Foot and Ankle Conditions Flashcards
When is malleolar grip strongest
During dorsiflexion - unstable during plantar flexion
Muscles of dorsiflexion
Tibialis anterior
Extensor digitorum longus
Extensor hallicus longus
Peroneus / Fibular tertius
Muscles of plantar flexion
Gastrocnemius Soleus Tibialis posteior Flexor hallicus longus Flexor digitorum longus Assisted by plantaris
Muscles of inversion
Tibialis anterior and posterior
Muscles of eversion
Fibularis longus and brevis
function of arches of foot
Shock absorbers
Distribute weight over foot
What is the integrity of the arches of the feet maintained by
Shape of united bones
Plantar aponeurosis
Long and short plantar ligaments
Intrinsic muscles of foot
What is a cavovarus foot and causes
High arch
- Neurological impairments i.e. muscle wasting
- Congenital - clubfoot
- Post-traumatic
What clinical sign can be seen in cavovarus foot
Peek-a-boo sign - can see heels behind arches from anterior view
Clinical features of cavovarus foot and causes
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
5 questions to ask patient with cavovarus foot
Progressive? FH? Muscle pain or weakness? Elevated CK? Altered sensation?
What test can be done to differentiate between a forefoot driven hindfoot varus and a hind foot driven varus?
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
What is hallux valgus
bunions
cause of hallux valgus
Genetic
Footwear - women more affected high heels?
Symptoms of hallux valgus
Pressure symptoms from shoes
Pain from crossing over toes
Metatarsalgia (pain at ball of foot)
Pathogenesis of hallux valgus
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.
Why does abnormalities of lesser toes occur in hallux valgus
As deformity progresses, sesamoid bones subluxation as less weight goes through the great toe
Diagnosis of hallux valgus
Clinical exam
X-ray to determine severity
Non-op management of hallux valgus
Shoes - wide and high toe box
Orthotics - offload pressure and correct deformity
Activity modification
Analgesia
Operative management of hallux valgus
Release lateral soft tissues
Osteotomy (removal) of 1st MT and proximal phalanx
What is hallux rigidus
Stiff big toe
Cause of hallux rigidus
Genetic - MT head more pointed than rounded
Microtrauma –> arthritis –> HR
Symptoms of hallux rigidus
asymptomatic common
pain - at extreme of dorsiflexion
limited RoM
Diagnosis of hallux rigidus
clinical - stiff osteophytes on exam
x-ray
Non-op management of hallux rigidus
Activity limitation
Shoes with rigid sole (stop bending –> pain)
Analgesia
Op management of hallux rigidus
Arthrodesis (joint fusion) to remove dorsal impingement - GOLD
Cheilectomy (remove bone spurs)
Arthroplasty (joint replacement) - good RoM
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