Disorders of the foot Flashcards
toes are all
different to eachother
conditions of the little toe
- Claw toe- imbalance due to neurological abnormalities
- Hammertoe- idiopathic imbalance/ hallux valgus
- Mallet toe- idiopathic
- Curly toe- congenital
conditions of the big toe
- bunions
- big toe arthritis
Mallet Toe
Mallet Toe is flexion at the distal interphalangeal joint (DIPJ)
Hammer toe
Hammer Toe is flexion at the proximal interphalangeal joint (PIPJ).
mallet toe and hammer toe are most common in
Both of these conditions are most common in the second toe.
causes of mallet and hammer toe
They are caused by ill-fitting shoes or pressure from the adjacent first toe having Hallux Valgus (lateral deviation of the Hallux). The change in shape of the toe can cause shoes to rub against it and this can lead to painful corns or calluses.
management of mallet and hammer toe
Management options include using inserts or pads to reposition the toe when wearing footwear (this will help to relive pressure and pain - this works best if the toe is still flexible); if this more conservative treatment is unsuccessful, surgery may be recommended to straighten/flatten the toe.
claw toe
A claw toe is a toe that is contracted at the PIP and DIP joints (middle and end joints in the toe), and can lead to severe pressure and pain. Ligaments and tendons that have tightened cause the toe’s joints to curl downwards. It often affects all 4 lateral toes at the same time and usually occurs secondarily to neurological damage, trauma or Rheumatoid Arthritis.
cause of claw toe
due to neurological abnormalities
Claw toes result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight. This results in the joints curling downwards. Arthritis can also lead to many different forefoot deformities, including claw toes.
two categories of claw toe
Flexible Claw Toe – where the joints remain mobile and pain is less severe.
Rigid Claw Toe – a fixed deformity that is very painful.
treatment of claw to
Flexible Claw Toe is treated by taping the affected toes/wearing a splint to keep the toes in the right position and performing exercises to maintain toe flexibility.
Rigid Claw Toe is treated with surgery, where the bone is shortened at the base of the toe to give them more room to straighten out.
curly toe
Curly toes is a common condition that affects infants and children and it is present from birth. The condition may become more noticeable as your child begins to walk.
It tends to occur in the third and fourth toes of both feet. The toes curl under because the tendons that bend the toes are too tight and pull one toe under the next toe, curling it towards the underside of the foot, as is seen in the picture above.
curly toe cause
Hallux Valgus
Hallux Valgus is the medial deviation of the first metatarsal, lateral deviation of the hallux and prominence of the first metatarsal head. It is commonly referred to as a ‘Bunion’.
who is hallux valgus common in
This condition is most common in middle aged females and is caused by abnormal mechanics of over-pronated feet (meaning more weight is transmitted through the medial side of the foot than the lateral side). This is the most common foot deformity.
management of hallux valgus
Management for this condition involves wearing wide shoes with low heels and soft soles, losing weight if overweight, and managing pain with over the counter medication.
If the pain caused by Hallux Valgus is very severe and chronic, surgery can be used to remove bunions (commonly by removing the head of the metatarsal), however, this only occurs if the condition is having a large effect on the patients’ life. This surgery is not done cosmetically on the NHS.
Hallux Rigidus
Hallux Rigidus is osteoarthritis of the metatarsal joint of the hallux.
why is the big toe prone to arthritis
This joint is very prone to osteoarthritis, due to the forces are transmitted through the foot on walking, so this is a common condition.
prentation of halux rigidus (big toe arthritis)
The patient usually presents with pain in the metatarsal phalangeal joint (MTPJ) upon flexion of the hallux.
feature of hallux rigidus
- loss of joint space
- osteophytes
- cysts
- subchondrals clerosis (marble)
management of hallux rigidus
In severe Hallux Rigidus, X-rays can be used to show the extent of the osteoarthritis order to decide if surgical intervention is required. However, normal management of the condition is to alter the patient’s shoes to take the strain off the hallux when walking.
conservative treatment for hallux rigidues
- Symptoms not bad enough for surgery
- Unfit for surgery
- Orthotics or aids
- Painkillers
- Steroid injections
- Symptoms not bad enough for surgery
- Unfit for surgery
- Orthotics or aids
- Painkillers
- Steroid injections
Toe Arthritis surgical treatment
- Re-align (taken weight off part of the joint)- osteotomy
- Remove= excision arthrolplasty
- Fuse= arthrodesis
- Replace- arthroplasty
Pes Planus
Pes Planus, also known as flat foot, is the collapse of the medial arch of the foot. It is important to note this condition is physiologically normal in children as the arch is still developing.
cause of flat foot in adults
In adults, it is caused due to stretching of the plantar calcaneonavicular ligament and plantar aponeurosis.
- e.g. weight increase
management of flat foot
This condition does not require treatment unless it is causing pain or restricting movement enough to affect daily life. If this is the case, exercises and specialised shoes may be recommended (surgical intervention is incredibly rare).
- insoles
- physiotherapy
signs of flat foot
- Change in shape
- Location of pain
- Female
- Middle aged
- Pain behind medial malleolus
Charcot Arthropathy
Charcot Arthropathy is the progressive destruction of bones, joints and soft tissues secondary to Diabetes Mellitus. This most commonly occurs in the feet and ankle but is generally considered a rare condition.
riskkf oc charcot arthropathy
Neuropathy causes reduced sensation in the feet, which means any damage/injury to the feet may worsen without the patient being aware.
Neuropathy can also lead to muscle spasticity, causing deformities. When the midfoot is involved in Charcot Arthropathy, Rocker-bottom foot (prominent calcaneus and convex/rounded bottom of the foot) can develop. Treatment can either be staying off the foot for 2-3 months or surgery.
% of diabtetic expreice foot problems
15%
25% of diabetic hospitalisation s are
for the foot
diabetes of the foot also causes
vascular disease
- 50% of major amputations are in diabetics
- 66% probability of contra-lateral amputation within 5 years
- To get the other one removed
- 50-70% mortality within 5 years of major amputation- worse than a lot of cancers
managment of diabtes of the foto
regular check ups, education, debridement may be needed
