foot and ankle

Question 1

what is the first rocker of gait

Answer 1

heel strike to flat foot

Question 2

what is the second rocker of gait

Answer 2

mid stance

Question 3

what is the third rocker of gait

Answer 3

heel rise

Question 4

name some muscles that power the foot

Answer 4

• tibialis posterior
• tibialis anterior
• peroneus longus
• peroneus brevis
• EHL, FHL
• EDL, FDL

Question 5

what is simmonds test for

Answer 5

TA rupture

Question 6

what is anterior draw test for

Answer 6

ankle stability

Question 7

what is mulder’s click test for

Answer 7

morton’s neuroma

Question 8

causes of hallux valgus

Answer 8

• family
• hypermobility
• rheumatoid, pes planus

Question 9

presentation of hallux valgus

Answer 9

• unable to wear closed shoes
• joint pain
• transfer metatarsalgia - feel like pebble in shoe
• falls risk/balance

Question 10

management of hallux valgus

Answer 10

• analgesia
• orthotics/splints/toe-spacers/bunion pads
• physio

Question 11

indication for operation on hallux valgus

Answer 11

• failure of non-op
• pain
• lesser toe deformity
• overlapping
• ulceration

Question 12

presentation of funny looking toes

Answer 12

• ulceration
• callosities
• corns
• nail problems

Question 13

4 types of funny toes

Answer 13

• claw
• hammer
• mallet
• curly toes

Question 14

what is morton’s neuroma

Answer 14

benign fibrotic thickening of a plantar digital nerve due to irritation
-degenerative process

Question 15

symptoms of morton’s neuroma

Answer 15

• burning
• tingling
• numbness
• pain on palpitation
• pain relieved by removal of shoe

Question 16

treatment for Morton’s neuroma

Answer 16

• weight loss
• stretch calf muscles
• RICE
• metatarsal padding
• biomechanical assessment and orthosis
• corticosteroid injection

Question 17

indications for surgery

Answer 17

symptoms persistent after footwear modification and metatarsal pads
inadequate response to steroid injection

Question 18

what is pes planus

Answer 18

flat feet

Question 19

will an arch form in flexible flat feet when a patient tip toes?

Answer 19

yes

Question 20

what is tibialis posterior dysfunction

Answer 20

most common cause of acquired flatfoot deformity in adult

Question 21

presentation of tibialis posterior dysfunction

Answer 21

• pain
• swelling
• change in foot shape
• diminished walking ability
• dislike of uneven surfaces
• more noticeable hallux valgus
• lateral wall impingement pain
• midfoot and ankle pain

Question 22

what are the risk factors for tibialis posterior dysfunction

Answer 22

• obese middle aged females
• increases with age
• hypertension
• diabetes
• steroid injection
• seronegative arthropathies
• idiopathic tendonosis

Question 23

presentation of type 1 TPD

Answer 23

• swelling
• tenderness
• weak muscle power

Question 24

presentation of type 2 TPD

Answer 24

• planovalgus
• midfoot abduction
• passively correctable

Question 25

treatment for TPD

Answer 25

- physio - insole - NO steroid injections - orthoses to accommodate foot shape - bespoke footwear - surgery

Question 26

what is Pes Cavus

Answer 26

high arched feet

Question 27

what is plantar fasciitis

Answer 27

tenderness over plantar aspect of heel and/or plantarmedial aspect of heel

Question 28

presentation of plantar fasciitis

Answer 28

- start up pain after rest - can be worse after exercise - fullness and swelling - Tinel's test positive for baxter's nerve

Question 29

causes of plantar fasciitis

Answer 29

- physical overload - seronegative arthropathies - diabetes - abnormal foot shape

Question 30

treatment for plantar fasciitis

Answer 30

- NSAIDs - night splints - taping - heel cups or medial arch support - physio - steroid injection - surgery

Question 31

what is achilles tendonopathy

Answer 31

repetitive microtrauma, failure of collagen repair with loss of fibre alignment

Question 32

management of achilles tendonopathy

Answer 32

- analgesia - NSAIDs - shockwave therapy - orthotics - physio - surgery

Question 33

symptoms of achilles tendonopathy

Answer 33

- pain - morning stiffness - eases with heat/walking

Question 34

what is a TA rupture

Answer 34

sudden deceleration with resisted calf contraction

Question 35

presentation of TA rupture

Answer 35

- unable to bear weight - weak plantar flexion - palpable painful gap - positive calf squeeze

Question 36

management of TA rupture

Answer 36

- operative - non-operative - rest tendon using crutches - analgesia - long recovery - cast

Question 37

management of ankle instability

Answer 37

- physio - arthroscopy for pain - brostrom is gold standard

Question 38

treatment for ankle arthritis

Answer 38

first line - weight loss - PRICE - analgesia - NSAIDs second line - biomechanical assessment and foot orthosis - footwear adaptations

Question 39

what is hallux rigidus

Answer 39

painful first MTP joint

Question 40

presentation of hallux rigidus

Answer 40

- stiffness - pain increases with activity/aggravated by shoes - dorsal exostosis - IPJ hyperextension

Question 41

management for hallux rigidus

Answer 41

first line - weight loss - PRICE - footwear advice - analgesia - NSAIDs second line - biomechanical assessment and foot orthosis - footwear adaptations

Question 42

what is the type of classification for ankle fractures

Answer 42

weber

Question 43

what is Talipes Equinovarus (club foot)

Answer 43

congenital deformity due to in utero abnormal alignment of the joints between the talus, calcaneus and navicular

Question 44

presentation of talipes equinovarus

Answer 44

- ankle equinus - supination of the forefoot - varus alignment of forefoot

Question 45

splintage technique for talipes equinovarus

Answer 45

ponseti technique

Question 46

what is tarsal calition

Answer 46

condition where an abnormal bridge between the calcaneus and navicular or between the talus and calcaneous can lead to flat foot in older children