Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

E - MSK > Foot and Ankle Conditions > Flashcards

Foot and Ankle Conditions Flashcards

1
Q

When is malleolar grip strongest

A

During dorsiflexion - unstable during plantar flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Muscles of dorsiflexion

A

Tibialis anterior
Extensor digitorum longus
Extensor hallicus longus
Peroneus / Fibular tertius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Muscles of plantar flexion

A 
Gastrocnemius
Soleus 
Tibialis posteior
Flexor hallicus longus 
Flexor digitorum longus 
Assisted by plantaris
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Muscles of inversion

A

Tibialis anterior and posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Muscles of eversion

A

Fibularis longus and brevis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

function of arches of foot

A

Shock absorbers

Distribute weight over foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the integrity of the arches of the feet maintained by

A

Shape of united bones
Plantar aponeurosis
Long and short plantar ligaments
Intrinsic muscles of foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a cavovarus foot and causes

A

High arch

  • Neurological impairments i.e. muscle wasting
  • Congenital - clubfoot
  • Post-traumatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What clinical sign can be seen in cavovarus foot

A

Peek-a-boo sign - can see heels behind arches from anterior view

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical features of cavovarus foot and causes

A

Weakness of intrinsic muscles –> toe clawing –> plantar callosities and shoe problems

Plunger effect of proximal phalanges and overaction of peroneus longus –> plantarflexion of MT –> plantar callosities and shoe problems

Weakness of peroneus brevis –> hind foot varus –> ankle instability

Weakness of tibialis anterior –> equinus –> altered gait

Overpull of tibialis posterior –> adduction of foot –> stress fractures of lateral metatarsals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

5 questions to ask patient with cavovarus foot

A 
Progressive?
FH?
Muscle pain or weakness? 
Elevated CK?
Altered sensation?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What test can be done to differentiate between a forefoot driven hindfoot varus and a hind foot driven varus?

A

Colemans Block Test - patient stands with 1st ray hanging over the edge of a block and if hind foot varus corrects, then it is compensating for a rigidly plantar flexed 1st ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is hallux valgus

A

bunions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

cause of hallux valgus

A

Genetic

Footwear - women more affected high heels?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Symptoms of hallux valgus

A

Pressure symptoms from shoes
Pain from crossing over toes
Metatarsalgia (pain at ball of foot)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pathogenesis of hallux valgus

A

Lateral angulation of the great toe causes tendons pull to be realigned to lateral of centre of rotation of the toe.

This worsens the deformity, resulting in a cycle of increased pull and deformity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why does abnormalities of lesser toes occur in hallux valgus

A

As deformity progresses, sesamoid bones subluxation as less weight goes through the great toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Diagnosis of hallux valgus

A

Clinical exam

X-ray to determine severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Non-op management of hallux valgus

A

Shoes - wide and high toe box
Orthotics - offload pressure and correct deformity
Activity modification
Analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Operative management of hallux valgus

A

Release lateral soft tissues

Osteotomy (removal) of 1st MT and proximal phalanx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is hallux rigidus

A

Stiff big toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cause of hallux rigidus

A

Genetic - MT head more pointed than rounded

Microtrauma –> arthritis –> HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Symptoms of hallux rigidus

A

asymptomatic common
pain - at extreme of dorsiflexion
limited RoM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diagnosis of hallux rigidus

