity causing hind foot varus

A

False - pronation causing hind foot valgus

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4
Q

True or false: pes cavus is a pronation deformity causing hind foot valgus

A

False - this is flat foot (pes planus). High arches (pes cavus) causes supination and hind foot varus.

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5
Q

Describe hallux valgus deformity and list 3 causes

A

Lateral migration of great toe

  1. Congenital - metatarsus primus varus
  2. Late-onset - shoe-shape
  3. Complication of RA
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6
Q

A 50 year old patient presents with a stiff, dorsiflexed and painful great toe. What is the diagnosis and how would you manage this patient?

A 
Hallux rigidus - OA of 1st MTP
Rx:
- Footwear
- Podiatry
- Surgical correction (some cases)
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7
Q

List 4 risk factors for developing metatarsalgia

A
  1. Women wearing heels
  2. Following trauma
  3. Hammer toe
  4. RA - ‘rheumatoid forefoot’
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8
Q

How does metatarsalgia manifest and how is it managed?

A
  1. Pain in ball of foot on weight-bearing
  2. Callosities and bursae under metatarsal heads
  3. Misalignment of metatarsals and severe pain in RA
    Rx:
    - Appropriate footwear
    - Podiatry
    - Surgery - in RA forefoot
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9
Q

A 45 year old female presents with pain, burning and numbness in their 3rd and 4th toes when walking. What is the diagnosis and how would you manage this patient?

A

Morton’s metatarsalgia

  • Wide cushioned shoes
  • Steroid injection
  • Surgical excision
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10
Q

What is a march fracture and how is it diagnosed?

A

Aka ‘stress fracture’ - # of the distal third of one of the metatarsals occurring because of recurrent stress.

  • Sudden onset severe weight bearing pain, localised
  • Local tenderness and swelling
  • Xray: initially normal - Dx delayed until callus formation
  • Radioisotope bone scan or MRI reveals # earlier
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11
Q

What is the issue in diagnosing march fracture?

A

Xray:

  • Initially normal
  • Dx delayed until callus formation

Radioisotope bone scan or MRI reveals # earlier

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12
Q

How would you manage a stress fracture?

A
  1. Reduced weight-bearing for a few weeks

2. Investigate and treat osteoporosis

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13
Q

A patient presents with burning, tingling and numbness of the toes, sole and medial arch. What is the diagnosis? What would you expect to find on examination?

A

Tarsal tunnel syndrome

  1. Tenderness below the medial malleolus
  2. Tinel’s sign - tapping produces shock-like pain
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14
Q

Where should a steroid injection be introduced to treat tarsal tunnel syndrome?

A

Under retinaculum, between medial malleolus and calcaneus

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15
Q

What is plantar fasciitis and what can it lead to?

A

Aka calcaneal enthesitis - an inflammation at the insertion of the Achilles tendon into the calcaneum
- Localised pain and tenderness under heel when weight-bearing

May lead to plantar spurs.

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16
Q

What are the risk factors for plantar fasciitis?

A
  1. Tight calf muscles
  2. Pes cavus
  3. Obesity
  4. Repetitive or new impact activity, e.g. running
  5. Spondyloarthritis
17
Q

What are plantar spurs and what age group do they commonly affect?

A

Traction lesions at the insertion of the plantar fascia in older people

  • Usually asymptomatic
  • Painful after trauma
18
Q

What is an adventitious bursa?

A

Pressure-induced bursa

19
Q

How is calcaneal bursitis distinguished from calcaneal enthesitis (plantar fasciiitis) pain?

A

Sideways compression of heel pad - produces pain in calcaneal bursitis

Diffuse (bursitis) versus localised pain (fasciitis)

20
Q

A patient present with pain under the heel which is worse in morning as soon as weight is placed on foot. What is your differential diagnosis?

A
  1. Plantar fasciitis
  2. Plantar spurs
  3. Calcaneal bursitis
21
Q

How is pain under the heel treated?

A
  1. Heel pads
  2. Reduced walking
  3. Dorsiflexion splint at night
    - Stretch plantar fascia
  4. Injection
    - Medial approach with US
22
Q

Where should a steroid injection be introduced to treat pain under the heel?

A

Medial approach under US guidance

23
Q

What is an apophysitis?

A

An inflammation of an outgrowth, projection, or swelling

24
Q

What is an enthesitis?

A

An inflammation at the site where tendons or ligaments insert into bone

25
Q

What is Sever’s disease?

A

A traction apophysitis of the Achilles tendon in young people due to inflammation of the calcaneal growth plate.

26
Q

True or false: Osgood-Schlatter disease is a traction apophysitis of the Achilles tendon in young people

A

False - this is Sever’s disease. Osgood-Schlatter disease is a similar disorder of the patellar tendon

27
Q

A patient present with a painful, tender swelling a few centimetres above the ankle posteriorly. They have recently received a course of antibiotics to treat a UTI. What is the most likely diagnosis?

A

Quinolone-induced Achilles tendonosis

28
Q

What are the risk factors for Achilles tendon rupture?

A
  1. Trauma - repetitive, unaccustomed use, poor sporting technique
  2. Quinolone antibiotic therapy
  3. Local injection
29
Q

How is Achilles tendonosis treated?

A

Tendonitis

  1. Rest
  2. NSAIDs, ice packs
  3. Steroid injection
  4. Autologous platelet concentrates - poor evidence
  5. Casting or splinting (equinus position) or orthosis
  6. Surgery - for rupture
30
Q

True or false: the Achilles bursa can be safely injected with corticosteroid

A

True - lies clearly anterior to tendon; treatment for Achilles bursitis

31
Q

A patient presents with severe pain in the front of the shin and foot drop. What is the most likely diagnosis?

A

Anterior tibial syndrome - may require immediate surgical decompression to prevent necrosis

32
Q

A patient present with lower leg pain that is aggravated by exercise. What is the differential diagnosis?

A
  1. Chronic compartment syndrome
  2. Vascular disorder
  3. Neurological disorder

Orthopedics (18 decks)

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