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Ortho AM > Foot and ankle > Flashcards

Foot and ankle Flashcards

1
Q

What is hallux valgus?

A

Bunion

Lateral angulation of great toe

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2
Q

What is the pathipysiology of bunions?

A

Pull of tendons realigned to lateral of centre, sesamoid bones sublux, putting less weight through great toe and causing abnormality of lesser toes

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3
Q

What is the presentation of hallux valgus?

A

Pressure symptoms from shoes
Pain from crossing of toes
MEtatarsalgia
Deformity

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4
Q

How is hallux valgus diagnosed?

A

Clinically

XR to determine severity of underlying deformity and exclude degenarive disease

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5
Q

What is the management of hallux valgus?

A

Shoe modification
Orthotics
Operative

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6
Q

What are the indications for operative management of hallux valgus?

A

Failure of non op management

Non op management not acceptable to patient

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7
Q

What are the types of surgery for hallux valgus?

A

Release of lateral soft tissues

Osteotomy 1st metatarsal +/- proximal phalanx

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8
Q

What is hallux rigidus?

A

Stiff big toe caused by OA of great toe

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9
Q

What is the presentation of hallux rigidus?

A

Mainly asymptomatic
Pain, often at extreme of dorsiflexion
Limited ROM
Stiffness

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10
Q

How is hallux rigidus diagnosed?

A

Clinical

XR

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11
Q

What are the management options for hallux rigidus?

A

Activity modification
Shoes with rigid sole
Analgesia
Operative

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12
Q

What are the operative management options for hallux rigidus?

A

Cheilectomy- removing dorsal impingement
Arthrodesis= gold standard- 1st MTPJ fusion
1st MTPJ hemiarthroplasty

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13
Q

What are some common lesser toe deformities?

A 
Hammer toe= PIP
Claw toe = PIP and DIP
Mallet toe = DIP
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14
Q

What is th management of lesser toe deformities?

A

Activity modification
Flat shoes with high toe box
orthotic soles
Surgery

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15
Q

What are the operative management options for lesser tor deformities?

A

Flexor to extensor transfer
Fusion of IP joint
Release of MTP joint
Shortening or osteotomy of metatarsal

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16
Q

What is Morton’s neuroma?

A

Interdigital neuroma

Mechanically induced degenerative neuropathy

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17
Q

What is Morton’s neuroma associated with?

A

High heeled shoes

Women 40-60yo

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18
Q

What is the presentation of Morton’s neuroma?

A

Typically 3rd or 2nd webspace
Neuralgic burning pain into toes, intermittent
Altered sensation in webspace

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19
Q

How is Morton’s neuroma diagnosed?

A

Clinical= Mulder’s click
US= gold standard
MRI

20
Q

What is the management of Morton’s neuroma?

A

Injection for small lesions

Excision f lesion including section of normal nerve

21
Q

What is the most commonly affected area in RA?

A

Forefoot

22
Q

What is th presentation of Rheumatoid forefoot?

A

Chronic synovitis
Dorsal dislocation of MTP joints
Hallux valgus

23
Q

What is the management of rheumatoid forefoot?

A

Shoe wear, orthotics
Activity
Operative

24
Q

What are the operative management options for rheumatoid forefoot?

A

1st MTPJ arthrodesis

2-5th toe excision arthroplasty

25
Q

Where do dorsal foot ganglia arise from?

A

Joint or tendon sheath

26
Q

What causes dorsal foot ganglia?

A

Idiopathic

Underlying arthritis or tendon pathology

27
Q

What is the presentation of dorsal foot ganglia?

A

Pain, esp from pressure

Lump

28
Q

What is the management of dorsal foot ganglia?

A

Aspiration, “family bible”
Excision
High recurrence rate

29
Q

What is plantar fibromatosis?

A

Non malignant thickening of deep connective tissue or fascia of feet
“Dupytren’s of the foot”

30
Q

What is the presentation of plantar fibromatosis?

A

Usually asymptomatic unless large on n weight bearing area

31
Q

What is the management of plantar fibromatosis?

A

Shoe wear, orthotics
Excision= 80% recurrence
Combination of radiotherapy and surgery= low risk recurrence, high risk complications

32
Q

Whatare the types of achilles tendinitis?

A 
Paratendonopathy= athletic 30-40yo
Tendonopathy= over 40s, overweight, DM, steroids
33
Q

What is the presentation of achilles tendonitis?

A 
Pain during and following exercise 
Recurrent episodes
Swelling
Difficulty fitting shoes
High risk of rupture
34
Q

How is Achilles tendonitis diagnosed?

A

Clinical

US or MRI if severe

35
Q

What is the management of achilles tendonitis?

A 
Activity modification, physio
Weight loss
Shoes with slight heel
Extracorporeal shock wave treatment 
Immobilisation
Operative
36
Q

What re the operative management options for achilles tendonitis?

A

Gastrocnemius resection

Release and debridement of tendon

37
Q

What is plantar fasciitis associated with?

A 
Athletes
Obesity 
Prolonged standing in job 
Foot/lower limb deformities
Tight gastric-soleus complex
38
Q

What is the presentation of plantar fasciitis?

A

Pain- first thing in morning, on weight bearing after rest, located at origin of plantar fascia
Flat feet

39
Q

How is plantar fasciitis diagnosed?

A

Clinically

40
Q

What is the management of plantar fasciitis?

A 
Rest, stretching 
Ice 
Orthoses
Weight loss 
Physio 
NSAIDs
Corticosteroid injections 
Night splinting 
3rd line treatment
41
Q

What are some of the 3rd line treatments for plantar fasciitis?

A 
Extracorporeal shock wave therapy 
Topaz plasma collation 
Nitric oxide
Platelet rich plasma 
Endoscopic/open surgery
42
Q

What is posterior tibial tendon dysfunction?

A

Acquired adult flat foot planovalgus

Most common type of flatfoot developed in adulthood

43
Q

What is the presentation of posterior tibial tendon dysfunction?

A

Medial or lateral pain
Flat foot
Inward rolling ankle
Turning out toes

44
Q

How is posterior tibial tendon dysfunction diagnosed?

A

Clinically- double and single heel raise- struggle to single heel raise
MRI if worry about tendon

45
Q

What is the management of posterior tibial tendon dysfunction?

A

Orthotics

Surgery= reconstruction of tendon, triple fusion

Ortho AM (23 decks)

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