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MSK Block > Foot and Ankle > Flashcards

Foot and Ankle Flashcards

1
Q

function of medial foot?

A

stability

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2
Q

function of lateral foot?

A

flexibility

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3
Q

functions of plantar fascia?

A

supports arch of foot
attaches skin to underlying structures, so skin doesn’t move away from foot when foot in contact with ground, which would make walking impossible.

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4
Q

factors to consider in ptnt presenting with pain in foot?

A

exact site- ask ptnt to point, is it over a bony prominence or joint?- probably a local disorder e.g. shoe pressure upon a local deformity, arthritis, tendinitis, or apophysitis in younger ptnt= inflammation over point where tendon inserts. Lateral= subtalar joint?
precipitants?- metatarsal stress fractures occur in ballet dancers and soldiers on route marches.

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5
Q

factors to consider in deformity presentation in ankle, foot or toes?

A

is this old/new?

has it progressed?

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6
Q

why is it important to ask about previous trauma in ptnt presenting with ankle pain?

A

ankle arthritis usually preceded by trauma

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7
Q

what are corns and callosities, and why do they occur?

A

thinkened, often tender, plaques of skin on toes or soles of feet, usually produced by localised pressure and friction e.g. from ill-fitting shoes.

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8
Q

why might a ptnt feel their ankle is ‘giving way’?

A

result of pain, or instability at ankle or subtalar joint

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9
Q

if swelling of foot over medial side of 1st metatarsal head, why might FH be considered?

A

likely to be a bunion (hallux valgus), which often run in families.

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10
Q

normal position of heels on standing and on tiptoes?

A

on standing= slight valgus

on tiptoes= inverted, should invert equally

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11
Q

what do inverted heels indicate when ptnt is standing on their tiptoes?

A

that subtalar joints are mobile, and tibialis posterior muscles are functioning.

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12
Q

name for a high-arched foot?

A

cavus

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13
Q

what deformities may be noted on observation of ptnt’s foot when standing?

A

flat-foot
cavus
hallux valgus
crooked toes

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14
Q

where are corns common?

A

over the proximal toe joints

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15
Q

4 stages of walking cycle?

A

heel strike
stance
push-off
swing-through

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16
Q

name for flat feet?

A

pes planus
or planovalgus foot= heel is valgus

collapsed longitudinal arch and medial border of foot in contact with ground

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17
Q

midtarsal joints tested in ankle and foot examination?

A

talo-navicular
calcaneo-cuboid

F+E, A+A, rotations
slight DF and PF, and pronation and supination?

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18
Q

what is hammer toe?

A

a fixed flexion deformity of proximal IP joint of 1 of lesser toes

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19
Q

what is the too many toes/Johnson sign?

A

when viewing foot from behind, can see > 1 and a half to 2 toes.
indicates tibialis posterior tendon dysfunction, as occurs in flat-feet (pes planovalgus).

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20
Q

what is arthrodesis?

A

artificial induction of joint ossification between 2 bones via surgery, so joint is basically removed and stiffening occurs.

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21
Q

4 features of OA on an X-ray?

A

osteophytes
reduced joint space
subchondral sclerosis
subchondral cysts

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22
Q

1st metatarsal posture in hallux valgus?

A

varus

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23
Q

components of the hindfoot?

A

talus

calcaneus

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24
Q

components of midfoot?

A

navicular, cuboid, cuneiforms

25
components of forefoot?
metatarsals and phalanges
26
what ligament stabilises the mid-forefoot junction (tarsometatarsal joints)?
the Lisfranc ligament injury indicated by loss of alignment of 2nd metatarsal with intermediate cuneiform on radiograph
27
how can abduction and adduction of forefoot occur?
mainly in midtarsal joint | some in tarsometatarsal joints and in ankle
28
what makes sure the rest of the foot also moves when the heel moves?
the calcaneo-cuboid joint (part of the midtarsal joint connecting the hindfoot with the midfoot.)
29
what are valgus heels assoc. with?
``` flat foot (planovalgus or pes planus) depressed medial longitudinal arch* ```
30
what are varus heels assoc. with?
pes cavus= high arch
31
commonest major congenital abnormality of the foot?
talipes equinovarus (club foot)
32
characteristics of clubfoot?
heel varus deformity, forefoot adduction | some degree of plantarflexion and supination
33
tment of clubfoot?
manipulative stretching of tightened structures, and apply cast from toes to groin repeated every 5-7 days abduction foot orthosis to be worn full time for 12 wks once full correction obtained
34
what is talipes calcaneus?
congenital foot abnormality in which dorsum of foot lies against shin treat with stretching and splintage
35
what residual deformity may be seen in clubfoot?
skewfoot- metatarsals are adducted, and there is a valgus deformity of hindfoot
36
what in intoeing usually the result of?
postural deformity of hips (IR) or excessive anteversion of femoral neck
37
how does pes cavus arise?
muscle imbalance, which disturbs forces controlling formation and maintenance of arches
38
appearance of foot in more severe cases of pes cavus?
toe clawing with foot intrinsic muscle wkness | excessive callus formation under metatarsal heads and heel
39
what specifically is a bunion?
a protective bursa | forms in hallux valgus, and is often assoc. with recurrent episodes of inflammation
40
what is hallux rigidus?
primary OA of MTPJ of great toe joint pain and stiffness commoner in males toe may be held in flexed position, and proximal phalanx and metatarsal head are thickened following joint narrowing and circumferential exostosis formation tment= fusion or Keller's arthroplasty-excision of deformities
41
what is splay foot?
widening of foot at level of metatarsal heads
42
what is Freiberg's disease?
osteochondritis of 2nd metatarsal head, assoc with palpable deformity and pain
43
present. complaint in plantar fasciitis?
heel pain
44
what is mallet toe?
fixed flexion deformity of distal IPJ of toe
45
what is claw toe?
both IP joint flexed, and MTPJ extended | all 3 joints flexed in curly toe
46
where does gout classically affect in the feet?
the MTPJ of the great toe
47
how is tarsal tunnel syndrome relieved?
division of flexor retinaculum
48
why is the ankle more unstable in plantarflexion?
talus is wider anteriorly, so in PF, talus gripped less firmly between malleoli as narrower portion being gripped
49
components of the lateral ligament of the ankle?
anterior and posterior talo-fibular ligaments | calcaneo-fibular ligament
50
tment of functional instability of ankle?
specialised physio
51
what movement do the inferior tibiofibular ligaments restrict?
lateral and proximal movement of distal end of fibula when foot dorsiflexed
52
normal range of plantarflexion?
55 degrees
53
normal range of dorsiflexion?
15 degrees
54
if dorsiflexion restricted, but normal range restored on knee flexion, what does this indicate?
tight Achilles tendon
55
what deformities may be seen on radiograph of foot in RA?
MTPJ dislocation, and associated lateral displacement of sesamoid bones toe valgus deformities bony erosion, OP apperance
56
what is a Morton's neuroma?
a compressive neuorpathy of the interdigital nerve, most commonly involving the 2nd and 3rd interdigital nerve between the metatarsal heads.
57
what imaging usually identifies a Morton's neuroma?
ultrasound- oval hypoechoic mass oriented parallel to metatarsal bones
58
what test is confirmatory for accurate diagnosis of a Morton's neuroma?
a common digital nerve block

MSK Block (15 decks)

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