Foot and ankle Flashcards
What is hallux valgus?
Bunion
Lateral angulation of great toe
What is the pathipysiology of bunions?
Pull of tendons realigned to lateral of centre, sesamoid bones sublux, putting less weight through great toe and causing abnormality of lesser toes
What is the presentation of hallux valgus?
Pressure symptoms from shoes
Pain from crossing of toes
MEtatarsalgia
Deformity
How is hallux valgus diagnosed?
Clinically
XR to determine severity of underlying deformity and exclude degenarive disease
What is the management of hallux valgus?
Shoe modification
Orthotics
Operative
What are the indications for operative management of hallux valgus?
Failure of non op management
Non op management not acceptable to patient
What are the types of surgery for hallux valgus?
Release of lateral soft tissues
Osteotomy 1st metatarsal +/- proximal phalanx
What is hallux rigidus?
Stiff big toe caused by OA of great toe
What is the presentation of hallux rigidus?
Mainly asymptomatic
Pain, often at extreme of dorsiflexion
Limited ROM
Stiffness
How is hallux rigidus diagnosed?
Clinical
XR
What are the management options for hallux rigidus?
Activity modification
Shoes with rigid sole
Analgesia
Operative
What are the operative management options for hallux rigidus?
Cheilectomy- removing dorsal impingement
Arthrodesis= gold standard- 1st MTPJ fusion
1st MTPJ hemiarthroplasty
What are some common lesser toe deformities?
Hammer toe= PIP Claw toe = PIP and DIP Mallet toe = DIP
What is th management of lesser toe deformities?
Activity modification
Flat shoes with high toe box
orthotic soles
Surgery
What are the operative management options for lesser tor deformities?
Flexor to extensor transfer
Fusion of IP joint
Release of MTP joint
Shortening or osteotomy of metatarsal
What is Morton’s neuroma?
Interdigital neuroma
Mechanically induced degenerative neuropathy
What is Morton’s neuroma associated with?
High heeled shoes
Women 40-60yo
What is the presentation of Morton’s neuroma?
Typically 3rd or 2nd webspace
Neuralgic burning pain into toes, intermittent
Altered sensation in webspace
How is Morton’s neuroma diagnosed?
Clinical= Mulder’s click
US= gold standard
MRI
What is the management of Morton’s neuroma?
Injection for small lesions
Excision f lesion including section of normal nerve
What is the most commonly affected area in RA?
Forefoot
What is th presentation of Rheumatoid forefoot?
Chronic synovitis
Dorsal dislocation of MTP joints
Hallux valgus
What is the management of rheumatoid forefoot?
Shoe wear, orthotics
Activity
Operative
What are the operative management options for rheumatoid forefoot?
1st MTPJ arthrodesis
2-5th toe excision arthroplasty
Where do dorsal foot ganglia arise from?
Joint or tendon sheath
What causes dorsal foot ganglia?
Idiopathic
Underlying arthritis or tendon pathology
What is the presentation of dorsal foot ganglia?
Pain, esp from pressure
Lump
What is the management of dorsal foot ganglia?
Aspiration, “family bible”
Excision
High recurrence rate
What is plantar fibromatosis?
Non malignant thickening of deep connective tissue or fascia of feet
“Dupytren’s of the foot”
What is the presentation of plantar fibromatosis?
Usually asymptomatic unless large on n weight bearing area
What is the management of plantar fibromatosis?
Shoe wear, orthotics
Excision= 80% recurrence
Combination of radiotherapy and surgery= low risk recurrence, high risk complications
Whatare the types of achilles tendinitis?
Paratendonopathy= athletic 30-40yo Tendonopathy= over 40s, overweight, DM, steroids
What is the presentation of achilles tendonitis?
Pain during and following exercise Recurrent episodes Swelling Difficulty fitting shoes High risk of rupture
How is Achilles tendonitis diagnosed?
Clinical
US or MRI if severe
What is the management of achilles tendonitis?
Activity modification, physio Weight loss Shoes with slight heel Extracorporeal shock wave treatment Immobilisation Operative
What re the operative management options for achilles tendonitis?
Gastrocnemius resection
Release and debridement of tendon
What is plantar fasciitis associated with?
Athletes Obesity Prolonged standing in job Foot/lower limb deformities Tight gastric-soleus complex
What is the presentation of plantar fasciitis?
Pain- first thing in morning, on weight bearing after rest, located at origin of plantar fascia
Flat feet
How is plantar fasciitis diagnosed?
Clinically
What is the management of plantar fasciitis?
Rest, stretching Ice Orthoses Weight loss Physio NSAIDs Corticosteroid injections Night splinting 3rd line treatment
What are some of the 3rd line treatments for plantar fasciitis?
Extracorporeal shock wave therapy Topaz plasma collation Nitric oxide Platelet rich plasma Endoscopic/open surgery
What is posterior tibial tendon dysfunction?
Acquired adult flat foot planovalgus
Most common type of flatfoot developed in adulthood
What is the presentation of posterior tibial tendon dysfunction?
Medial or lateral pain
Flat foot
Inward rolling ankle
Turning out toes
How is posterior tibial tendon dysfunction diagnosed?
Clinically- double and single heel raise- struggle to single heel raise
MRI if worry about tendon
What is the management of posterior tibial tendon dysfunction?
Orthotics
Surgery= reconstruction of tendon, triple fusion
