foot and ankle Flashcards
what is the first rocker of gait
heel strike to flat foot
what is the second rocker of gait
mid stance
what is the third rocker of gait
heel rise
name some muscles that power the foot
- tibialis posterior
- tibialis anterior
- peroneus longus
- peroneus brevis
- EHL, FHL
- EDL, FDL
what is simmonds test for
TA rupture
what is anterior draw test for
ankle stability
what is mulder’s click test for
morton’s neuroma
causes of hallux valgus
- family
- hypermobility
- rheumatoid, pes planus
presentation of hallux valgus
- unable to wear closed shoes
- joint pain
- transfer metatarsalgia - feel like pebble in shoe
- falls risk/balance
management of hallux valgus
- analgesia
- orthotics/splints/toe-spacers/bunion pads
- physio
indication for operation on hallux valgus
- failure of non-op
- pain
- lesser toe deformity
- overlapping
- ulceration
presentation of funny looking toes
- ulceration
- callosities
- corns
- nail problems
4 types of funny toes
- claw
- hammer
- mallet
- curly toes
what is morton’s neuroma
benign fibrotic thickening of a plantar digital nerve due to irritation
-degenerative process
symptoms of morton’s neuroma
- burning
- tingling
- numbness
- pain on palpitation
- pain relieved by removal of shoe
treatment for Morton’s neuroma
- weight loss
- stretch calf muscles
- RICE
- metatarsal padding
- biomechanical assessment and orthosis
- corticosteroid injection
indications for surgery
symptoms persistent after footwear modification and metatarsal pads
inadequate response to steroid injection
what is pes planus
flat feet
will an arch form in flexible flat feet when a patient tip toes?
yes
what is tibialis posterior dysfunction
most common cause of acquired flatfoot deformity in adult
presentation of tibialis posterior dysfunction
- 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
what are the risk factors for tibialis posterior dysfunction
- obese middle aged females
- increases with age
- hypertension
- diabetes
- steroid injection
- seronegative arthropathies
- idiopathic tendonosis
presentation of type 1 TPD
- swelling
- tenderness
- weak muscle power
presentation of type 2 TPD
- planovalgus
- midfoot abduction
- passively correctable
treatment for TPD
- physio
- insole
- NO steroid injections
- orthoses to accommodate foot shape
- bespoke footwear
- surgery
what is Pes Cavus
high arched feet
what is plantar fasciitis
tenderness over plantar aspect of heel and/or plantarmedial aspect of heel
presentation of plantar fasciitis
- start up pain after rest
- can be worse after exercise
- fullness and swelling
- Tinel’s test positive for baxter’s nerve
causes of plantar fasciitis
- physical overload
- seronegative arthropathies
- diabetes
- abnormal foot shape
treatment for plantar fasciitis
- NSAIDs
- night splints
- taping
- heel cups or medial arch support
- physio
- steroid injection
- surgery
what is achilles tendonopathy
repetitive microtrauma, failure of collagen repair with loss of fibre alignment
management of achilles tendonopathy
- analgesia
- NSAIDs
- shockwave therapy
- orthotics
- physio
- surgery
symptoms of achilles tendonopathy
- pain
- morning stiffness
- eases with heat/walking
what is a TA rupture
sudden deceleration with resisted calf contraction
presentation of TA rupture
- unable to bear weight
- weak plantar flexion
- palpable painful gap
- positive calf squeeze
management of TA rupture
- operative
- non-operative
- rest tendon using crutches
- analgesia
- long recovery
- cast
management of ankle instability
- physio
- arthroscopy for pain
- brostrom is gold standard
treatment for ankle arthritis
first line
- weight loss
- PRICE
- analgesia - NSAIDs
second line
- biomechanical assessment and foot orthosis
- footwear adaptations
what is hallux rigidus
painful first MTP joint
presentation of hallux rigidus
- stiffness
- pain increases with activity/aggravated by shoes
- dorsal exostosis
- IPJ hyperextension
management for hallux rigidus
first line
- weight loss
- PRICE
- footwear advice
- analgesia - NSAIDs
second line
- biomechanical assessment and foot orthosis
- footwear adaptations
what is the type of classification for ankle fractures
weber
what is Talipes Equinovarus (club foot)
congenital deformity due to in utero abnormal alignment of the joints between the talus, calcaneus and navicular
presentation of talipes equinovarus
- ankle equinus
- supination of the forefoot
- varus alignment of forefoot
splintage technique for talipes equinovarus
ponseti technique
what is tarsal calition
condition where an abnormal bridge between the calcaneus and navicular or between the talus and calcaneous
can lead to flat foot in older children
