Foot and ankle Flashcards
What are RF for an achilles tendonopathy?
Acvities that strain your achilles tendon eg running, dance, tennis
quinolones e.g. ciprofloxacin, ofloxacin!!
DM
hyperlipidaemia
Inflammatory conditions
How does Achilles tendonopathy present?
Achilles:
Tenderness, swelling, pain, stiffness, nodularity on palpation.
What does the achilles tendon help to connect?
The soleus and gastricneums muscles (calf muscles) to the calcaneous of the ankle.
How do you rule out an achilles rupture?
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.
How do you mx an achille tendinopathy?
RICE
PT
Orthoptics (insoles)
NO STEROIDS as could cause rupture
How does achilles rupture present?
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
How do you diagnose achille’s tendon rupture?
U/S
How do you manage achilles tendon rupture?
RICE
VTE prophylaxis
can do surgery or non-surgery mx:
Use boot to help reattach or can have surgery to reattach
What is plantar fasciitis?
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
How do you present with plantar fasciitis?
With gradually increasing pain on the plantar aspect of the foot.
Worse with walking/ standing
How is plantar fasciitis mx?
Manage wirth RICE, NSAIDs, PT, steroid injections. If really bad surgery.
What is fat pad atrophy?
The fat on the heel of the foot atrophies
What can cause fat pad atrophy?
Obesity
Steroid injections for plantar fasciitis
Repetitive impact from exercise
What are the sx of fat atrophy?
Similar to plantar fasciitis
How do you manage fat pad atrophy?
Insoles
Address RF
What is Morton’s neuroma?
An issue with the nerve in the space between the 3rd and 4th metatarsal
What are sx of morton’s neuroma?
Presents with pain at location of 3rd/4th metatarsal
Feeling of something being in shoe
Tingling/ numbness/ burning in distal toes
What are the tests for Morton’s neuroma?
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
What is the medical name for bunions?
Hallux Valgus
How do bunions present?
The bunion is a lump on the metatarsalphalnageal joint moves the metatarsal medially. Whereas the halluz moves laterally towards the little toes.
How are bunions managed?
Managed with insoles, correct footwear and analgesia. Definitive management is surgery.
How do you mx Morton’s neuroma?
Avoid aggrating activities e.g. high heels NSAIDs wt loss if needed insoles steroids surgery potentially to excise neuroma
What are the Ottawa Ankle/ foot rules?
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
