Foot and Ankle Disorders Flashcards
What is the role of tibias posterior?
Support the medial arch of the foot
What are the risk factors for tibialis posterior dysfunction?
- obesity
- age
- flat foot
- hypertension
- diabetes
- steroid injection
- seronegative arthropathies
- idiopathic tendonitis
How will tibialis posterior dysfunction present?
Pain/swelling posterior to medial malleolus
Change in foot shape
Diminished walking ability/balance
Dislike of uneven surfaces - hallux valgus
Describe the 4 types of tibialis posterior dysfunction
I - swelling, tenderness, weak muscle power
II - planovalgus mid foot abduction
III/IV - fixity and mortise signs
How is tibialis posterior dysfunction treated?
Physio No steroids Insoles Orthoses Special footwear Surgery
What causes pes cavus?
Usually idiopathic but can be secondary to HSMN, CP, polio, spina bifida, club foot
How is pes cavus treated?
Surgery may be required - soft tissue releases, tendon transfers, calcaneal osteotomy, arthrodesis
How does plantar fasciitis present?
Start up pain after rest, worse after exercise, fullness/swelling of plantar medial aspect of heel
What causes plantar fasciitis?
- physical overload
- seronegative arthropathie
- diabetes
- abnormal foot shape
How is plantar fasciitis treated?
NSAIDS, night splints, taping/support, physio, steroids, surgery
Self limiting
Define Hallux Valgus
Deformity of the great toe due to medial deviation of the 1st metatarsal and lateral deviation of the toe
How is affected by hallux valgus?
Older women with joint laxity
Rheumatoid arthrits
What is hallux rigidus?
Osteoarthritis of the 1st MTP joint
Primary
Secondary to osteochondral injury
Describe Morton’s Neuroma
Degenerative fibrosis of digital nerve near its bifurcation
How will a patient with morton’s neuroma present?
Burning and tingling in toes
Describe the examination findings in mortons neuroma
Loss of sensation
Mulder’s click - compression will reproduce symptoms
Ultrasound will show swollen nerve
How is Morton’s neuroma diagnosed?
Modify footwear
Steroids
Anaesthetic injections
Name the risks of achilles tendonitis
Ciprofloxacin
Steroids
Rhematoid arthritis
How does achilles tendonitis present?
Pain, morning stiffness eased by heat/walking
How is achilles tendonitis diagnosed?
Examination
Ultrasound
MR
How is achilles tendonitis managed?
Physio Splint/boot NSAIDs Surgery Analgesia
What is the mechanism of injury for achilles tendonitis ?
Sudden deceleration with resisted calf contraction leads to pain and difficulty weight bearing
What test can be done in achilles rupture?
Simmonds - no plantar flexion of foot when squeezing calf
What are the risk factors for achilles rupture?
Rheumatoid
Arthritis
Steroids
How is achilles rupture managed?
Surgery
Cast in equinous position
How are sprains and strains treated?
Rest
Ice
Compression
Elevation
Describe the weber system for ankle fractures
A - below syndesmosis
B - at level of syndesmosis
C - above syndesmosis
What criteria is used to assess need for ankle x-ray?
Ottowa
How is an ankle fracture treated?
Boot, cast, surgery if unstable