Foot and Ankle disorders Flashcards
Possible causes of achilles tendon disorders and some risk factors?
Tendinopathy (tendonitis),
Partial tendon tear,
Complete rupture of the achilles tendon.
Risk factors = quinolone use or hypercholesterolaemia.
Presentation and management of achillies tendinitis?
Gradual onset of posterior heel pain worse following activity with morning pain and stiffness.
Management - supportive with simple analgesia, reduce precipitating activities and calf muscle exercises.
Presentation, examination, investigations and management of achillies tendon rupture?
Presentation - Audible pop in ankle, sudden onset pain in ankle/calf or inability to walk.
Examination - Simmond’s triad
Ix - Ultrasound.
Rx - Acute referral to orthopaedics.
Presentation of low ankle sprain?
Inversion is the most common mechanism of injury. There is often pain, swelling and tenderness over ligaments and bruising.
Usually able to weight bear unless severe
Grading of low ankle sprains?
Grade 1 - Stretch or microtear, minimal bruising and no pain on weight bearing.
Grade 2 - Partial tear with moderate bruising and minimal pain on weight bearing.
Grade 3 - Complete tear with severe bruising and severe pain on weight bearing.
Investigations and treatment of low ankle sprains?
Ix - X-ray according to ottowa rules. MRI if pain is persistent.
Rx - RICE, may need cast/crutches and if no improvement then further ix and referral.
Features of high ankle sprains?
Sprain of syndesmotic ligaments.
Presentation - difficulty weight bearing, pain when tibia and fibula squeezed together at mid calf point (Hopkin’s squeeze test).
Ix - X-ray may show widening of tibiofibular joint (diastasis) or ankle mortise.
Rx - if no diastasis then non weight bearing othosis. If this fails or there is diastasis then operative fixation.
Pathophysiology, presentation and management of planter Fasciitis?
Pathophysiology - Inflammation of plantar fascia.
Presentation - Gradual onset of pain on planter aspect of heel, worse with pressure and when standing for prolonged periods.
Management - Rest, ice, nsaids, physio and steroid injections (risk of rupture of fascia or fat pad atrophy).
Rarely may need extracorporeal shockwave therapy or surgery.
What is fat pad atrophy, presentation and management?
Atrophy of fat pad which protects the heel from impact. Can occur with age or repetitive inflammation (jumping/running) or steroid injections.
Symptoms similar to plantar fasciitis so ultrasound to look at thickness of fat pad.
Management - comfortable shoes, insoles etc
Explain features of Morton’s Neuroma - what it is and presentaiton
It is dysfunction of a nerve in intermetatarsal space towards top of foot.
Presents with pain at front of foot at location of lesion, sensation of lump in shoe, burning/numbness/pins and needles felt in distal toes.
Investigations and management for Morton’s neuroma
Investigations - Deep pressure, metatarsal squeeze test and Mulder’s sign (painful click felt). Ultrasound or MRI used to confirm diagnosis.
Management: Adapting activities, NSAIDs, insoles, weight loss, steroid injections, radiofrequency ablation, surgery.
Explain features of Bunions/Hallux valgus?
Bony lump created by deformity at MTP joint at base of big toe. Cause is not clear.
Weight bearing X-rays can be used to assess deformity.
Surgery is definitive treatment
Name for high arches and flat feet?
High arches - Cavus.
Flat feet - Planus
