Foot and ankle disorders Flashcards
describe simmonds test
assess for rupture of achilles tendon
-get patient to knee on chair with feet hanging off the edge
-squeeze each calf in turn
-foot should platarflex
if achilies ruptured= no movement of foot
define hallux valgus
big toe deviates laterally at the metatarsophalangeal joint
what is hallux valgus associated with
genetic predisposition
female gender
age and BMI
type of footwear
what can hallux valgus cause 2
pressure on MTPJ against the show leads to bunion formation
secondary arthritis in the joint is common
management of hallux valgus 4
bunion pads and plastic wedges between 1st and 2nd toes may relieve pain
severe defomrity requires surgery
mainly metatarsal osteotomy
1/3 unhappy with result
endstage MTPJ OA (hallux rigidus)
-treated with arthrodesis
define pes cavus
accentuatted longitundinal foot arches
-Does not flatten with weight bearing
cause of pes cavus 3
idiopathic or associated with underlying neurological conditions
underlying neuro conditions:
-spina bifida-
-charcot-marie-tooth-*
-cerebral palsy
-polio
-syringomyelia
-spinal tumour
-firedreichs ataxia*
syx of pes cavus 6
claw toes may occur
difficulty with shoes
foot fatigue
decreased mobility
ankle instbaliity/ sparins
callosities
Mx of pes cavus 3
if previously normal- refer to neurologist
-MRI may help establish any underlying disease
orthoses and custom footwear
surgical procedures if vascular supply is good:
-soft-tissue releases
-tendon transfers
-arthrodesis (fusion of two bones)
define pes planus
flat feeet
-medial longitunal arch collapses
leads to whole sole coming into contact with ground
causes of pes planus 2
normal in child learning to walk
-medial arch develops over the next fear years
in adults
-flat feet assoc w dysfunction of posterior tibilais tendon (PTT) (dynamic stabiliser of medial arch)
clinical features of pes planus 4
asymptomaitc in most
pain medially over the PTT
progressive forefoot abduction
Hindfoot valgus -deformity with loss of ability to heel rise
management of pes planus 5
if asyx and arch restores itself on standing on tiptioe
-no intervention needed
weight loss
supportive shoes with insoles
orthosis (brace or splint)
prevention best cure
-barefoot while <6yrs
define hammer toes
extended at MTPJ
-hyperflexed at PIPJ
-extended at DIPJ
most commonly affects 2nd toe
define claw toes
extened MTPL flexed at both PIPJ and DIPJ
Mx of hammer and claw toe 2
metatarsal shortening (flexible deformity)
PIPJ arthrodesis
define mallet toes and Mx
felxion deformity ofthe DIPJ in isolation
-treated with flexor tenotomy or DIPJ arthrodesis
clinical features of achille tendon 5
sudden pain at back of ankle during running or jumping
pain perceived as a ‘kick’
posssile to walk and some plantarflexion remains
-impossible to raise the heel from the floor when standing
gap may be palpated in the tendon
diagnose with simmonds test
achilles tendon rupture risk factors 6
age 30-40
male
sport
steroid injection
certain ABx- ciprofloxacin or lveofloxatin
obesity
Mx of achilles tedon rupture 4
tendon repair is preferred by young, athletic patients
late-presenting ruptures- need reconstruction
surgery has lower re-rupture risk but devastating infection
for smokes, DM and >50yo
-conservative management preferred
-inital casting in equinus position
-no weight-bearing for 6-8wks
pathophys of diabetic foot disease 2
neuropathy
-resulting in loss of protective sensation (eg not noticing a stone in the shoe)
-charctos arthropathy
-dry skin
peripheral arterial disease
-diabetes is a risk for both macro and microvascular ischaemia
presenatiotn of diabetic foot disease 2
neuropathy-loss of sensation
ischaemia
-absent foot pulses
-reduced ABPI
-intermittent claudication
complications of diabetic foot disesae 6
calluses
ulceration
charcots arthropathy
cellulitis
osteomyelitis
gangrene
define charots arthropathy
a progressive condition of the musculoskeletal system that is characterized by joint dislocations, pathologic fractures, and debilitating deformities
-complication of diabetes, syphilis, chronic alcoholism, leprosy, meningomyelocele, spinal cord injury, syringomyelia, renal dialysis, and congenital insensitivity to pain
screening for diabetic foot
annual basis
-screen for ischaemia -palpate both dorsalis pedis and posterior tibial artery pulse
screen for neuropathy
-10g monofilament is used on various parts of the sole of the foot
define low risk diabetic foot 1
no risk factors except callus alone
define moderate risk diabetic foot 3
deformity
neuropathy
non-critical limb ischaemia
define high risk diabetic foot 6
previous ulceration
previous amputation
renal replacement therapy
neuropathy and non-critical limb ischaemia together
neuropathy in combination with callus and/or deformity
non-critical limb ischaemia in combination with callus and/or deformity
