Foot and ankle Flashcards by Anna McCallum

What is hallux valgus?

Bunion

Lateral angulation of great toe

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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

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What is the presentation of hallux valgus?

Pressure symptoms from shoes
Pain from crossing of toes
MEtatarsalgia
Deformity

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How is hallux valgus diagnosed?

Clinically

XR to determine severity of underlying deformity and exclude degenarive disease

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What is the management of hallux valgus?

Shoe modification
Orthotics
Operative

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What are the indications for operative management of hallux valgus?

Failure of non op management

Non op management not acceptable to patient

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What are the types of surgery for hallux valgus?

Release of lateral soft tissues

Osteotomy 1st metatarsal +/- proximal phalanx

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What is hallux rigidus?

Stiff big toe caused by OA of great toe

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What is the presentation of hallux rigidus?

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

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How is hallux rigidus diagnosed?

Clinical

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What are the management options for hallux rigidus?

Activity modification
Shoes with rigid sole
Analgesia
Operative

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What are the operative management options for hallux rigidus?

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

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What are some common lesser toe deformities?

Hammer toe= PIP
Claw toe = PIP and DIP
Mallet toe = DIP

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What is th management of lesser toe deformities?

Activity modification
Flat shoes with high toe box
orthotic soles
Surgery

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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

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What is Morton’s neuroma?

Interdigital neuroma

Mechanically induced degenerative neuropathy

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What is Morton’s neuroma associated with?

High heeled shoes

Women 40-60yo

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What is the presentation of Morton’s neuroma?

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

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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