Foot And Ankle Conditions Flashcards
what is achilles tendonitis
inflammation of the achilles tendon
what does tendonitis predispose to
tendon rupture
risk factors for achilles tendonitis
overtraining
quinolone antibiotics
RA, gout
give an example of a quinolone antibiotic
ciprofloxacin
pathophysiology of achilles tendonitis
repetitive microtrauma, failure of collagen repair with loss of fibre alignments/structure
clinical presentation of achilles tendonitis
- Pain of the Achilles tendon or at its insertion in the calcaneus
- Morning stiffness
- Pain and stiffness eases with walking
investigation of achilles tendonitis
usually a clinical diagnosis
management of achilles tendonitis
activity modification, analgesia, NSAIDs
physiotherapy
who usually presents with achilles tendon rupture
> 40
risk factors for achilles tendon rupture
diabetes
RA
steroid use
symptoms of achilles tendon rupture
sudden deceleration with resisted calf muscle contraction
leads to sudden pain and difficulty weight bearing
clinical signs of achilles tendon rupture
- Weakness of plantar flexion and a palpable gap in the tendon are usually apparent
- Unable to tiptoe stand
- Positive calf squeeze (Simmonds) test
usual investigation of achiles tendon rupture
US
conservative management of achilles tendon rupture
series of casts in the equinus position
surgical management of achilles tendon rupture
suture repair of the tendon
what usually causes an ankle fracture
inversion injury with a rotational force applied to the foot
what can ankle fractures often affect
lateral, medial and posterior malleolus
what is used to classify ankle fractures
weber classification (A,B,C)
imaging of ankle fracture
AP and lateral x-ray
conservative management of ankle fracture
cast or moonboot
operative management of ankle fracture
ORIF
what does ORIF stand for
open reduction internal fixation
what usually causes an ankle sprain
twisted ankle
what is the most common type of ankle sprain
lateral
what commonly causes a lateral ankle sprain
inversion of the plantar flexed foot
how are ankle sprains graded
- Grade 1: microscopic tear (stretch)
- Grade 2: partial tear
- Grade 3: complete rupture
what is a chronic ankle sprain
recurrent sprains or giving way, persisting for more than 6 months
clinical presentation of an ankle sprain
tenderness and swelling
bruising
functional loss
mechanical instability
investigations done in ankle sprain
x-ray to rule out fracture
management of ankle sprain
PRICE
physio
what does PRICE stand for in injury management
protection
rest
ice
compression
elevation
what does a calcaneus fracture usually follow
axial compression e.g. falling from height onto the heel
management of calcaneus fracture
cast immobilisation with no weight bearing for 6-12 weeks
complication of calcaneus fracture
compartment syndrome
what is the cause of claw and hammer toes
acquired imbalance between the flexor and extensor tendons
pathophysiology of claw toes
hyperextension at the MTPJ with flexion at the PIPJ and DIPJ
pathophysiology of hammer toes
PIPJ flexion, DIPJ extension and neutral MTPJ
supportive management of claw and hammer toes
toe sleeves and corn plasters
surgical solutions of claw and hammer toes
tenotomy, tendon transfer, arthrodesis, toe amputation
pathophysiology of hallux valgus
medial deviation of the 1st metatarsal and lateral deviation of the toe itself
who is more likely to get hallux valgus
females
name some intrinsic risk factors of hallux valgus
ligament laxity, pes planus, RA, cerebral palsy, 2nd toe amputation
extrinsic risk factors for hallux valgus
shoes with heels and narrow toe box
clinical presentation of hallux valgus
usually bilateral
big to turned towards other toes
ulceration/loss of balance
conservative management of hallux valgus
analgesia, physio, spacers, wear comfy shoes
when may you use surgical management of hallux valgus and what does it include
osteotomies when conservative management fails
what is hallux rigidus
osteoarthritis of the first MTPJ
symptoms of hallux rigidus
- Painful 1st MTP joint
- Stiffness
- Pain increases with activity/aggravated by shoes
clinical signs of hallux rigidus
- Dorsal exostosis (bone spur)
- IPJ hyperextension
investigation of hallux rigidus
XR
gold standard for surgical management of hallux rigidus
arthrodesis
what is a lisfranc injury
tarsometatarsal fracture dislocation
clinical presentation of a lisfranc injury
severe midfoot pain
inability to bear weight
investigation of lisfranc injury
XR: AP and oblique views
management of lisfranc injuries
ORIF
what is a stress fracture
a break in the bone that happens with repeated injury or stress
which toes are most at risk of a stress fracture
2nd, followed by 3rd
management of metatarsal stress fracture
prolonged rest in a rigid soled boot
what is mortons neuroma
benign fibrotic thickening of a plantar digital nerve due to irritation
what is the most common nerve involved in mortons neuroma
third interspace nerve
risk factors for mortons neuroma
age: 45-50
obesity
female
clinical presentation of mortons neuroma
burning pain and tingling that radiates to affected toes
pain exacerbated by footwear - relieved by removal of shoe
clinical test for mortons neuroma
mulders click test
what is mulders click test
medio‐lateral compression of the metatarsal heads (exerted by squeezing the forefoot with your hand) may reproduce symptoms or produce a characteristic ‘click’
what is the diagnostic test for mortons neuroma
US shows swollen nerve
usual management of mortons neuroma
conservative: RICE, weight loss, metatarsal pad or offloading insole
what is pes cavus
abnormally high arch of the foot
what is pes cavus often linked to
cerebral palsy, polio, spina bifida, charcot-marie-tooth
what often accompanies pes cavus
claw toes
conservative management of pes cavus
accommodative shoe wear, ankle braces, orthotics
what is plantar fasciitis
inflammation of the plantar aponeurosis at its origin on the calcaneus
name some risk factors for plantar fasciitis
physical overload
diabetes
age
abnormal foot shape
walking on hard floors with poor cushioning
clinical signs of plantar fasciitis
- Fullness or swelling on plantarmedial aspect of heel
- Localised tenderness on palpation of the plantar aspect of heel and/or plantarmedial aspect of heel
- Tinel’s test positive for Baxter’s nerve
management of plantar fasciitis
rest, NSAIDs, physio
how long can plantar fasciitis symptoms take to resolve
2 years
what is the role of the tibialis posterior tendon
supports the medial arch of the foot
what is the most common cause of acquired flat foot in adults
tibialis posterior tendon dysfunction
name some risk factors for tibialis posterior tendon dysfunction
obesity
increasing age
hypertension/diabetes
steroid injections
clinical presentation of tibialis posterior tendon dysfunction
pain or swelling posterior to the medial malleolus
change in foot shape
diminished walking/balance
management of tibialis posterior tendon dysfunction
physiotherapy, good shoes
what causes talus fractures
forced dorsiflexion or rapid deceleration
name some risks of talus fractures
AVN
osteoarthritis
what causes a talar dome margin fracture
excessive inversion/eversion
what causes a 5th metatarsal fracture
inversion injury
clinical presentation of a 5th metatarsal fracture
pain over lateral border of forefoot, especially with weight bearing
