Foot and ankle Flashcards
most common ligaments for spraining the ankle
ATFL
CFL (less common)
Structures of the medial hind foot
Tom Dick and Harry
Tibias posterior
flexor digitorium longus
HFL nerve
features of the medial and hind foot
medial malleolus anteromedial tibiotalar joint deltoid ligament PTT, FDL, FHL posterior tibial artery
structures in the posterior ankle and hind foot
achilles tendon calcaneal insertion retrocalcaneal space perineal tendons FHL
anterior ankle structures
anterior ankle joint superficial perineal N EHL EDL Saphernous N (just over medial malleolus)
structures in the plantar surface of the foot
heel pad 5th MT base plantar fascia metatarsal heads tib post insertion
Foot and ankle examination LOOK
look
patient age obvious rheumatoid disease walking aids shoes, raises, insoles, never wear skin changes atrophy, skin, hair gait
3 rockers of gait
1- heal strike to flat floor
2- mid stance
3-heel rise
Foot and ankle examination MOVE
ankle joint subtler joint talonavicular and CC joints Lis Franc MTPJs PJs hindfoot/forefoot relationship
what happens when achilles tendon is ruptured
in Thomson’s test there is no relation between leg and foot
when do children develop arches
around 6 or 7
what can cause adult acquired flat foot
tibias posterior dysfunction
seen in up to 10% of elderly women
can’t push off properly, tiring to walk
who gets tibias posterior dysfunction
obese middle aged women increases with age flat foot hypertension diabetes steroid injection seronegative arthropathies idiopathic tendonitis
symptoms of tibias posterior dysfunction
pain and/or swelling posterior to medial malleolus change in foot shape diminished walking ability/balance dislike of uneven surfaces more noticeable hallux valgus lateral wall 'impingement' pain mid foot and ankle pain
Treatment for tibias posterior dysfunction
physio insole support for medial arch NO steroid injections orthotics bespoke footwear surgery
what causes pes cavus
idiopathic
v high arches suggest underlying pathology most commonly HSNM, club foot, polio, CP)
what is pes cavus
v high arch?
what is plantar fasciitis
start up pain after rest
can be worse after exercise
fullness or swelling of plantar medial aspect of feel
tender over plantar aspect of heel
treatment for plantar fasciitis
NSAIDS night splints taping heel cups or medial arch supports physio steroid injection
self-limiting over 18-24 months
causes of plantar fasciitis
physical overload - excessive exercise or weight seronegative arthropathy diabetes abnormal foot shape improper footwear
what are bunions (hallux valgus)
deformity at first MTP joint
4 causes for bunion pain
- medial nerve
- from the bursa
- intrinsic joint pain
- transfer of load through other toes
who gets hallux valgus
females:males 2:1
increases with age
usually bilateral
adolescent subgroup
how do you treat hallux valgus
non-operative (shoe modifications, padding)
operative
what surgery can you do for hallux valgus
scarf/akin
break the bone an move the head laterally
what is hallux rigidus
osteoarthritis of the 1st MTP joint
how do you manage hallux rigidus
non-operative
joint replacement
fusion
what operation do you do for rheumatoid arthritis in the feet
same as for hallux rigidus
joint fusion
what is the pathogenesis of RA in the feet
synovitis
proteinases and collagenases
impaired integrity of joint capsules
destruction of the hyaline cartilage
what is the main reason foot problems arise in diabetes
peripheral neuropathy
- cant feel when they’ve hurt they’re feet
- poor wound heeling
what is charcots foot
weakness in the bones of the foot due to nerve damage
with continued walking the bones become deformed
30-50% chance of ulceration which can lead to osteomyelitis
how do you treat charcots foot
conservative
failed conservative measures - surgery
things to consider before operating on charcots foot
normal pulses nutrition optimisation of HbA1C soft tissue envelope-ideally closed location of deformity presence of infection or osteomyelitis
what type of surgery is done for charcots
fixed surgery primary internal, primary external or a combination of both external fixation (external metal work on patient)
what is Morton’s neuroma
degenerative fibrosis of digital nerve near its bifurcation
causes forfeit pain, burning and tingling in toes
who gets Morton’s neuroma
45-50 y/o F>M
how is Mortons’s neuroma managed
non-op (insoles and injections)
operative (excise)
tendon-achiles tendinosis
repetitive micro trauma, failure of collagen repair with loss of fibre alignment/structure
