Foot and Ankle Conditions

Question 1

What is hallux valgus?

Answer 1

Lateral deviation of the big toe, which forms a bony lump medially

Question 2

Hallux valgus is commoner in males. True/False?

Answer 2

False

Females 4:1 males

Question 3

What is a bunion?

Answer 3

Inflamed bursa over the 1st metatarsal head

Question 4

List conservative treatment for hallux valgus

Answer 4

Wearing more accommodating shoes

Spacers between 1st webspace

Question 5

Surgery for cosmesis in hallux valgus is really effective and patients are usually super happy. True/False?

Answer 5

False

Quite the contrary.

Question 6

What is hallux rigidus?

Answer 6

OA of the 1st metatarso-phalangeal joint

Question 7

What is the gold standard surgical treatment for hallux rigidus?

Answer 7

Arthrodesis - alleviates pain but reduced motion

Question 8

Arthrodesis prevents women wearing high-heels. True/False?

Answer 8

True

Question 9

What is Morton’s neuroma?

Answer 9

Irritation and degeneration of plantar interdigital nerves near their bifurcation, causing inflammation and swelling (neuroma)

Question 10

List clinical features of Morton’s neuroma

Answer 10

Forefoot pain
Burning/tingling radiating within toes
Loss of sensation in webspace

Question 11

What is a Mulder’s +ve click test for Morton’s neuroma?

Answer 11

Compression of metatarsal heads causes symptoms/clicking

Question 12

Women are more affected by Morton’s neuroma - what is a significant implicated cause of this?

Answer 12

High-heels

Question 13

Where do metatarsal stress fractures usually occur?

Answer 13

2nd-3rd metatarsal

Question 14

List aetiology for Achilles tendonitis

Answer 14

Repetitive strain (sports)
Quinolone antibiotics
Rheumatoid arthritis
Gout

Question 15

Steroid injections are contraindicated at the Achilles tendon. True/False?

Answer 15

True

Question 16

What clinical test is used to define tendon rupture?

Answer 16

Simmonds test (no plantarflexion of foot when calf is squeezed)

Question 17

List proposed causative factors for plantar fasciitis

Answer 17

Diabetes
Obesity
Walking on hard floors
Poor cushioning in shoes

Question 18

Where does the tibialis posterior tendon predominately insert?

Answer 18

Navicular bone

Question 19

What is pes cavus? What are some common causes?

Answer 19

Abnormal high arch of the foot

Infection, neurological conditions

Question 20

Describe claw toes

Answer 20

Hyperextension at MTPJ

Hyperflexion at PIPJ + DIPJ

Question 21

Describe hammer toes

Answer 21

Hyperextension at DIPJ + MTPJ

Hyperflexion at PIPJ

Question 22

Describe mallet toes

Answer 22

Hyperflexion at DIPJ

Question 23

What is the most common cause of acquired pes planus in adults?

Answer 23

Tibialis posterior dysfunction

Question 24

What is a fairly specific finding in tibialis posterior dysfunction?

Answer 24

Pain and swelling posterior to medial malleolus

Question 25

What is pes planus?

Answer 25

Flat foot - loss of medial arch of the foot

Question 26

What is a fairly specific finding of tibialis posterior dysfunction?

Answer 26

Pain and swelling posterior to the medial malleolus

Question 27

List treatments for plantar fasciitis

Answer 27

``` NSAIDs Rest Splints (particularly at night) Heel cups/arch support Steroid injection ```

Question 28

What are the operative indications for hallux valgus?

Answer 28

Failure of non-op Pain + infiltration of little toes Ulceration Functional/lifestyle limitations

Question 29

List some features of rheumatoid foot

Answer 29

Hallux valgus Subluxed MTPs Clawed toes Painful plantar calluses

Question 30

What is the difference between tendinitis and tendinosis?

Answer 30

Tendinitis is inflammation resulting from microtears | Tendinosis is degeneration of collagen from chronic overuse

Question 31

In claw, hammer and mallet toe, what is the main deformity?

Answer 31

Hyperextension

Question 32

In claw toe, which joints are flexed?

Answer 32

PIPDIP

Question 33

In mallet toe, which joint is flexed?

Answer 33

DIP

Question 34

In hammer toe, which joint is flexed?

Answer 34

PIP

Question 35

Outline the treatment for pes planus

Answer 35

Physio Insole (to support medial arch) Appropriate footwear Surgery

Question 36

How is pes cavus managed?

Answer 36

Surgery - soft tissue release, tendon transfer, calcaneal osteotomy, arthrodesis

Question 37

What is plantar fasciitis?

Answer 37

Mechanical problem affecting the plantar membrane of the foot, causing heel pad pain when walking

Question 38

Hallux valgus has a strong association with family history. True/False?

Answer 38

True

Question 39

What surgical procedure is offered for the treatment of hallux valgus?

Answer 39

Osteotomy

Question 40

What is the gold standard surgical treatment for Morton's neuroma?

Answer 40

Steroid and local anaesthetic injection

Question 41

What conservative management should be used in ankle sprain?

Answer 41

RICE (Rest, ice, compress, elevate) | Physio