Foot and Ankle problems Flashcards
what causes ankle OA
may be idiopathic/primary or as a consequence of a previous injury
2 surgical options for ankle OA
arthrodesis and ankle replacement
pros/cons arthrodesis
perhaps more reliable than replacement
re-operation rates much lower
pros/cons ankle replacement
better functional outcome
high rates of early loosening, component sinkage and failure
should be reserved for elderly patients
what is hallux valgus
deformity of the great toe due to medial deviation of 1st metatarsal and lateral deviation of the toe itself
risk factors for hallux valgus
female
RA
other inflammatory arthropathies
neuromuscular disease
what is a bunion
inflamed bursa over the medial 1st metatarsal
what is hallux rigidus
1st metatarsophalangeal joint OA
what causes hallux rigidus
can be primary (degenerative) or secondary to osteochondral injury
treatment of hallux rigidus
wearing of a stiff-soled shoe to limit motion of a joint
removal of osteophytes
gold standard surgical treatment is arthrodesis
what is Morton’s neuroma
when plantar interdigital nerves overlying the intermetatarsal ligaments become swollen and inflamed due to repeated trauma
complaint in mortons neuroma
burning pain and tingling sensation radiating to the affected toes
what is mulders click test
squeezing forefoot reproduces symptoms or produces characteristic click on Mortons neuroma
diagnosis in mortons neuroma
USS - shows swollen nerve
management of Mortons neuroma
metatarsal pad or offloading insole
steroid/local anaesthetic injection
neuromas can be excised
most common place for metatarsal stress fracture
2nd met followed by 3rd
how long before a fracture may occur on X-ray and what will be seen
3 weeks
resorption at fracture ends or callus appears
treatment for stress fracture
prolonged rest 6-12wks in rigid soled boot
predisposing factors to tendonitis
quinolone antibiotic use, RA, other inflammatory arthropathies and gout
why should steroid injections not be administered around the Achilles tendon
risk of rupture
presentation of plantar fasciitis
pain with walking felt on instep of foot, with localised tenderness on palpation of this site
what is pes planus
flat foot
in what percentage of the population is pes planus a normal variant
20%
why does pes planus occur in some individuals
medial arch fails to develop in childhood
what are flat footed people at higher risk of
tendonitis of tibialis posterior tendon
what causes acquired flat foot
tibialis posterior stretch or rupture, RA or diabetes with Charcot foot
what does the tibialis posterior tendon do
support the medial arch of the foot
what is pes cavus
abnormally high arch of the foot
what often causes pes cavus
neuromuscular conditions
what often accompanies pes cavus
claw toes
treatment for pain from pes cavus
soft tissue release and tendon transfer or calcaneal osteotomy
severe cases may require arthrodesis
why do claw and hammer toe occur
acquired imbalance between flexor and extensor tendons
features of claw toe
hyperextension at MTPJ with hyperflexion at PIPJ and DIPJ
features of hammer toe
hyperextension at MTPJ with hyperflexion at PIPJ and hyperextension at DIPJ
surgical solutions for claw and hammer toe
tenotomy, tendon transfer, arthrodesis or toe amputation
