Foot and Ankle / DFU

Question 1

State Wagner Classification

Answer 1

Question 2

Describe the general principle of treatment for DFU

Answer 2

1. Elimination of infection
   - Debridement
   - Antibiotic
   - Wound care
2. Reduction of plantar pressure (off-loading)
   - Total contact plaster cast
   - Non-weight-bearing crutches
3. Vascular management
   - Angioplasty or bypass
4. Medical management
   - Good diabetic control
5. Reduce risk of recurrence (Foot wear and foot care)

Question 3

Define Charcot joint

Answer 3

A chronic, progressive, degenerative, neuropathic arthropathy resulting from loss of protective sensation

Question 4

List 4 indication of amputation

Answer 4

1. Dead/dying (e.g gangrenous leg or traumatic injury)
2. Deformed/dysfunctional. Deformed leg with loss of sensation
3. Deadly (e.g osteosarcoma or infection (septic)
4. Damn nuisance (e.g large smelly ulcer/wound)

Question 5

Define hallux valgus

Answer 5

The 1st metatarsal deviates medially to a variable degree
The great toe deviates laterally and may be rotated into pronation

Question 6

Define Hammer toe

Answer 6

Flexion deformity affecting PIPJ + Extension of MTPJ

Question 7

Define Claw toe

Answer 7

Dorsiflexion of the proximal phalanx on lesser metatarsophalangeal joint, combined with flexion of both PIPJ and DIPJ

Question 8

Define Mallet toe

Answer 8

Flexion deformity affecting DIPJ

Question 9

Define Plantar fasciitis

Answer 9

Inflammation of the aponeurosis of the plantar fascia at its origin on the calcaneus

Question 10

What are the findings of plantar fasciitis on physical examination?

Answer 10

1. Tenderness at medial tuberosity of calcaneus
2. Gastrocnemius tightness (limited ankle dorsiflexion)

Question 11

What are the 2 mechanism for Achilles tendon rupture

Answer 11

1. Trauma during sports event
   - Sudden forced plantar flexion
   - Violent dorsiflexion in a plantar flexed foot
2. Repeated steroid injection