Foot and Ankle Flashcards
pes planus
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
what are flat footed people at a higher risk of
tendonitis of tibialis posterior tendon
what test is used to determine if flat feet are mobile
jack test - medial arch reforms on dorsiflexion of the hallux
3 reasons for mobile flat feet
ligamentous laxity
dynamic- weight bearing only
normal variant in children
what does rigid flatfootedness imply
underlying tarsal coalition - surgery
underlying inflammatory/neurological disorder
acquired flat foot
can be due to tibialis posterior tendon stretch/rupture, RA or diabetes with Charcot foot (neuropathic joint destruction)
what is the most common cause of acquired flat foot
tibialis posterior dysfunction
who is tibialis posterior dysfunction often seen in
middle aged obese females
tibialis posterior dysfunction
under repeated stress can degenerate and develop tendonitis, elongate and eventually rupture.
clinical features of tibialis posterior dysfunction
pain or swelling posterior to medial malleolus
change in foot shape
diminshed walking ability/balance
dislike of uneven surfaces
hallux valgus
how should tibialis posterior tendonitis be treated
splint with medial arch support to prevent rupture
what happens if the tibialis posterior tendon elongates/ruptures
loss of medial arch and valgus of heel
subsequent degenerative OA of hindfoot and midfoot may occur
treatment of elongation/rupture posterior tibialis
foot supple with no OA - tendon transfer
OA - arthrodesis (fuse bones)
pes cavus
abnormally high arch of foot - often clawed toes present
causes of pes cavus
idiopathic
neuromuscular conditions - CP, spina bifida, polio
plantar fasciitis
self limiting repetitive stress/overload or degenerative condition of the foot
thickening of plantar fascia
where is plantar fasciitis felt
in-step of foot
- origin of plantar aponeurosis on the distal plantar aspect of the calcaneal tuberosity
localised tenderness on palpation at this site
causes of plantar fasciitis
diabetics, physical overload, obesity, frequent walking on hard floors with poor cushioning
cushioning heel fat pad atrophies with age
what is plantar fasciitis associated with
heel spurs
treatment and prognosis of plantar fasciitis
rest, achilles and plantar fascia stretching and a gel filled heel pad
corticosteroid injection
symptoms can take up to 2 years to resolve
hallux valgus
deformity of great toe due to medial deviation of 1st metatarsal and lateral deviation of toe itself
eg bunion
primus varus
1st metarsal bone is rotated and angled away from the 2nd
bialteral broad feet and inc in intermetatarsal angle
who is hallux valgus more common in
females
- inappropriate footwear?
where is pain from hallux valgus felt
inside of big toe - important to clinically distinguish
treatment of hallux valgus
conservative - footwear choice
surgery - many patients are unhappy with results
hallux rigidus
OA of 1st MTPJ
can be primary or secondary to osteochondral injury
pain felt on top of big toe
grind test positive
treatment of hallux rigidus
conservative - stiff sold shoe to limit motion, removal of osteophytes
gold standard surgical - arthrodesis
arthrodesis for the treatment of hallux rigidus
successful fusion should alleviate pain with the small sacrifice of no motion (limited anyway)
prevents women from wearing high heels
surgical term for removal of osteophytes
cheilectomy
morton’s neuroma
degenerative fibrosis of plantar interdigital nerves near its bifurcation, due to repeated trauma
irritated nerve becomes swollen - neuroma - neuralgic pain (burning and tingling)
what nerve is most commonly affected in morton’s neuroma
3rd interspace nerve
then 2nd
who is more likely to get morton’s neuroma
women
morton’s neuroma - clinical examination
loss of sensation in affected web space
Mulder’s click test
diagnosis of morton’s neuroma
US - shows swollen nerve
managment of morton’s neuroma
conservative - metatarsal pad/offloading insole. steroid and local anesthetics
neuroma can be excised - continue to expereince pain/recurrence
tendo-achilles tendinosis
can occur due to repetitive strain which leads to a peritendonitis or due to a degenerative process with intrasubstance microtears
predisposes to tendon rupture
what may predispose to tendonitis
quinolone antibiotics, RA, other inflammatory arthropathies and gout
treatment of tendo-achilles tendinosis
rest, physio, heel raise to offload tendon and use of splint or boot
what should not be administered for tendo-achilles tendinosis
steroid injection - prediposed to Achilles tendon rupture and this may cause this
achilles tendon rupture
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
simmonds test
achilles tendon rupture - no plantarflexion of foot when squeezing the calf
treatment of achilles tendon rupture
repair damaged tendon
cast in equinous position (plantarflexed with toes pointing down)
8 weeks or so
claw toes
hyperextend MTP
hyperflex PIP and DIP
hammer toe
hyperextend MTP and DIP
hyperflex PIP
what are ankle sprain caused by
twisting force - usually inversion or twisting on a planted foot
what classification is used for lateral malleolar fractures
Weber classification
treatment of ankle sprain
physio and RICE
metatarsal stress fractures
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)
which metatarsal commonly fracture due to an inversion injury
5th
