Foot and ankle disorders Flashcards
List the clinical and radiological features of hallux valgus (bunions)
painful medial promimence on 1st MTP joint (big toe)
symptoms often worsen overtime and worse on weight bearing and wearing shoes
Weight bearing Xrays:
lateral deviation and joint subluxation
What are the risk factors of bunions
F>M
Connective tissue disorders
Hypermobility issues
Footwear
What are the treatment options for hallux valgus
Non operative: Accomodative (wide, comfortable) shoes and orthotics, analgesia and Physio
Operative is osteotomy
Indications (pain, failed non operative and skin compromise)
Anatomy of achilles tendon and what is achilles tendon rupture
Unites the gastrocnemius, and soleus muscles to the calcaneus and produces plantarflexion of the ankle.
Achilles tendon rupture-
Sudden onset injury which causes rupture of the achilles tendon and loses the connection between the gastrocnemius muscle and calcaneous bone (BG of achilles tendonitis)
What are the risk factors for Achilles tendon rupture
- Exisiting Achilles tendonitis
- Sports that stress the achilles (tennis, basketball, track athletics)
- Increasing age
- Fluroquinone Abx use (ciprofloxacin)
- Steroids
- FH
What abx is associated with Achilles tendon rupture
Fluroquinone (Ciprofloxacin)
Rupture can occur spontaneously within 48 hours of starting treatment.
What are the symptoms of Achilles rupture
Pain in ankle or calf
Snapping sound
Feeling as though something has hit them in tha back of the leg
What are the signs/ clinical examination findings of achilles tendon rupture
- Legs dangling- affected foot will be dorsiflexed
- Tenderness to the area
- Palpable gap in achilles tendon
- Weakness of plantar flexion
- Unable to stand on tiptoes in affected leg
What is the special test for achilles tendon rupture
Simmonds Calf squeeze test
Positivie test- no plantar flexion in injured foot
Diagnosis for achilles tendon rupture
Ultrasound
What is the management of Achilles tendon rupture
Initial Management: AIRE
A- Analgesia
I- Ice
R- rest and immobolisation
E- Elevation
VTE prophylaxis
Non surgical management- specialist boot to immobolise the ankle
Surgical management- surgically reattaching the achilles
What is Pes cavus and its clinical features and conditions associated with it
High arched foot
Painful or asymptomatic
Charcot Marie tooth disease and Fredreichs Araxia
What is Pes planus and features and conditions associated with it
Flat foot
Pain
Quite common in children
What are the two main factors seen in diabetic foot disease and how they present
Peripheral Neuropathy
* loss of sensation
* not noticing stone in shoe
Peripheral arterial disease
* absent pedal pulses
* reduced ABPI
* intermittent claudication
* arterial ulcers
What are the complications of diabetic foot disease
Calluses, ulceration, Charcot’s arthropathy, cellulitis, osteomyelitis, gangrene
