Foot and Ankle Flashcards
What is hallux valgus?
It commonly presents alongside burstitis of the 1st metatarsal joint. What is this called?
Medial deviation of 1st metatarsal and lateral deviation of 1st (big) toe
Bunion
How can hallux valgus be managed conservatively and surgically?
Wear wider shoes
Osteotomy - correct bone alignment (does not improve appearance)
What is hallux rigidus?
What is the gold standard surgical treamtent?
OA in the 1st metatarsal
Arthodesis
- artificial fusion of the joint
What causes Morton’s neuroma?
Why is it suggested that women are 4x more likely to be affected?
Irritation of nerves in the plantar surface of foot
Irritation -> inflam and swelling -> neuroma
Wearing of high heels
Female patient presents with burning/tingling sensation radiating into 3rd and 4th toes.
Describe what examination you would do.
What would need to be done to diagnose the condition?
Morton’s neuroma
Mulder’s click test
- squeeze the affected site (dorsum and palmar wise)
- squeeze forefoot across metatarsal heads -> “click” sound/ lump
USS - shows swollen nerve
How can Morton’s neuroma be managed?
Insole with padding at ball of foot
Neuromas can be excised as well
What bones are most likely to be damaged in metatarsal stress fracture?
Once it has been diagnosed on Xray (can take up to 3 weeks to become visible) what then needs to be done?
2nd and 3rd metatarsal
6-12 weeks in a boot
What is weak plantarflexion (standing of tip toes) a sign of?
- Achilles tendonitis/rupture
- Tibialis posterior tendon dysfunction
A patient presents with pain in tendon on posterior leg/ankle and on examination it is tender to touch.
The clinician suspects achilles tendonitis. Steroid injections are suggested as a form of treatment. Is this correct?
No this can lead to rupture
Instead... rest physio heel raise splint/boot
Where is pain felt in plantar fasciitis?
What kind of patient is likely to present with this condition?
What should patients be told to do?
Pain in heel - can be dull/bruisy/achy pain
Diabetics/obese/hard floor walking
Rest and wear heel pads to limit impact
For what foot condition can steroid injections sometimes be useful?
Plantar fasciitis
Describe the difference between pes planus and pes cavus?
What condition is related to neuromuscular diseases?
Pes planus - flat feet
Pes cavus - abnormally high arch
Pes cavus
What ligament rupture can lead to development of pes planus?
Tibialis posterior
Describe the difference between hammer and claw toes?
Hammer toes
- Hyperextension at MTCP
- Hyperflexion at PIPJ
- HyperEXTENSION at DIPJ
Claw toes
- Hyperextension at MTCP
- HyperFLEXION at DIPJ and PIPJ
Patient presents with unsteady gait, pain and swelling on lateral ankle and valgus of the heel.
When foot is viewed laterally it can be seen to be in pes planus. The patient also struggles when asked to stand on tip toes (plantarflexion)
What condition does this patient most likely have?
What orthotic would be most useful?
Tibialis posterior tendon rupture/dysfunction
Splint with medial arch
