Foot and ankle Flashcards
tests to see if pes planus is flexible
form arch on tiptoe
Jack’s test ( form arch when extend big toes)
tibialis posterior courses immediately posterior to __
attachments =
function =
medial malleolus
navicular tuberosity + plantar aspect of medial and middle cuneiforms
elevates arch, invertor and plantar-flexor
most common cause of acquired pes planus =
tibialis posterior dysfunction
tibialis posterior dysfunction is common in which group of patients
obese middle age women and increasing incidence with age
hbp and diabetes
causes of tibialis posterior dysfunction =
steroid injection
sero-ve arthropathies
idiopathic tendinosis (most common)
sign of pes planus on observation
from back can see too many toes (poke out laterally)
Type 1 pes planus
swelling tender and slightly weak power
type 2 pes planus =
planovalgus
midfoot abduction
passively correctable
type 3 pes planus =
fixity and mortise signs
Rx of pes planus
physio
insole
steroid injection only if florid synovitis
Sx - fuse if stage 4 (FDL replaces tib post tendon)
pes cavus causes
commonest - idiopathic
neuro - HSMN, CP, polio, spina bifida, club foot
plantar fasciitis:
worst = ___ and eases off, worse with ___
__ pain
++_ at plantarmedial heel
first step in the morning
activity
stabbing
fullness, swelling and tender
plantar fasciitis: ___ test +ve for Baxter’s nerve
Tinnel’s test
heel spurs are present in __ of population
=
1/4
calcification of insertion at calcaneus
causes of plantar fasciitis
excessive exercise / wt sero -ve arthropathy diabetes planovalgus / cavovarus footwear hypothyroid
Rx of plantar fasciitis
NSAIDs night splints (v painful, in dorsiflexion) tape physio steroid injection usually self-limiting 18-24mnths
Hallux valgus
usually uni/bilateral
M:F
causes =
bilateral F3:1M familial (laxity/alignment) shoes CT disease rheumatoid splayed forefoot ass with loss of muscle tone and age
possible sequelae of hallux valgus
transfer metatarsalgia (as 2nd MTP takes over wt bearing) lesser toe impingement (usually PIPJ) bunion neuralgia shoe difficulties
Rx of hallux valgus
shoe modifications
padding
Sx if not managed / deformities = osteotomies to realign
OA of 1st MTPJ =
Rx (3) =
Hallux rigidus
non op
joint replace
arthrodesis
feet features of RA
subluxed MTPJ
hallux valgus
clawed toes
painful plantar calluses
Morton’s neuroma =
s+s =
degenerative fibrosis (maybe due to traction/bursitis) of digital nerve near bifurcation metatarsalgia, burning and tingling in toes
mortons neuroma
age
F:M
45-50yo
F>M
management of mortons neuroma
examine and US
insoles injections / exercise
achilles tendonitis is due to repetitive microtrauma at ___
eg of causes =
hypovascular region 2-6cm proximal to insertion overtrain ciprofloxacin steroids CT diseases
Ix for achilles tendonitis
examine
US
MRI
treatment of achilles tendonitis
activity modification NSAIDs orthotics physio Sx
Achilles rupture:
mechanism =
age =
s+s =
sudden deceleration with resisted calf contraction >40yo cant wt bear weak plantarflex painful gap \+ve calf squueze (Simmond's) test
acquired imbalances between flexors and extensors in toes => (4)
claw
mallet
hammer toes
mechanism of ankle sprain
inversion on planted foot
typical ligaments that are sprained in a sprained ankle
ATFL and CFL
management of ankle sprain =
RICE and physio
Sx - Brostrum Gould - direct repair
Weber A ankle # =
Rx =
below syndesmoses - stable and no ligament rupture
moon boot
Weber B ankle # =
Rx =
at syndesmoses - can be stable/unstable
if talar shift needs fixed to prevent OA
Wever C ankle # =
unstable
Pilon # =
distal tibial #
high E and causes sig soft tissue problems
5th MT common # mechanism =
inversion injury
3 types of MT #
avulsion by peroneus brevis tendon Jones # prox shaft (stress #)
tarsoMT dislocation # =
high/low E
can sometimes dislocate __ from __
Lisfranc
high
hindfoot from forefoot
calcaneal fracture => __+__ foot
broad and flat (bone explodes outwards)
talus fracture mechanism = __/___
has a __ blood supply and so may lead to __
dorsiflexion/rapid deceleration
reversed
AVN
