Foot and Ankle Flashcards by Eilidh Selfridge

Where is the sural nerve found

Lateral foot - behind malleolus

Can be used for biopsy and grafting

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Which ligaments are found in the lateral part of the foot

Anterior talofibular ligament

Calcaneofibular ligament

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Which ligaments are found in the medial part of the foot

Posterior tibial
Flexor digitorum longus
Flexor hallucis longus

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What are the 3 normal ‘rockers’ of someone’s gait

1st - heel strikes to flat foot
2nd - mid stance
3rd - heel rises

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Which nerves supply the foot

saphenous
sural 
deep peroneal 
superficial peroneal 
tibial 
medial and lateral plantar

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Pes planus is always a problem - true or false

False
Common problem that doesn’t often cause problems or need treated
All children will be flat footed until about 6 or 7

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Describe the path of tibialis posterior

Courses immediately posterior to medial malleolus

Attaches on to navicular tuberosity and plantar aspect of medial and middle cuneiforms

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What is the function of tibialis posterior

Stabiliser of medial longitudinal arch

Inverts foot and plantar-flexes

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What are some risk factors for tibialis posterior dysfunction

Obesity 
Females 
Flat footed 
Hypertension 
Diabetes

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What are some symptoms of tibialis posterior dysfunction

Pain and/or swelling posterior to medial malleolus
Change in foot shape Decrease in balance
Pain in lateral wall, midfoot and ankle

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How do you treat tibialis posterior dysfunction

Physio
Insole to support arch
Orthoses to accommodate foot shape
Surgery - fusion in extreme cases

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What are some causes of pes cavus

Idiopathic
Neurological issues - HSMN, polio, spina bifida
Club foot

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What are the symptoms of plantar fasciitis

Pain after rest
Worse after exercise
Fullness/swelling of plantarmedial aspect of heel
Tenderness over plantar aspect of heel

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What are some causes of plantar fasciitis

Physical overload - excessive weight or exercise
Seronegative arthropathy
Diabetes
Abnormal foot shape

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How does hallux valgus present

Deformity at first MCP
Pain and discomfort (due to inflamed bursae)
Problems with shoes
Cosmetic concerns

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What causes hallux valgus

Familial - laxity and alignment of joints
Footwear
General joint laxity
Rheumatoid conditions

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Which sex is hallux valgus most common in

Females

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How can you treat hallux valgus

Shoe modification
Padding
Surgery - osteotomy

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What is hallux rigidus

Osteoarthritis of the 1st MTP joint in foot

How can you treat Morton’s neuroma

Insoles
Injections into area
Surgery to excise fibrosis and nerves

What causes Achilles tendinosis

Repetitive micro-trauma to the tendon
Damage occurs faster than it can be repaired
Failure of collagen repair with loss of fibre alignment

What are the symptoms of Achilles tendinosis

Pain
Morning stiffness
Eases with walking or heat

How do you treat Achilles tendinosis

Activity modifications 
Analgesia 
NSAID
Orthotics 
Physio 
Surgery - severe cases

Which patients commonly rupture their Achilles

Over 40’s

Pre-existing tendinosis

What are the symptoms of a ruptured Achilles

Unable to bear weight Weak plantar flexion Palpable painful gap Positive calf squeeze (Simmonds) test

How do you manage a ruptured Achilles

Either operate or cast | Both have long recovery and involve time in a cast

What ligaments are most commonly affected in ankle sprains

Lateral ligaments | Anterior talofibular and calcaneofibular

What are the signs of an ankle sprain

History of twisting injury | Pain, bruising and tenderness

How do you manage an ankle sprain

Physio - build up strength and stability | RICE - rest, ice, compression and elevation

What classification is used for ankle fractures

Weber classification | A, B and C

List the joints of the foot

Subtalar - between talus and calcaneus Midtarsal - made of 2 joints: calcaneocuboid & talocalcaneonavicular Tarsometatarsal- between cuneiforms and cuboid and metatarsals Metatarsal phalangeals Interphalangeal

Describe the midtarsal joint

Made of 2 joints: calcaneocuboid & talocalcaneonavicular Synovial joint Movement is inversion and eversion of the foot

Describe the metatarsophalangeal joints

Synovial joints | Allow flexion, extension, abduction, adduction and circumduction of the digits

Describe the interphalangeal joints

Synovial hinge joints | Allow flexion and extension of toes

What are the functions of the arches of the foot

Shock absorption Increased capacity for weight bearing - redistributes it across foot Push-off spring function

What is the plantar aponeurosis

Thickened central area of plantar fascia Helps support the arches Protects foot from puncture wounds

List the arches of the foot

Medial longitudinal Lateral longitudinal Transverse

Describe the medial longitudinal arch

Composed of bones of medial foot - calcaneus, talus, navicular, cuneiforms and metatarsals 1-3 Supported by FHL and attachments of tibialis anterior and fibularis longus

Describe the lateral longitudinal arch

Formed by calcaneus, cuboid and metatarsals 4&5 Less important than medial Usually weight bears when standing

Describe the transverse arch

Consists of the cuboid, cuneiforms and the bases of all 5 metatarsals Supported by fibularis longus and tib post

What arteries supply the foot

Dorsalis pedis - branch of anterior tibial, gives off the arcuate artery on dorsum Medial and lateral plantar arteries - branches from posterior tibial, contribute to deep plantar arch Deep plantar and arcuate give off metatarsal which branch into digital

What does the dorsal venous arch of the foot give rise to

Great and small saphenous veins (superficial veins)

List the deep veins of the foot

anterior and posterior tibial and the fibular veins | These all joint to form the popliteal vein

Which nerve gives motor supply to the intrinsic muscles of the foot

Tibial nerve to sole | Deep fibular to dorsum

Which nerves give sensory supply to the dorsum of the foot

Mainly superficial fibular nerve Deep fibular nerve supplying the first interdigital cleft Sural nerve supplying the proximal lateral border Saphenous nerve supplying the proximal medial border

Which nerves give sensory supply to the plantar surface of the foot

Mainly tibial nerve to the heel and majority of sole Sural nerve supplying the proximal lateral border saphenous nerve supplying the proximal medial border