Foot and Ankle Disorders

Question 1

Features of hallux valgus

Answer 1

• Great toe deviates laterally at the MTP joint (>15^o metatarsophalangeal angle on X-ray)
• Pressure of MTP against shoe can lead to bunions
• Also increases weight bearing at second metatarsal head
• Pain and hammer toe
• Risk factors include wearing pointed shoes and high heals

Question 2

Management of hallux valgus

Answer 2

• Conservative
  
  • Bunion pads
  • Plastic wedge between great and second toes
• Surgical
  
  • Metatarsal osteotomy

Question 3

Features of achilles tendon rupture

Answer 3

• Feeling of being kicked in the calf
• Pain and swelling near the heal
• Inability to bend foor downward or ‘push off’ the injured leg when walking
• Inability to stand on the toes of the injured leg
• Popping or snapping sound when injury occurs
• Risk factrs include:
  
  • Age 30-40 years
  • Male gender (5x more common)
  • Recreational sports
  • Steroid injections
  • Certain antibiotics (fluoroquinolone antibiotics like ciprofloxacin or levofloxacin)
  • Obesity

Question 4

Management of achilles tendon ruptures

Answer 4

• Functional bracing/casting in resting equinus - prevents the tendon from overstretching too early
• End-to-end operative repair for acute ruptures
• Reconstuction for chronic ruptures

Question 5

Features of pes cavus and pes planus

Answer 5

• Pes cavus - abnormally high medial longitudinal arch
  
  • Patients present with lateral foot pain from increased weight bearing
  • Associated with Charcot-Marie-Tooth disease and Friedreich’s Ataxia
• Pes planus - flattened/lowered longitudinal arch
  
  • Foot pain
  • Can be born with it but also caused by tarsal coalitions, accessory navicular bone, ligament laxity in conditions like Margan’s and Ehlers-Danlos, trauma, obesity, DM, neuropathy, pregnancy, osteoporosis and overuse)