Conditions Of The Foot And Surgery Flashcards
What part of the foot is most commonly affected by osteoarthritis?
What is this called?
1st MTPJ
Hallux rigidus
Management of osteoarthritis in the toe
- weight management
- comfortable wide footwear
- sole insoles
- analgesia
- steroid injections
- joint fusion
- arthroscopy + debridement (removal of osteophytes)
Complications of osteoarthritis in the foot
- hallux rigidus
- bunions
- corns + calluses
Describe the plantar fascia
Thick connective tissue
Attaches to the calcaneus + travels along the sole of the foot
Connects to the flexor tendons of the toes
Presentation of plantar fasciitis
- gradual onset heel pain
- worse with pressure (prolonged walking or standing)
- tenderness to palpation in the area
Management of plantar fasciitis
- rest
- ice
- analgesia
- Physiotherapy to stretch the fascia
- extracorporeal shockwave therapy (rarely)
What is fat pad atrophy?
wasting away of the fat pad over the heel of the foot
How does fat pad atrophy occur?
- age
- inflammation from repetitive impacts (e.g. running, obesity, jumping)
- local steroid injections
Symptoms of fad pad atrophy
- pain and tenderness over the plantar aspect of the heel
- worse with activity - especially when barefoot on hard surfaces
Investigations for fat pad atrophy
USS to measure thickness of fat pad
Management of fat pad atrophy
- comfortable shoes
- custom insoles
- adapting activities e.g. avoid high heels
- weight loss
What is Morton’s neuroma?
The dysfunction of a nerve in the intermetatarsal space towards the top of the foot
Most commonly between the 3rd + 4th metatarsal
What is Morton’s neuroma caused by?
Irritation of the nerve relating to the biomechanics of the foot
High heels or narrow shoes can exacerbate it
Presentation of Morton’s neruoma
- pain at the front of the foot
- sensation of a lump in the shoe
- burning, numbness, pins + needles felt in distal toes
What three tests can be used to test for Morton’s neuroma?
- deep pressure applied to the affected area causes pain
- metatarsal squeeze test
- mulder’s sign
What is the metatarsal squeeze test?
What is it used to test for?
- Squeezing the forefoot with one hand to create a concave shape to the plantar aspect while using the other hand to press the affected area on the plantar aspect causes pain
- Morton’s neuroma
What is the Mulder’s sign?
What is it used to test for?
- a painful click is felt when using two hands on either side of the foot to manipulate the metatarsal heads to rub the neuroma
- Morton’s neuroma
Imaging to confirm diagnosis of Morton’s neuroma
USS or MRI
Management of Morton’s neuroma
- lifestyle modification
- analgesia
- insoles
- weight loss
- steroid injections
- radio-frequency ablation
- surgery - excision of the neuroma
Describe hallux valgus
- a bony lump created by a deformity at the 1st MTPJ
- 1st Metatarsal is Medially deviated
- hallux becomes laterally deviated
Risk factors of hallux valgus
- female
- > 65 years old
- connective tissue disorders
- hyper mobility syndromes
What imaging is used to assess the severity of hallux valgus
Weight bearing X-ray
Management of hallux valgus
- wide comfortable shoes
- analgesia
- bunion pads
- surgical correction
What demographic is flat foot normal in and why?
Young children
Arches haven’t developed yet
The medial arch forms ~ 5years
What type of angulation does flat foot cause?
Valgus angulation of the hind food ><
What are the three types of flat feet?
Flexible
Rigid
Adult acquired
Outline flexible flat foot
- No medial arch when standing normally
- Medial arch appears when standing on tiptoes + valgus hind foot disappears
Outline rigid flat foot
- always abnormal
- no medial arch
- valgus hindfoot
- due to tarsal coalition
- abnormality remains when on tiptoes
What is adult acquired flat foot due to?
- Due to dysfunction of tibilais posterior tendon (normally supports medial arch)
- stretching of spring ligament + aponeurosis causes flat medial arch
What is charot foot?
Rare complication of diabetes-related neuropathy
Progressive destruction of bone + soft tissue of foot
Complications of charot foot
- fractures don’t heel
- dislocations
- arch collapse
Name 4 toe deformities
- claw toe
- mallet toe
- hammer toe
- curly toe
What is the most commonly fractured metatarsal?
Proximal 5th metatarsal
What is the most commonly site of metatarsal stress fractures?
2nd metatarsal shaft
