foot and ankle Flashcards
hallux valgus causes
bunion
genetic
foot wear
female
hallux valgus presentation
pressure from shoe
pain from crossing toes
metatarsalgia- weight distributed on lesser metatarsal heads
pathogenesis hallux valgus
lateral angulation of big toe
tendons pull to realign to lateral of centre of rotation of toe worsening deformity
increased pull increased deformity and so on
diagnosis hallux valgus
clinical
x rays to determine severity
management hallux valgus
shoe wear modified
orthotics to offload pressure
activity modification
analgesia
surgery if non operative failed or unacceptable to patient
release lateral soft tissues
osteotomy 1st metatarsal- break bone
takes several months 12-18 to heal
recurrence inevitbale
hallux rigidus
stiff big toe
osteoarthritis of 1st MTP joint
bimodal distribution of age
possibly genetic. unknown cause
many asymtpomatic
often incidental on x ray
sometimes pain on extreme dorsiflexion
limited rom
hallux rigidus management
activity modification no running uphill
shoe wear with rigid sole
analagesia
1st MTPJ fusion gold standard
1st MTPJ hemiarthroplasty high failure rate but good option to mainatin rom and good for low demand patients
cheilectomy- remove dorsal impingement
arthrodesis
arthroplasty
lesser toe deformities
hammer toe only first joint
claw toe 2 joints
mallet toe only end joint
lesser toe deformities cause
imbalance between flexors and extensors
shoewear
neurological- clawing
RA
unknown
symptoms of lesser toe deformities
deformity
pain
treatment lesser toe deformities
activity modification
change shoes- flat shoes high toe box
orthotic insoles
surgery- lots of morbidity associated
mortons neuroma
dysfunction of a nerve in the intermetatarsal space (between the toes) towards the top of the foot
usually located between the third and fourth metatarsal
caused by irritation of the nerve relating to the biomechanics of the foot. High-heels or narrow shoes may exacerbate it.
traumatised nerve. new nerves grow and fibrous tissue around them and painful lump
symptoms mortons neuroma
pain at front of foot
sensation of lump
burning numbness pins and needs at distal toes
investigations mortons neuroma
ultrasound best
MRI good
mulders click- press on lump and squeeze over metatarsal heads then click
managment mortons neuroma
injection for small lesions
excision of lesion including a section of normal nerve
recurrence
usually dorsal approach due to pain in plantar
metatarsalgia
symptom not diagnosis
rheumatoid forefoot
bunions, degenerative joints
shoewear change
gold standard- 1st MTPJ arthrodesis or 2-5th excision arthroplasty
dorsal foot ganglia
arise from joint or tendon sheath
idiopathic cause
pain
aspiration
bible
excision
high rate of return
midfoot arthritis
x ray guided injections
or fusions with metal
plantar fibromatosis
dupuytrens of foot
progressive
asymptomatic unless very large or weightbearing area
lumpy areas
avoid pressure
excision but 80% risk of recurrence. avoid on minor problem
radiotherapy same recurrence
combination
achilles tendinopathy
insertional or non insertional (2cm of insertion or beyond)
damage, swelling, inflammation and reduced function in the Achilles tendon.
achilles tendinopathy risk factors
Sports that stress the Achilles
Inflammatory conditions
Diabetes
Raised cholesterol
Fluoroquinolone antibiotics (e.g., ciprofloxacin and levofloxacin)
Presentation achilles tendinopathy
Pain or aching in the Achilles tendon or heel, with activity or after
recurrent episodes
Stiffness
Tenderness
Swelling
Nodularity on palpation of the tendon
rupture because weakens
Achilles tendinopathy diagnosis
clinical diagnosis
does not usually require any investigations exclude Achilles tendon rupture using Simmonds’ calf squeeze test
Ultrasound is used to diagnose Achilles tendon rupture.
Achilles tendinopathy Management
Rest and altered activities
Ice
Analgesia
Physiotherapy
Orthotics (e.g., insoles)
Extracorporeal shock-wave therapy (ESWT)
Surgery- gastrocnemius recession or release and debridement of tendon
not steroid injections due to rupture
paratendonopathy vs tendonopathy
para- commonest in athletic, male more, 30-40, true inflammatory condition
tendonopathy- non athletic, over 40, obese, steroids, diabetes
plantar fasciitis
inflammation of plantar fascia. thick connective tissue. It attaches to the calcaneus at the heel, travels along the sole of the foot and branches out to connect to the flexor tendons of the toes.
chronic degenerative change, disorganised blood vessels and collagen, cant make ECM for repair and remodelling
plantar fasciitis cause
high intensity, or rapid increase in training in athletes
running with poorly padded shoes
prolonged standing at work or elsewhere
rotational deformities of limb
symptoms plantar fasciitis
pain first thing in morning
pain on weight bearing after rest
pain at origin of plantar fascia
long lasting 2 years or more
diagnosis plantar fasciitis
mainly clinical
ultrasound and mri
treatment plantar fasciitis
rest, stretching, ice, NSAIDs
orthoses
physio
weight loss
corticosteroid injections good in short term
night splinting
Extracorporeal shockwave therapy
can do endoscopic or open surgery but if dont resolve painful scar
ankle arthritis
post traumatic
46 years mean
pain and stiffness
clinical, radiograohs, CT to exclude joint arthritis
non operative
arthrodesis gold standard
joint replacement for some but not ideal long term outcoem
