Cortex - Adult orthopaedics pelvis and lower limb 5 (foot and ankle problems)

Question 1

What are the key factors of plantar fasciitis ?

Answer 1

• Risk factors - Diabetes, obesity and frequent walking on hard floors
• Inferior Heel pain (stabbing or knife-like)
• Pain relieved with rest - worse when walking
• Post-static dyskinesia - pain that occurs after a period of rest. It is often associated with heel pain, specifically plantar fasciitis.
• Localised tenderness on palpation of site

Question 2

What is the treatment of plantar fasciitis ?

Answer 2

1st line - rest and stretching of achilles and plantar fascia

Adjunct:

• A gel filled heel pad may help.
• Corticosteroid injection may also alleviate symptoms.

Question 3

Where does the tibialis posterior tendon insert and what is its function in terms of the foot ?

Answer 3

• Attaches to the plantar surfaces of the medial tarsal bones
• Its function is to support the medial arch of the foot (as well as being a plantarflexor and invertor of the foot).

Question 4

What are the signs/symptoms of tibilias posterior tendonitis?

Answer 4

• pain, typically around the inside of the foot and ankle.
• swelling, warmth, and redness along the inside of the foot and ankle.
• pain that worsens during activity.
• flattening of the foot (remember it helps support the medial arch of the foot)
• inward rolling of the ankle.
• turning out of the toes and foot.

Question 5

What is the treatment of tibialis posterior tendonitis ?

Answer 5

1st line - splint with a medial arch support to avoid rupture

2nd line - surgical decompression and tenosynovectomy may prevent rupture

Question 6

What does elongatio or rupture of the tibialis posterior result in ?

Answer 6

Valgus of the heel and flattening of the medial arch of the foot.

Question 7

What is the most appropriate surgical management once OA ensuses in tibialis posterior tendonitis ?

Answer 7

Arthrodesis

Question 8

What is pes cavus ?

Answer 8

Abnormally high arch of the foot.

Question 9

What is pes cavus often related to ?

Answer 9

Neuromuscular conditions including:

• Hereditary Senoryand Motor Neuropathy
• Cerebral palsy
• Polio(unilateral)
• Spinal cord tethering from spina bifida occulta

Question 10

What other foot abnormality is often seen accompanying pes cavus ?

Answer 10

Claw toes (also seen in the pic)

Question 11

What is the treatment of pes cavus ?

Answer 11

• If supple - soft tissue release and tendon transfers
• If more rigid - soft tissue releases and calcaneal osteotomy
• Severe cases may require arthrodesis

Question 12

Why do claw and hammer toes tend to occur ?

Answer 12

Due to an imbalance between the flexor and extensor tendons

Question 13

Describe the presentation of claw toes

Answer 13

Hyperextension at the MTPJ with hyperflexion at the PIPJ and DIP

Question 14

Describe the presentation of hammer toes

Answer 14

Claw toes have hyperextension at the MTPJ with hyperflexion at the PIPJ and then hyperextension at the DIPJ

Question 15

What are the treatment options for claw and hammer toes ?

Answer 15

• Toe “sleeves” and corn plasters can prevent skin problems.
• Surgical solutions include tenotomy (division of an overactive tendon), tendon transfer, arthrodesis (PIPJ) or toe amputation.