A

clinical - stiff osteophytes on exam

x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Non-op management of hallux rigidus
Activity limitation Shoes with rigid sole (stop bending --> pain) Analgesia
26
Op management of hallux rigidus
Arthrodesis (joint fusion) to remove dorsal impingement - GOLD Cheilectomy (remove bone spurs) Arthroplasty (joint replacement) - good RoM
27
Name some lesser toe deformities
Claw toes - dorsiflexion of proximal phalanx on lesser MTP joint with flexion of both proximal and distal IP joints (2nd-5th toes) Hammer Toe - bent PIPJ of 2nd, 3rd or 4th toe Mallet Toe - bent DIPJ of 2nd, 3rd or 4th toe
28
Causes of lesser toe deformities
``` Imbalance between flexors and extensors Shoe wear - too short / narrow, high-heels Neurological RA Idiopathic ```
29
Non-op treatment of lesser toe deformities
Activity limitation Shoe wear Orthotic insoles
30
Operative treatment of lesser toe deformities
Flexor to extensor transfer IP joint fusion MTP joint release Shortening osteotomy of MT
31
What is Morton's neuroma
A mechanically induced, degenerative neuropathy where the common digital nerve is relatively tethered to one MT and movement in the adjacent MT causes mechanical shear The 3rd MT joint is quite rigid, so thought that it rubs against the 2nd / 4th MTs resulting in the nerve getting pulled down
32
Symptoms of Mortons neuroma
``` Neuralgic burning pain into toes Intermittent Altered sensation in webspace Tends to affect females 40-60 3rd webspace most common then 2nd ```
33
diagnosis of Mortons neuroma
Clinical exam Mudler's click (squeeze MT heads together to hear) USS - best MRI - good
34
Treatment of Mortons neuroma
Steroid injection for small lesions Surgery - excision of lesion + section of normal nerve - causes numbness and recurrence as nerves attempt to regenerate but if there is no end for it to join up with then another neuroma can form
35
Treatment of rheumatoid forefoot
Non-op - shower, orthotics, activity limitation, analgesia | Operative - 1st MTPJ arthrodesis + 2nd-5th toe excision arthroplasty (destructive but helps bad pain)
36
What is a dorsal foot ganglion
A benign cystic swelling containing gelatinous material arising from a joint or tendon sheath
37
Symptoms of dorsal foot ganglion
Pain from pressure from shoes or from underlying problem
38
Treatment of dorsal foot ganglion
Non-op - aspirate | Operative - excision
39
Treatment of mid foot arthritis
Non-op - shoewear, activity limitation, orthotics Injections Operative fusion
40
What is plantar fibromatosis
Ledderhose disease - dupuytrens of the foot, progressive disease - is usually asymptomatic unless very large or on WBing area
41
Treatment of plantar fibromatosis
Non-Op - avoid pressure, shoewear, orthotics Operative excision - 80% recurrence RT - recurrence high Excision + RT best for low recurrence but high risk of complications
42
What is achilles tendinitis / tendinosis
A degenerative overuse condition (no inflammation) resulting in pain and swelling of calf
43
Types of achilles tendinosis
Insertional - within 2cm of insertion, degenerative Mid-Substance - middle of tendon (2-7cm) Bursitis - retro- or superficial-calcanea Paratendinopathy - inflammation and/or degeneration of the thin membrane around the achilles tendon
44
Causes of Achilles tendinopathy
Paratendonopathy - athlete, 30-40, MALE | Tendonopathy - non-athlete, >40, obese, steroids, DM
45
Symptoms of achilles tendinopathy
Pain during and after exercise Difficulty fitting shoes RUPTURE - sudden painful blow with audible pop
46
Diagnosis of achilles tendinopathy
Clinical - Simmonds Triad test for rupture - look for angle of dangle - feel - palpate for gap along length of tendon - move - calf squeeze
47
Investigations for achilles tendinopathy
USS, MRI if diagnosis unclear
48
Treatment of achilles tendinopathy
``` Activity modification, weight loss, shoes w slight heel Physio - eccentric stretching Extra-corporeal shockwave treatment Immobilisation Surgery - gastrocnemius release - release and debridement of tissues ```
49
What is plantar fasciitis
A chronic degenerative change of the plantar fasciitis, presumable due to repetitive micro tears
50
Pathological changes in plantar fasciitis
Fibroblast hypertrophy Absence of inflammatory cells Dysfunctional and disorganised blood vessels and collagen Avascularity
51
Causes of plantar fasciitis
``` Athletes who rapidly increase intensity of training Running in unpadded shoes Obesity Occupations involving prolonged standing Foot rotational deformities Tight gastro-soleus complex ```
52
Symptoms of plantar fasciitis
Pain first thing in morning Pain on WBing after rest (post-static dyskinesia) at the origin of plantar fascia Frequently long lasting (2y +)
53
DDx for plantar fasciitis
Nerve entrapment syndrome Arthritis Calcaneal pathology
54
Diagnosis of plantar fasciitis
Clinical | X-ray, MRI, USS if unsure
55
Treatment of plantar fasciitis
``` Orthothic heel pads, taping Stretching techniques, night splints Rest, change training, weight loss NSAIDs Physio Cortisone injections Extracorporeal Shockwave therapy ```
56
Treatment of ankle arthritis
Non-Op - weight loss - activity modification - physio - analgesia and steroid injections Operative - Arthrodesis (GOLD) - Arthroscopic Anterior Debridement (if symptoms exclusively anterior) - Joint replacement - maintains RoM
57
What is posterior tibial tendon dysfunction
Acquired adult flatfoot | Presenting with pain and swelling of medial hindfoot and may also have change in the shape of the foot
58
What shape changes of the foot occur in posterior tibial tendon dysfunction
``` Valgus heel (heel rotates lateral when seen behind) Flattened longitudinal arch Abducted forefoot ```
59
Diagnosis of posterior tibial tendon dysfunction
Double and single heel raise - heels should swing from valgus to varus as heel raises
60
Management of posterior tibial tendon dysfunction
NSAIDS, rest, immobilisation Orthotics - medial arch support Hindfoot Osteotomy + Tendon transfer (if early) Arthrodesis - triple fusion of subtalar, talonavicular, calcaneo-cuboid (later)
61
Causes of diabetic foot ulcer
Neuropathy - unaware of trauma to foot Autonomic Neuropathy - lack of sweating --> dry cracked skin --> more sensitive to microtrauma Poor vascular supply
62
Treatment of diabetic foot ulcer
Prevention - control diabetes, smoking, improve vascular supply, splints, shoe wear, prevent infection and deformity, good nutrition Surgery - Improve vascular supply - Debride ulcers and get samples for microbiology - Correct deformity to offload area - amputation
63
What is Charcot neuropathy
A destructive process of bone and joint, typically seen in a foot that has lost its protective sensory innervation.
64
Clinical presentation of Charcot neuropathy
Suspect in any patient with diabetes and neuropathy who presents with a warm, swollen, red foot - NB often not painful
65
Pathophysiology of Charcot neuropathy
Neurotraumatic - lack of proprioception and protective pain sensation Neurovascular - abnormal ANS --> increased vascular supply and bone resorption
66
What bone changes is Charcot neuropathy characterised by
1. Fragmentation 2. Coalescence 3. Remodelling
67
Diagnosis of Charcot
Clinical X-ray MRI
68
management of Charcot
Prevention Immobilisation and casting (non-Wing until fragmentation resolved) Correct deformity which can --> ulceration --> infection --< amputation

E - MSK (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions