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MSK > Cortex- Lower Limb: Foot and Ankle > Flashcards

Cortex- Lower Limb: Foot and Ankle Flashcards

1
Q

what can cause ankle OA

A

idiopathic, primary or consequence of a previous injury

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2
Q

what are the two surgical options for patients with significant advanced ankle OA

A

arthrodesis and ankle replacement

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3
Q

what is hallux valgus

A

deformity of the great toe due to medial deviation of the 1st metatarsal and lateral deviation of the toe itself

in severe cases hallux may override the second toe

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4
Q

who gets hallux valgus

A

commoner in females (4:1) there a familial tendency

incidence increases with age but can occur in adolescence

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5
Q

what other conditions is hallux valgus commoner in

A

RA, inflammatory arthropathies, neuromuscular diseases (multiple sclerosis, cerebral palsy)

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6
Q

why is hallux valgus painful

A

joint incongruence and a wideneing forefoot may cause a bunion
great toe and second toe may rub causing ulceration and skin breakdown

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7
Q

what is a bunion

A

when rubbing of the foot with shoes causes an inflamed bursa over the medial 1st metatarsal head

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8
Q

what causes hallux valgus

A

unknown cause but higher in shoe wearing populations

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9
Q

what is the conservative treatment for hallux valgus

A

wider and deeper shoes to prevent bunions

spacer in the first web space

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10
Q

what is the surgical management for hallux valgus

A

osteotomies to realign the bones and soft tissue procedures to tighten slack tissues and release tight tissues

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11
Q

what is surgery cautioned in hallux valgus

A

if doing for cosmesis many will be unhappy with the result
30% will be dissatisfied due to altered biomechanics of the foot
some have pain of metatarsal heads after surgery

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12
Q

what is hallux ridigus

A

OA of the first MTPJ

can be primary (degenerative) or secondary to osteochondral injury

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13
Q

what is the conservative treatment for hallux ridigus

A

wearing stiff soled shoes to limit motion at the MTPJ

removal of dorsal osteophytes (cheilectomy) when they impinge during dorsiflexion

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14
Q

what is the gold standard surgical treatment for hallux rigidus

A

arthrodesis (stabilisation of a joint by fusion of the bones)
should alleviate pain with the small sacrifice of no motion

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15
Q

what might be the problem with women an arthodesis

A

cant wear high heals

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16
Q

can you do MTP joint replacement in hallux ridigus

A

yes but failure rates high and once failed salvage surgery is difficult

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17
Q

what is mortons neuroma

A

plantar interdigital nerves (from the medial and lateral plantar nerves) overlying the intermetatarsal ligaments can be subjected to repeat trauma
irritated nerves can become inflamed and swollen (forming a neuroma)

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18
Q

what are the symptoms of a mortons neuroma

A

burning pain and tingling radiating into the affected toes

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19
Q

who gets mortons neuroma

A

women (4 times)

wearing high heals has been implicated as a cause

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20
Q

what is the most common areas to be affected by mortons neuroma

A

third interspace nerve

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21
Q

what might be seen on clinical examination of mortons neuroma

A

loss of sensation in the affected web space
mulders click test- compression of the metatarsal heads (squeezing forefoot with your hand) may reproduce symptoms or a characteristic click

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22
Q

what imaging might be useful for the diagnosis of mortons neuroma

A

ultrasound can demonstrate a swollen nerve

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23
Q

what is the conservative management of mortons neuroma

A

the use of a metatarsal pad or offloading insole

steroid and local anaesthetic injections may relieve symptoms and aid diagnosis

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24
Q

is surgery for mortons neuroma possible

A

yes but some continue to experience pain and there is a small risk of recurrence

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25
Q

where in foot do metatarsal stress fractures most commonly occur

A

in the 2nd metatarsal followed by the 3rd

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26
Q

who get metatarsal stress fractures

A

runners, soldiers on prolonged marches, dancers, or distance walking in those not used to it

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27
Q

when can x rays show metatarsal stress fractures

A

after 3 weeks wen resorption at the fracture ends occur or callus begins to appear

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28
Q

what might be useful in diagnosing a metatarsal stress fracture

A

bone scan

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29
Q

what is the treatment for a metatarsal stress fracture

A

prolonged rest for 6-12 weeks in a ridgid soled boot

30
Q

what causes tendonitis of the achilles tendon

A

repetitive strain (from sports) which leads to a peritendonitis or due to degenerative process with intrasubstance microtears

31
Q

what can predispose to achilles tendonitis

A

quinolone antibiotcs (ciprofloxacin), RA, inflammatory arthropathies, gout

32
Q

what is the treatment for achilles tendonitis

A

rest, physio, heel raise to offload the tendon, use of a splint or a boot

resistant cases may benefit from tendon decompression and resection of paratendon

condition usually self limiting

33
Q

where is the pain in achilles tendonitis

A

main body of achilles, its insertion at the calcaneus

34
Q

what does tendonitis predispose to

A

tendon rupture

35
Q

why do you never administer steroid injection around the achilles tendon

A

as risks rupture

36
Q

who get achilles tendon rupture and why

A

occurs in middle aged or older groups and is usually due to degenerative changes within the tendon or recent tendonitis

