Foot and Ankle Elective Flashcards
Examples of foot and ankle elective
-Ankle sprains
-Hallux valgus
-Hallux rigidus
Describe hallux valgus
-Complex collection of deformities of the fore- and mid- foot (bunions)
-Diabetic foot complication, OA or RA, family history
-Results in:
=Deformity (deformity caused by the base joint of the big toe developing sideways. This pushes the bones of the big toe towards the smaller toes.)
=Difficulty with footwear (poorly fitting)
=Pain over bony prominences (with swelling)
-Altered biomechanics -> pain
Investigation and management of hallux valgus
-First line: shoe modification and pads
-If conservative measures fail -> surgery:
=Several different procedures depending on the deformities that are present and their magnitude
=The most common are:
==Scarf osteotomy (1st metatarsal)
==Akin osteotomy (proximal phalanx)
==Modified McBride release (lateral release and medial imbrication)
Achilles tendinopathy overview
-Features
=gradual onset of posterior heel pain that is worse following activity, pain in calf when standing on tiptoes
=morning pain and stiffness are common
=pain in a tendon that gets worse when you move
=difficulty moving the joint
=feeling a grating or crackling sensation when you move the tendon
=swelling, sometimes with heat or redness
-The management is typically supportive
=simple analgesia
=reduction in precipitating activities
=calf muscle eccentric exercises: this may be self-directed or under the guidance of physiotherapy
=PT
-Some people with severe tendonitis may be offered:
=steroid injections, which may provide short-term pain relief
=-surgery to remove damaged tissue or repair a ruptured tendon
-Tendonitis is usually caused by sudden, sharp movements or repetitive exercise, such as running, jumping or throwing.
-It can also be caused by repetitive movements, or having poor posture or technique while at work or when playing a sport. This is known as repetitive strain injury (RSI).
-You cannot always prevent tendonitis. But there are things you can do to help reduce the chance of a tendon injury.
=Warm up, gentle stretch
=Supportive shoes or insoles
=Regular breaks from repetitive exercise
Risk factors for Achilles tendon disorders
-quinolone use (e.g. ciprofloxacin) is associated with tendon disorders
-hypercholesterolaemia (predisposes to tendon xanthomata)
Overview of hallux rigidus
-Hallux rigidus, is arthritis (pain and stiffening) of the main joint of the big toe in the ball of the foot. It is due to a wearing out of the joint surfaces. Sometimes only the upper part of the joint is affected and the rest of the joint is undamaged. In other people the whole joint is worn out.
-Risk: stress when walking, previous injury, gout
-Pain, stiffness, bony prominence (osteophyte, dorsal bunion)
-Appropriate footwear/ orthoses/ painkillers/ weight loss/ steroid injection/ surgery
Causes of ankle pain
-Sprained ankle
=Pain, swelling, bruising, started after intense or repetitive exercise
-Achilles tendonitis
=Pain in ankle and heel, pain in calf when standing on tiptoes
-Bursitis
=Redness and swelling, dull aching pain
-Broken ankle
=Sudden sharp pain, swelling, popping or snapping sound during injury, difficulty walking, ankle at odd angle
Causes of heel pain
-Plantar fasciitis
=Sharp pain between arch and heel, feels worse when you start walking and better when resting, difficulty raising toes off floor
=Pain worse around medial calcaneal tuberosity
-Achilles tendonitis
=Back of heel, ankle, calf
-Bursitis
=Redness and swelling, dull aching pain in heel
-Heel fracture or ruptured Achilles tendon
=Sudden sharp pain in heel, swelling, popping or snapping sound during injury, difficulty walking
Causes of toe pain
-Ingrown toe nail
=Pain or swelling around nail, nails curl into toe
-Bunion
=Hard bony lump near big toe
-Raynaud’s or chilblains
=Pain, tingling, numbness when you’re cold or stressed, toes can change colour
-Broken toe
=Pain, swelling, red, bruised toe, hurts to walk
-Gout
=Sudden pain, stiffness, red or hot swollen skin around toe joint
Causes of pain in top of foot
-Sprain or strain
=Pain, swelling, bruising, started after intense or repetitive exercise
-Tendonitis or OA
=Pain, swelling, stiffness that lasts a long time, grating or crackling sensation when moving, a lump along tendon
-Gout
=Rot, hot, swollen skin, sudden or severe pain when anything touches foot, pain usually starts near bottom of big toe
Causes of pain in bottom of foot
-Sprain
-Morton’s neuroma
=Sharp, burning or shooting pain near toes (ball of foot), feels like lump of small stone under foot
-Plantar fasciitis
=Sharp pain between arch and heel, feels worse when start walking and better resting difficulty raising toes off floor
-Flat feet (fallen arch)
=No gap (arch) under foot when stand up, foot presses flat on floor
Causes of pain in ball of foot
-Sprain
-Morton’s neuroma
-Bursitis
-Bunions
Conservative methods for management of foot pain
-Rest and raise your (foot) when you can
-Put an ice pack (or bag of frozen peas) wrapped in a towel on your (foot) for up to 20 minutes every 2 to 3 hours
-Wear wide comfortable shoes with a low heel and soft sole
-Use soft insoles or heel pads in your shoes
-Wrap a bandage around your (foot) to support it
-Try regular gentle stretching exercises
-Use painkillers such as paracetamol or ibuprofen gel (or ibuprofen tablets if needed)
-buddy strap a broken toe – put a small piece of cotton wool or gauze between your sore toe and the next toe, and use tape to loosely strap it up (do not do this for a big toe or a badly broken toe)
-Do not walk or stand for long periods, especially barefoot
-Do not wear high heels or tight pointy shoes
When to see a GP for foot pain
-Ankle pain is stopping you doing normal activities
-The pain is getting worse or keeps coming back
-The pain has not improved after treating it at home for 2 weeks
-You have any tingling or loss of sensation in your foot
-You have diabetes and foot pain – foot problems can be more serious if you have diabetes
When to go to A&E with foot pain
you have severe pain in the bottom of your foot
you’re not able to walk
your foot has changed shape or is at an odd angle
you heard a snap, grinding or popping noise at the time of injury
you feel faint, dizzy or sick from the pain
