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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
Q

components of forefoot?

A

metatarsals and phalanges

26
Q

what ligament stabilises the mid-forefoot junction (tarsometatarsal joints)?

A

the Lisfranc ligament

injury indicated by loss of alignment of 2nd metatarsal with intermediate cuneiform on radiograph

27
Q

how can abduction and adduction of forefoot occur?

A

mainly in midtarsal joint

some in tarsometatarsal joints and in ankle

28
Q

what makes sure the rest of the foot also moves when the heel moves?

A

the calcaneo-cuboid joint (part of the midtarsal joint connecting the hindfoot with the midfoot.)

29
Q

what are valgus heels assoc. with?

A 
flat foot (planovalgus or pes planus)
depressed medial longitudinal arch*
30
Q

what are varus heels assoc. with?

A

pes cavus= high arch

31
Q

commonest major congenital abnormality of the foot?

A

talipes equinovarus (club foot)

32
Q

characteristics of clubfoot?

A

heel varus deformity, forefoot adduction

some degree of plantarflexion and supination

33
Q

tment of clubfoot?

A

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
Q

what is talipes calcaneus?

A

congenital foot abnormality in which dorsum of foot lies against shin

treat with stretching and splintage

35
Q

what residual deformity may be seen in clubfoot?

A

skewfoot- metatarsals are adducted, and there is a valgus deformity of hindfoot

36
Q

what in intoeing usually the result of?

A

postural deformity of hips (IR) or excessive anteversion of femoral neck

37
Q

how does pes cavus arise?

A

muscle imbalance, which disturbs forces controlling formation and maintenance of arches

38
Q

appearance of foot in more severe cases of pes cavus?

A

toe clawing with foot intrinsic muscle wkness

excessive callus formation under metatarsal heads and heel

39
Q

what specifically is a bunion?

A

a protective bursa

forms in hallux valgus, and is often assoc. with recurrent episodes of inflammation

40
Q

what is hallux rigidus?

A

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
Q

what is splay foot?

A

widening of foot at level of metatarsal heads

42
Q

what is Freiberg’s disease?

A

osteochondritis of 2nd metatarsal head, assoc with palpable deformity and pain

43
Q

present. complaint in plantar fasciitis?

A

heel pain

44
Q

what is mallet toe?

A

fixed flexion deformity of distal IPJ of toe

45
Q

what is claw toe?

A

both IP joint flexed, and MTPJ extended

all 3 joints flexed in curly toe

46
Q

where does gout classically affect in the feet?

A

the MTPJ of the great toe

47
Q

how is tarsal tunnel syndrome relieved?

A

division of flexor retinaculum

48
Q

why is the ankle more unstable in plantarflexion?

A

talus is wider anteriorly, so in PF, talus gripped less firmly between malleoli as narrower portion being gripped

49
Q

components of the lateral ligament of the ankle?

A

anterior and posterior talo-fibular ligaments

calcaneo-fibular ligament

50
Q

tment of functional instability of ankle?

A

specialised physio

51
Q

what movement do the inferior tibiofibular ligaments restrict?

A

lateral and proximal movement of distal end of fibula when foot dorsiflexed

52
Q

normal range of plantarflexion?

A

55 degrees

53
Q

normal range of dorsiflexion?

A

15 degrees

54
Q

if dorsiflexion restricted, but normal range restored on knee flexion, what does this indicate?

A

tight Achilles tendon

55
Q

what deformities may be seen on radiograph of foot in RA?

A

MTPJ dislocation, and associated lateral displacement of sesamoid bones
toe valgus deformities
bony erosion, OP apperance

56
Q

what is a Morton’s neuroma?

A

a compressive neuorpathy of the interdigital nerve, most commonly involving the 2nd and 3rd interdigital nerve between the metatarsal heads.

57
Q

what imaging usually identifies a Morton’s neuroma?

A

ultrasound- oval hypoechoic mass oriented parallel to metatarsal bones

58
Q

what test is confirmatory for accurate diagnosis of a Morton’s neuroma?

A

a common digital nerve block

MSK Block (15 decks)

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