Foot and ankle

Question 1

What are RF for an achilles tendonopathy?

Answer 1

Acvities that strain your achilles tendon eg running, dance, tennis
quinolones e.g. ciprofloxacin, ofloxacin!!
DM
hyperlipidaemia
Inflammatory conditions

Question 2

How does Achilles tendonopathy present?

Answer 2

Achilles:

Tenderness, swelling, pain, stiffness, nodularity on palpation.

Question 3

What does the achilles tendon help to connect?

Answer 3

The soleus and gastricneums muscles (calf muscles) to the calcaneous of the ankle.

Question 4

How do you rule out an achilles rupture?

Answer 4

Calf squeeze test - normally if you squeeze the calf near the tendon the foot will plantarflex but if its ruptured the tendon isnt working and the foot wont plantarflex.

Question 5

How do you mx an achille tendinopathy?

Answer 5

RICE
PT
Orthoptics (insoles)
NO STEROIDS as could cause rupture

Question 6

How does achilles rupture present?

Answer 6

Sudden onset pain
Snapping sound
feels as if something has hit them in the back of the leg

O/E:
on relaxation ankle is more dorsiflexed
Tender
Can't stand on tiptoes (can't plantar flex)
Positive calf squeeze test 
May feel a gap where ruptured

Question 7

How do you diagnose achille’s tendon rupture?

Answer 7

U/S

Question 8

How do you manage achilles tendon rupture?

Answer 8

RICE
VTE prophylaxis
can do surgery or non-surgery mx:
Use boot to help reattach or can have surgery to reattach

Question 9

What is plantar fasciitis?

Answer 9

Inflammation of the plantar fascia - the thick connective tissue fascia covering the bottom of the feet from the calcaneous to the flexor tendons of the toes

Question 10

How do you present with plantar fasciitis?

Answer 10

With gradually increasing pain on the plantar aspect of the foot.
Worse with walking/ standing

Question 11

How is plantar fasciitis mx?

Answer 11

Manage wirth RICE, NSAIDs, PT, steroid injections. If really bad surgery.

Question 12

What is fat pad atrophy?

Answer 12

The fat on the heel of the foot atrophies

Question 13

What can cause fat pad atrophy?

Answer 13

Obesity
Steroid injections for plantar fasciitis
Repetitive impact from exercise

Question 14

What are the sx of fat atrophy?

Answer 14

Similar to plantar fasciitis

Question 15

How do you manage fat pad atrophy?

Answer 15

Insoles

Address RF

Question 16

What is Morton’s neuroma?

Answer 16

An issue with the nerve in the space between the 3rd and 4th metatarsal

Question 17

What are sx of morton’s neuroma?

Answer 17

Presents with pain at location of 3rd/4th metatarsal
Feeling of something being in shoe
Tingling/ numbness/ burning in distal toes

Question 18

What are the tests for Morton’s neuroma?

Answer 18

Metatarsal squeeze - squeeze base of foot up whilst using other hnd to press the affected toes

Deep pressure between the 3rd and 4th metatarsal

Mulder’s sign - click heard when manipulate area on either side

Can U/S

Question 19

What is the medical name for bunions?

Answer 19

Hallux Valgus

Question 20

How do bunions present?

Answer 20

The bunion is a lump on the metatarsalphalnageal joint moves the metatarsal medially. Whereas the halluz moves laterally towards the little toes.

Question 21

How are bunions managed?

Answer 21

Managed with insoles, correct footwear and analgesia. Definitive management is surgery.

Question 22

How do you mx Morton’s neuroma?

Answer 22

Avoid aggrating activities e.g. high heels
NSAIDs
wt loss if needed
insoles
steroids 
surgery potentially to excise neuroma

Question 23

What are the Ottawa Ankle/ foot rules?

Answer 23

Help you decide whether to XR the foot
Bony tenderness along the medial/ lateral malleolus or base of 5th metatarsal or navicular. Inability to wt bear both after injury and <4 steps upon assessment