Foot and Ankle Flashcards
Hallux valgus - clinical features
Commonly asymptomatic
Pain
Hallux valgus
Bursal inflammation
Nervous symptoms - digital nerve compression
Secondary osteoarthritis in 1st metatarsophalangeal joint
Hallux valgus - radiological features
Sesamoids displaced laterally
Degenerative changes
Measurements change
- hallux valgus (normally <15 degrees)
- intermetatarsal (normally <9 degrees)
- distal metatarsal articular (normally <10 degrees)
- hallux valgus interphalangeus (normally <10 degrees)
Hallux valgus - risk factors
Genetic Increased distal metatarsal articular angle Laxity of ligaments Convex metatarsal head 2nd toe deformity Pes planus Rheumatoid arthritis Cerebral palsy Shoes with a high heel and narrow toe box
Hallux valgus - management
Non-operative - show modification/orthosis Operative - surgical correction - performed if shoe modification doesn't succeed
Achilles tendon rupture - typical history
Traumatic injury during sport - sudden plantar flexion or violent dorsiflexion
Feel a tear/pop
Extreme pain
Trouble walking
Achilles tendon rupture - clinical features
Weakness Difficulty walking Sudden/severe pain in heel Deformity - palpable gap in heel - calf swelling due to haematoma Positive Thompson test - absent passive plantar flexion
Achilles tendon rupture - risk factors
Pre-existing degenerative condition Poor physical condition Medication - local glucocorticoids - fluoroquinolone - systemic glucocorticoids - immunosuppressants Episodic athletes
Achilles tendon rupture - management
Conservative
- gravity equinus cast - angle of angle at dangle
- allows the achilles tendon to heal in a relaxed position
- no tightness
Surgery
- open end-to-end achilles tendon repair
Pes cavus - clinical features
High longitudinal arch Hindfoot varus Lateral foot pain Plantar calluses Plantar fasciitis
Pes planus - clinical features
Flat foot - arch only on tip-toe
Metatarsalgia
Hallux valgus
Hindfoot valgus
Pes cavus - causes
Congenital Neurological condition - cerebral palsy - charcot-Marie-Tooth disease - spinal cord lesions - polio
Pes planus - causes
Congenital Loss of active or passive support during dynamic weight-bearing activities - flexible pes planus Fusion of tarsal bones - rigid Inflammatory joint disease - rigid
Diabetic foot - clinical features
Ulceration (ischaemic - neuro cause) Infection - cellulitis, pus, gangrene Sensory neuropathy - painless Failure to heal Decreased circulation - weak/absent pulses
Diabetic foot - complications
Lack of healing of injuries/ulcers - causes gangrene Calluses Dry skin Nail disorders Hallux valgus Charcot foot Poor blood flow - due to atherosclerosis - causes tissue death and may require amputation
Diabetic foot - MDT team
Tissue viability nurse District nurse - dressings Vascular surgeons GPs Podiatrists Infectious disease specialist Diabetic nurse specialist Endocrine doctor Orthotist
