Foot and Ankle

Question 1

pes planus

Answer 1

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

Question 2

what are flat footed people at a higher risk of

Answer 2

tendonitis of tibialis posterior tendon

Question 3

what test is used to determine if flat feet are mobile

Answer 3

jack test - medial arch reforms on dorsiflexion of the hallux

Question 4

3 reasons for mobile flat feet

Answer 4

ligamentous laxity

dynamic- weight bearing only

normal variant in children

Question 5

what does rigid flatfootedness imply

Answer 5

underlying tarsal coalition - surgery

underlying inflammatory/neurological disorder

Question 6

acquired flat foot

Answer 6

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

Question 7

what is the most common cause of acquired flat foot

Answer 7

tibialis posterior dysfunction

Question 8

who is tibialis posterior dysfunction often seen in

Answer 8

middle aged obese females

Question 9

tibialis posterior dysfunction

Answer 9

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

Question 10

clinical features of tibialis posterior dysfunction

Answer 10

pain or swelling posterior to medial malleolus

change in foot shape

diminshed walking ability/balance

dislike of uneven surfaces

hallux valgus

Question 11

how should tibialis posterior tendonitis be treated

Answer 11

splint with medial arch support to prevent rupture

Question 12

what happens if the tibialis posterior tendon elongates/ruptures

Answer 12

loss of medial arch and valgus of heel

subsequent degenerative OA of hindfoot and midfoot may occur

Question 13

treatment of elongation/rupture posterior tibialis

Answer 13

foot supple with no OA - tendon transfer

OA - arthrodesis (fuse bones)

Question 14

pes cavus

Answer 14

abnormally high arch of foot - often clawed toes present

Question 15

causes of pes cavus

Answer 15

idiopathic

neuromuscular conditions - CP, spina bifida, polio

Question 16

plantar fasciitis

Answer 16

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

thickening of plantar fascia

Question 17

where is plantar fasciitis felt

Answer 17

in-step of foot

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

localised tenderness on palpation at this site

Question 18

causes of plantar fasciitis

Answer 18

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

cushioning heel fat pad atrophies with age

Question 19

what is plantar fasciitis associated with

Answer 19

heel spurs

Question 20

treatment and prognosis of plantar fasciitis

Answer 20

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

corticosteroid injection

symptoms can take up to 2 years to resolve

Question 21

hallux valgus

Answer 21

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

eg bunion

Question 22

primus varus

Answer 22

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

bialteral broad feet and inc in intermetatarsal angle

Question 23

who is hallux valgus more common in

Answer 23

females

• inappropriate footwear?

Question 24

where is pain from hallux valgus felt

Answer 24

inside of big toe - important to clinically distinguish

Question 25

treatment of hallux valgus

Answer 25

conservative - footwear choice surgery - many patients are unhappy with results

Question 26

hallux rigidus

Answer 26

OA of 1st MTPJ can be primary or secondary to osteochondral injury pain felt on top of big toe grind test positive

Question 27

treatment of hallux rigidus

Answer 27

conservative - stiff sold shoe to limit motion, removal of osteophytes gold standard surgical - arthrodesis

Question 28

arthrodesis for the treatment of hallux rigidus

Answer 28

successful fusion should alleviate pain with the small sacrifice of no motion (limited anyway) prevents women from wearing high heels

Question 29

surgical term for removal of osteophytes

Answer 29

cheilectomy

Question 30

morton's neuroma

Answer 30

degenerative fibrosis of plantar interdigital nerves near its bifurcation, due to repeated trauma irritated nerve becomes swollen - neuroma - neuralgic pain (burning and tingling)

Question 31

what nerve is most commonly affected in morton's neuroma

Answer 31

3rd interspace nerve then 2nd

Question 32

who is more likely to get morton's neuroma

Answer 32

women

Question 33

morton's neuroma - clinical examination

Answer 33

loss of sensation in affected web space Mulder's click test

Question 34

diagnosis of morton's neuroma

Answer 34

US - shows swollen nerve

Question 35

managment of morton's neuroma

Answer 35

conservative - metatarsal pad/offloading insole. steroid and local anesthetics neuroma can be excised - continue to expereince pain/recurrence

Question 36

tendo-achilles tendinosis

Answer 36

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

Question 37

what may predispose to tendonitis

Answer 37

quinolone antibiotics, RA, other inflammatory arthropathies and gout

Question 38

treatment of tendo-achilles tendinosis

Answer 38

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

Question 39

what should not be administered for tendo-achilles tendinosis

Answer 39

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

Question 40

achilles tendon rupture

Answer 40

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

Question 41

simmonds test

Answer 41

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

Question 42

treatment of achilles tendon rupture

Answer 42

repair damaged tendon cast in equinous position (plantarflexed with toes pointing down) 8 weeks or so

Question 43

claw toes

Answer 43

hyperextend MTP hyperflex PIP and DIP

Question 44

hammer toe

Answer 44

hyperextend MTP and DIP hyperflex PIP

Question 45

what are ankle sprain caused by

Answer 45

twisting force - usually inversion or twisting on a planted foot

Question 46

what classification is used for lateral malleolar fractures

Answer 46

Weber classification

Question 47

treatment of ankle sprain

Answer 47

physio and RICE

Question 48

metatarsal stress fractures

Answer 48

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)

Question 49

which metatarsal commonly fracture due to an inversion injury

Answer 49

5th