Foot and ankle disorders

Question 1

describe simmonds test

Answer 1

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

Question 2

define hallux valgus

Answer 2

big toe deviates laterally at the metatarsophalangeal joint

Question 3

what is hallux valgus associated with

Answer 3

genetic predisposition

female gender

age and BMI

type of footwear

Question 4

what can hallux valgus cause 2

Answer 4

pressure on MTPJ against the show leads to bunion formation

secondary arthritis in the joint is common

Question 5

management of hallux valgus 4

Answer 5

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

Question 6

define pes cavus

Answer 6

accentuatted longitundinal foot arches
-Does not flatten with weight bearing

Question 7

cause of pes cavus 3

Answer 7

idiopathic or associated with underlying neurological conditions

underlying neuro conditions:
-spina bifida-
-charcot-marie-tooth-*
-cerebral palsy
-polio
-syringomyelia
-spinal tumour
-firedreichs ataxia*

Question 8

syx of pes cavus 6

Answer 8

claw toes may occur

difficulty with shoes

foot fatigue

decreased mobility

ankle instbaliity/ sparins

callosities

Question 9

Mx of pes cavus 3

Answer 9

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)

Question 10

define pes planus

Answer 10

flat feeet
-medial longitunal arch collapses

leads to whole sole coming into contact with ground

Question 11

causes of pes planus 2

Answer 11

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)

Question 12

clinical features of pes planus 4

Answer 12

asymptomaitc in most

pain medially over the PTT

progressive forefoot abduction

Hindfoot valgus -deformity with loss of ability to heel rise

Question 13

management of pes planus 5

Answer 13

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

Question 14

define hammer toes

Answer 14

extended at MTPJ
-hyperflexed at PIPJ
-extended at DIPJ

most commonly affects 2nd toe

Question 15

define claw toes

Answer 15

extened MTPL flexed at both PIPJ and DIPJ

Question 16

Mx of hammer and claw toe 2

Answer 16

metatarsal shortening (flexible deformity)

PIPJ arthrodesis

Question 17

define mallet toes and Mx

Answer 17

felxion deformity ofthe DIPJ in isolation

-treated with flexor tenotomy or DIPJ arthrodesis

Question 18

clinical features of achille tendon 5

Answer 18

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

Question 19

achilles tendon rupture risk factors 6

Answer 19

age 30-40

male

sport

steroid injection

certain ABx- ciprofloxacin or lveofloxatin

obesity

Question 20

Mx of achilles tedon rupture 4

Answer 20

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

Question 21

pathophys of diabetic foot disease 2

Answer 21

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

Question 22

presenatiotn of diabetic foot disease 2

Answer 22

neuropathy-loss of sensation

ischaemia
-absent foot pulses
-reduced ABPI
-intermittent claudication

Question 23

complications of diabetic foot disesae 6

Answer 23

calluses

ulceration

charcots arthropathy

cellulitis

osteomyelitis

gangrene

Question 24

define charots arthropathy

Answer 24

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

Question 25

screening for diabetic foot

Answer 25

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

Question 26

define low risk diabetic foot 1

Answer 26

no risk factors except callus alone

Question 27

define moderate risk diabetic foot 3

Answer 27

deformity

neuropathy

non-critical limb ischaemia

Question 28

define high risk diabetic foot 6

Answer 28

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