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RB Y2 MSK 04 - Adult Orthopaedics > Foot and Ankle > Flashcards

Foot and Ankle Flashcards

1
Q

pes planus

A

can be a normal variant, where the medial arch doesnt develop in childhood

paitients with generalised ligamentous laxity are more likely to have flat feet

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2
Q

what are flat footed people at a higher risk of

A

tendonitis of tibialis posterior tendon

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3
Q

what test is used to determine if flat feet are mobile

A

jack test - medial arch reforms on dorsiflexion of the hallux

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4
Q

3 reasons for mobile flat feet

A

ligamentous laxity

dynamic- weight bearing only

normal variant in children

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5
Q

what does rigid flatfootedness imply

A

underlying tarsal coalition - surgery

underlying inflammatory/neurological disorder

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6
Q

acquired flat foot

A

can be due to tibialis posterior tendon stretch/rupture, RA or diabetes with Charcot foot (neuropathic joint destruction)

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7
Q

what is the most common cause of acquired flat foot

A

tibialis posterior dysfunction

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8
Q

who is tibialis posterior dysfunction often seen in

A

middle aged obese females

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9
Q

tibialis posterior dysfunction

A

under repeated stress can degenerate and develop tendonitis, elongate and eventually rupture.

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10
Q

clinical features of tibialis posterior dysfunction

A

pain or swelling posterior to medial malleolus

change in foot shape

diminshed walking ability/balance

dislike of uneven surfaces

hallux valgus

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11
Q

how should tibialis posterior tendonitis be treated

A

splint with medial arch support to prevent rupture

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12
Q

what happens if the tibialis posterior tendon elongates/ruptures

A

loss of medial arch and valgus of heel

subsequent degenerative OA of hindfoot and midfoot may occur

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13
Q

treatment of elongation/rupture posterior tibialis

A

foot supple with no OA - tendon transfer

OA - arthrodesis (fuse bones)

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14
Q

pes cavus

A

abnormally high arch of foot - often clawed toes present

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15
Q

causes of pes cavus

A

idiopathic

neuromuscular conditions - CP, spina bifida, polio

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16
Q

plantar fasciitis

A

self limiting repetitive stress/overload or degenerative condition of the foot

thickening of plantar fascia

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17
Q

where is plantar fasciitis felt

A

in-step of foot

  • origin of plantar aponeurosis on the distal plantar aspect of the calcaneal tuberosity

localised tenderness on palpation at this site

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18
Q

causes of plantar fasciitis

A

diabetics, physical overload, obesity, frequent walking on hard floors with poor cushioning

cushioning heel fat pad atrophies with age

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19
Q

what is plantar fasciitis associated with

A

heel spurs

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20
Q

treatment and prognosis of plantar fasciitis

A

rest, achilles and plantar fascia stretching and a gel filled heel pad

corticosteroid injection

symptoms can take up to 2 years to resolve

21
Q

hallux valgus

A

deformity of great toe due to medial deviation of 1st metatarsal and lateral deviation of toe itself

eg bunion

22
Q

primus varus

A

1st metarsal bone is rotated and angled away from the 2nd

bialteral broad feet and inc in intermetatarsal angle

23
Q

who is hallux valgus more common in

A

females

  • inappropriate footwear?
24
Q

where is pain from hallux valgus felt

A

inside of big toe - important to clinically distinguish

25
Q

treatment of hallux valgus

A

conservative - footwear choice

surgery - many patients are unhappy with results

26
Q

hallux rigidus

A

OA of 1st MTPJ

can be primary or secondary to osteochondral injury

pain felt on top of big toe

grind test positive

27
Q

treatment of hallux rigidus

A

conservative - stiff sold shoe to limit motion, removal of osteophytes

gold standard surgical - arthrodesis

28
Q

arthrodesis for the treatment of hallux rigidus

A

successful fusion should alleviate pain with the small sacrifice of no motion (limited anyway)

prevents women from wearing high heels

29
Q

surgical term for removal of osteophytes

A

cheilectomy

30
Q

morton’s neuroma

A

degenerative fibrosis of plantar interdigital nerves near its bifurcation, due to repeated trauma

irritated nerve becomes swollen - neuroma - neuralgic pain (burning and tingling)

31
Q

what nerve is most commonly affected in morton’s neuroma

A

3rd interspace nerve

then 2nd

32
Q

who is more likely to get morton’s neuroma

A

women

33
Q

morton’s neuroma - clinical examination

A

loss of sensation in affected web space

Mulder’s click test

34
Q

diagnosis of morton’s neuroma

A

US - shows swollen nerve

35
Q

managment of morton’s neuroma

A

conservative - metatarsal pad/offloading insole. steroid and local anesthetics

neuroma can be excised - continue to expereince pain/recurrence

36
Q

tendo-achilles tendinosis

A

can occur due to repetitive strain which leads to a peritendonitis or due to a degenerative process with intrasubstance microtears

predisposes to tendon rupture

37
Q

what may predispose to tendonitis

A

quinolone antibiotics, RA, other inflammatory arthropathies and gout

38
Q

treatment of tendo-achilles tendinosis

A

rest, physio, heel raise to offload tendon and use of splint or boot

39
Q

what should not be administered for tendo-achilles tendinosis

A

steroid injection - prediposed to Achilles tendon rupture and this may cause this

40
Q

achilles tendon rupture

A

middle aged groups

usually due to degenerative changes or recent tendonitis

sudden deceleration with resisted calf muscle contraction (eg lunging at squash) leads to sudden pain and difficulty weight bearing

weakness of plantarflexion and palpable gap in the tendon

41
Q

simmonds test

A

achilles tendon rupture - no plantarflexion of foot when squeezing the calf

42
Q

treatment of achilles tendon rupture

A

repair damaged tendon

cast in equinous position (plantarflexed with toes pointing down)

8 weeks or so

43
Q

claw toes

A

hyperextend MTP

hyperflex PIP and DIP

44
Q

hammer toe

A

hyperextend MTP and DIP

hyperflex PIP

45
Q

what are ankle sprain caused by

A

twisting force - usually inversion or twisting on a planted foot

46
Q

what classification is used for lateral malleolar fractures

A

Weber classification

47
Q

treatment of ankle sprain

A

physio and RICE

48
Q

metatarsal stress fractures

A

common in 2nd metatarsal (then 3rd)

often occur in runners and soldiers

x ray may not demonstrate a fracture until around 3 weeks

bone scan/MRI to confirm diagnosis

prolonged rest in thick soled boot (6-12w)

49
Q

which metatarsal commonly fracture due to an inversion injury

A

5th

RB Y2 MSK 04 - Adult Orthopaedics (7 decks)

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