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musculoskeletal > Foot And Ankle Conditions > Flashcards

Foot And Ankle Conditions Flashcards

1
Q

what is achilles tendonitis

A

inflammation of the achilles tendon

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1
Q

what does tendonitis predispose to

A

tendon rupture

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2
Q

risk factors for achilles tendonitis

A

overtraining
quinolone antibiotics
RA, gout

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3
Q

give an example of a quinolone antibiotic

A

ciprofloxacin

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4
Q

pathophysiology of achilles tendonitis

A

repetitive microtrauma, failure of collagen repair with loss of fibre alignments/structure

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5
Q

clinical presentation of achilles tendonitis

A
  • Pain of the Achilles tendon or at its insertion in the calcaneus
  • Morning stiffness
  • Pain and stiffness eases with walking
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6
Q

investigation of achilles tendonitis

A

usually a clinical diagnosis

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7
Q

management of achilles tendonitis

A

activity modification, analgesia, NSAIDs
physiotherapy

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8
Q

who usually presents with achilles tendon rupture

A

> 40

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9
Q

risk factors for achilles tendon rupture

A

diabetes
RA
steroid use

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10
Q

symptoms of achilles tendon rupture

A

sudden deceleration with resisted calf muscle contraction
leads to sudden pain and difficulty weight bearing

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11
Q

clinical signs of achilles tendon rupture

A
  • Weakness of plantar flexion and a palpable gap in the tendon are usually apparent
  • Unable to tiptoe stand
  • Positive calf squeeze (Simmonds) test
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12
Q

usual investigation of achiles tendon rupture

A

US

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13
Q

conservative management of achilles tendon rupture

A

series of casts in the equinus position

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14
Q

surgical management of achilles tendon rupture

A

suture repair of the tendon

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15
Q

what usually causes an ankle fracture

A

inversion injury with a rotational force applied to the foot

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16
Q

what can ankle fractures often affect

A

lateral, medial and posterior malleolus

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17
Q

what is used to classify ankle fractures

A

weber classification (A,B,C)

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18
Q

imaging of ankle fracture

A

AP and lateral x-ray

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19
Q

conservative management of ankle fracture

A

cast or moonboot

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20
Q

operative management of ankle fracture

A

ORIF

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21
Q

what does ORIF stand for

A

open reduction internal fixation

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22
Q

what usually causes an ankle sprain

A

twisted ankle

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23
Q

what is the most common type of ankle sprain

A

lateral

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24
Q

what commonly causes a lateral ankle sprain

A

inversion of the plantar flexed foot

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25
Q

how are ankle sprains graded

A
  • Grade 1: microscopic tear (stretch)
  • Grade 2: partial tear
  • Grade 3: complete rupture
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26
Q