37
Q

what is the usual history of an achilles tendon rupture

A

sudden deceleration with resisted calf muscle contraction (lunging at squash) leads to sudden pain (like being kicked in back of leg) and difficulty weight bearing

weakness of plantar flexion and a palpable gap in the tendon are usually apparent

38
Q

what is simmonds test

A

positive in a torn achilles when no plantarflexion of the foot is seen when squeezing the calf

39
Q

what is the treatment for a ruptured achilles tendon

A

controversial: operative and non operative

suture repair of the damaged tendon to restore to tension of the tendon
followed by 8 weeks of casts

non operative- series of casts in the equinous position (ankle plantar flexed with the toes pointing down (closes gap in torn tendon) for 8 weeks

40
Q

what is plantar fasciitis

A

self limiting repetitive stress/ overload or degenerative condition of the foot causing inflammation of the plantar fascia

41
Q

what are the symptoms of plantar fasciitis

A

pain with walking is felt on the instep of the foot, localised tenderness on palpation of this site

42
Q

where specifically is pain felt in plantar fasciitis

A

at the origin of the plantar aponeurosis on the distal plantar aspect of the calcaneal tuberosity

43
Q

what are causative factors of plantar fasciitis

A

diabetes, obesity, frequent walking on hard floors with poor cushioning floors

cushioning heel fat pad atrophies with age

44
Q

what is the treatment for plantar fasciitis

A

rest, achilles and plantar fascia stretching exercises
gel filled heel pad
corticosteroid injection

symptoms may take up to 2 years to resolve

surgery avoided due to risk of plantar nerve damage

45
Q

what is pes panus

A

flat feet

46
Q

what causes normal flat feet in adults

A

failure of medial arch development in childhood

47
Q

who is more likely to have pen panus

A

people with ligamentous laxity

has familial tendency

48
Q

does developmental pes panus need treatment

A

no

49
Q

what are people with developmental pes panus more likely to develop

A

tendonitis of the tibialis posterior tendon

50
Q

what can cause acquired flat feet

A

tibialis posterior tendon stretch or rupture, RA, diabetes with charcot foot

51
Q

what is charcot foot

A

neuropathic joint destruction

weakening of bones due to nerve damage

52
Q

where does the tibialis posterior tendon insert

A

onto the medial navicular

53
Q

what does the tibial posterior tendon do

A

supports the medial arch of the foot
platarflexor
invertor of the foot

54
Q

the tibialis posterior tendon is under repeated stress and can degenerate, what can this cause?

A

tendonitis, elongation, rupture

55
Q

what else can cause tibialis posterior tendon

A

synovitis from RA

56
Q

how should tibialis posterior tendonitis be treated

A

splint and medial arch support to prevent rupture
physio

if this fails to settle symptoms, surgical decompression and tenosynovectomy may prevent rupture

57
Q

what happens if the tibialise posterior tendon elongates or ruptures

A

medial arch is lost causing valgus of the heel and flattening of the medial arch of the foot

subsequent degenerative OA of the hindfoot and midfoot may occur

58
Q

what surgery can be done in a tibialis posterior tendon dysfunction when the foot is supple with no OA

A

tendon transfer with a calcaneal osteotomy to reduce stress

prevents secondary OA

59
Q

what is type of surgery can be done in tibialis posterior tendon rupture once OA ensues

A

arthrodesis

60
Q

what is pes cavus

A

abnormally high arch of the foot

61
Q

what causes pes cavus

A

idiopathic
related to neuromuscular conditions: hereditary sensory and motor neuropathy, cerebral palsy, polio (unilateral), spinal cord tethering from spina bifida occulta

62
Q

what toe feature often accompanies pes cavus

A

claw toes

63
Q

what is the treatment for pes cavus

A

pain- if supple:soft tissue releases, tendon transfer (lateral transfer of tibialis anterior
if more rigid: calcaneal osteotomy

severe cases may require arthodesis

64
Q

what causes claw and hammer toes

A

an acquired imbalance between the flexor and extensor tendons

65
Q

describe claw toes

A

hyperextension at the MTPJ with hyperflexion at the PIPJ and DIP

66
Q

describe hammer toes

A

hyperextension at the MTPJ with hyperextension at the DIPJ

67
Q

claw and hammer toes can be painful and rub on footwear causing corns and skin breakdown. what are the treatment options

A

toe ‘sleeves’
corn plasters

surgery: tenotomy (division of an overactive tendon), tendon transfer, athrodesis (PIPJ), toe amputation

68
Q

what prediposes to tibialis posterior dysfunction

A 
obesity 
middle aged females 
flat foot 
hypertension
diabetes
steroid injection 
seronegative arthropathies 
idiopathic tenonosis
69
Q

what nerve reacts in the tinels test in plantar fasciitis

A

lateral plantar nerve

70
Q

when in tibialis posterior tendon rupture can a tendon transfer be performed and how and why is it done

A

if the foot remains supple with no OA

to prevent secondary OA

done with calcaneal osteotomy to reduce stress

MSK (71 decks)

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