what is a chronic ankle sprain

A

recurrent sprains or giving way, persisting for more than 6 months

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27
Q

clinical presentation of an ankle sprain

A

tenderness and swelling
bruising
functional loss
mechanical instability

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28
Q

investigations done in ankle sprain

A

x-ray to rule out fracture

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29
Q

management of ankle sprain

A

PRICE
physio

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30
Q

what does PRICE stand for in injury management

A

protection
rest
ice
compression
elevation

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31
Q

what does a calcaneus fracture usually follow

A

axial compression e.g. falling from height onto the heel

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32
Q

management of calcaneus fracture

A

cast immobilisation with no weight bearing for 6-12 weeks

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33
Q

complication of calcaneus fracture

A

compartment syndrome

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34
Q

what is the cause of claw and hammer toes

A

acquired imbalance between the flexor and extensor tendons

35
Q

pathophysiology of claw toes

A

hyperextension at the MTPJ with flexion at the PIPJ and DIPJ

36
Q

pathophysiology of hammer toes

A

PIPJ flexion, DIPJ extension and neutral MTPJ

37
Q

supportive management of claw and hammer toes

A

toe sleeves and corn plasters

38
Q

surgical solutions of claw and hammer toes

A

tenotomy, tendon transfer, arthrodesis, toe amputation

39
Q

pathophysiology of hallux valgus

A

medial deviation of the 1st metatarsal and lateral deviation of the toe itself

40
Q

who is more likely to get hallux valgus

A

females

41
Q

name some intrinsic risk factors of hallux valgus

A

ligament laxity, pes planus, RA, cerebral palsy, 2nd toe amputation

42
Q

extrinsic risk factors for hallux valgus

A

shoes with heels and narrow toe box

43
Q

clinical presentation of hallux valgus

A

usually bilateral
big to turned towards other toes
ulceration/loss of balance

44
Q

conservative management of hallux valgus

A

analgesia, physio, spacers, wear comfy shoes

45
Q

when may you use surgical management of hallux valgus and what does it include

A

osteotomies when conservative management fails

46
Q

what is hallux rigidus

A

osteoarthritis of the first MTPJ

47
Q

symptoms of hallux rigidus

A
  • Painful 1st MTP joint
  • Stiffness
  • Pain increases with activity/aggravated by shoes
48
Q

clinical signs of hallux rigidus

A
  • Dorsal exostosis (bone spur)
  • IPJ hyperextension
49
Q

investigation of hallux rigidus

A

XR

50
Q

gold standard for surgical management of hallux rigidus

A

arthrodesis

51
Q

what is a lisfranc injury

A

tarsometatarsal fracture dislocation

52
Q

clinical presentation of a lisfranc injury

A

severe midfoot pain
inability to bear weight

53
Q

investigation of lisfranc injury

A

XR: AP and oblique views

54
Q

management of lisfranc injuries

A

ORIF

55
Q

what is a stress fracture

A

a break in the bone that happens with repeated injury or stress

56
Q

which toes are most at risk of a stress fracture

A

2nd, followed by 3rd

57
Q

management of metatarsal stress fracture

A

prolonged rest in a rigid soled boot

58
Q

what is mortons neuroma

A

benign fibrotic thickening of a plantar digital nerve due to irritation

59
Q

what is the most common nerve involved in mortons neuroma

A

third interspace nerve

60
Q

risk factors for mortons neuroma

A

age: 45-50
obesity
female

61
Q

clinical presentation of mortons neuroma

A

burning pain and tingling that radiates to affected toes
pain exacerbated by footwear - relieved by removal of shoe

62
Q

clinical test for mortons neuroma

A

mulders click test

63
Q

what is mulders click test

A

medio‐lateral compression of the metatarsal heads (exerted by squeezing the forefoot with your hand) may reproduce symptoms or produce a characteristic ‘click’

64
Q

what is the diagnostic test for mortons neuroma

A

US shows swollen nerve

65
Q

usual management of mortons neuroma

A

conservative: RICE, weight loss, metatarsal pad or offloading insole

66
Q

what is pes cavus

A

abnormally high arch of the foot

67
Q

what is pes cavus often linked to

A

cerebral palsy, polio, spina bifida, charcot-marie-tooth

68
Q

what often accompanies pes cavus

A

claw toes

69
Q

conservative management of pes cavus

A

accommodative shoe wear, ankle braces, orthotics

70
Q

what is plantar fasciitis

A

inflammation of the plantar aponeurosis at its origin on the calcaneus

71
Q

name some risk factors for plantar fasciitis

A

physical overload
diabetes
age
abnormal foot shape
walking on hard floors with poor cushioning

72
Q

clinical signs of plantar fasciitis

A
  • 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
73
Q

management of plantar fasciitis

A

rest, NSAIDs, physio

74
Q

how long can plantar fasciitis symptoms take to resolve

A

2 years

75
Q

what is the role of the tibialis posterior tendon

A

supports the medial arch of the foot

76
Q

what is the most common cause of acquired flat foot in adults

A

tibialis posterior tendon dysfunction

77
Q

name some risk factors for tibialis posterior tendon dysfunction

A

obesity
increasing age
hypertension/diabetes
steroid injections

78
Q

clinical presentation of tibialis posterior tendon dysfunction

A

pain or swelling posterior to the medial malleolus
change in foot shape
diminished walking/balance

79
Q

management of tibialis posterior tendon dysfunction

A

physiotherapy, good shoes

80
Q

what causes talus fractures

A

forced dorsiflexion or rapid deceleration

81
Q

name some risks of talus fractures

A

AVN
osteoarthritis

82
Q

what causes a talar dome margin fracture

A

excessive inversion/eversion

83
Q

what causes a 5th metatarsal fracture

A

inversion injury

84
Q

clinical presentation of a 5th metatarsal fracture

A

pain over lateral border of forefoot, especially with weight bearing

musculoskeletal (30 decks)

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