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MSK > Foot and Ankle Problems > Flashcards

Foot and Ankle Problems Flashcards

1
Q

Non-operative management of foot and ankle problems

A 
Analgesia
Shoe wear modification 
Activity modification 
weight loss
physio 
orthotics including insoles and bracing
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2
Q

Only indication for operative management in foot and ankle problems

A

Failure of non-operative management

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3
Q

Definition of achilles tendonitis/tedinosis

A

Degeneration/overuse condition of the achilles tendon with little inflammation

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4
Q

Definition of paratendinopathy

A

True inflammatory problem showing paratendoitis histologically

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5
Q

What is tendinopathy?

A

A term used to describe symptoms

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6
Q

Who gets paratendinopathy in achilles tendonitis?

A

Athletic populations
30-40 y/os
M > F

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7
Q

Who gets tendinopathy in achilles tendonitis?

A 
Non-athletic populations
> 40 y/os
Obesity
Steriods
Diabetes
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8
Q

Symptoms of achilles tendonitis

A 
Pain during exercise
Pain following exercise
Recurrent episodes
Difficulty fitting shoes (insertional)
RUPTURE
tenderness
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9
Q

Investigations for achilles tendonitis

A 
tenderness
Simmonds test 
angle of dangle and matles 
USS
MRI
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10
Q

Tests for rupture of achilles tendon

A

Simmonds test

Angle of dangle and matles

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11
Q

how does Simmonds test work?

A

Feet hanging off the bed lying face down
calf is squeexed
IF MOVES FOOT - then tendon not fully ruptured between the soleus mucle and heel bone
IF DOESNT MOVE FOOT - then full rupture of the tendon

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12
Q

Treatment of achilles tendonitis

A 
activity modification 
weight loss
shoe wear modification - > slight heel 
Extracorpeal shockwave treatment
Physio-eccentric stretching 
Immbolilisation (below knee cast)
operative
- gastrocnemius resection 
- release and debridement of tendon
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13
Q

Definition of plantar fasciitis

A

inflammation of the plantar fascia that runs along the bottom of the foot and connects the heel bone to the toes

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14
Q

Pathology of plantar fasciitis

A 
Chronic degenerative change
fibroblast hypertrophy 
absence of inflammatory cells
disorganised and dysfunctional vessels and collagen 
avascularity
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15
Q

Who is plantar fasciitis seen in?

A

Athletes with high intensity or rapid increase in training
Running in poorly padded shoes or on hard surfaces
Obesity
occupations with prolonged standing
foot/lower limb rotational deformities
tight gastro-soleus complex

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16
Q

Symptoms of plantar fasciitis

A

Pain first thing in the morning
Pain on weight bearing after rest - post static dyskinesia
Pain located at origin of plantar fascia
Frequently long lasting > 2 + years

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17
Q

Differential diagnosis of plantar fasciitis

A

nerve entrapement syndrome
arthritis
calcaneal pathology

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18
Q

Investigations of plantar fasciitis

A

Mainly clinical
Xrays
USS
MRI

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19
Q

Treatment of plantar fasciitis

A 
Rest, change training 
Stretching = achilles +/- direct stretching
Ice
NSAIDs
Arthoses - heel pads
physio 
weight loss
injections - corticosteriods
extracorpoel shockwave therapy 
nitric oxide
endoplasmic/open surgery 
platlet rich plasma 
topaz plasma coblation
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20
Q

What is hallux valgus?

A

Bunions

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21
Q

Which gender is hallux valgus most seen in?

A

Females

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22
Q

Causes of hallux valgus

A

Genetic

footwear

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23
Q

Symptoms of hallux valgus

A

deformed foot shape pressure
pressure symptoms from shoewear
pain from crossing over toes
metatarsalgia

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24
Q

What is metatarsalgia?

A

Pain and inflammation in the ball of the foot

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25
Q

Pathology of hallux valgus

A

Lateral angulation of great toe
Tendon pull realigned to centre of rotation of worsening deformity
Viscous cycle of increased pull creating increased deformity
Sesamoid bones sublex - less weight goes through the great toe
As deformity progresses, abnormality of the lesser toes occur

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26
Q

Investigations of hallux valgus

A

clinical
x-ray
- severity of deformity
- exclude associated degenerative change

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27
Q

Treatment of hallux valgus

A

shoe wear modification (wide +/- high toe box)
orthotics to offload pressure/correct deformity
activity modification
analgesia
operative
- release lateral soft tissues
- osteotomy 1st metatarsal +/- proximal phalanx

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28
Q

What is hallux rigidus?

A

Osteoarthritis of 1st MTP joint - stiff big toe

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29
Q

Causes of hallux rigidus

A

unknown
genetic
multiple microtrauma

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30
Q

Symptoms of hallux rigidus

A

mainly asymptomatic
extreme pain on dorsiflexion
limited ROM

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31
Q

Investigations of hallux rigidus

A

clinical

radiographs

32
Q

Treatment of hallux rigidus

A 
activity modification 
shoe wear with rigid sole (limited bending of toe)
analgesia
Surgery 
- cheilectomy
- arthrodesis
- arthroplasty
- 1st MTPJ fusion - GOLD STANDARD
- 1st MTPJ hemiarthropalsty
33
Q

Pathology of claw toes

A

MTP hyperextended

Distal and proximal ITP flexed

34
Q

Pathology of hammer toe

A

MTP can be extended but sometimes not

Distal ITP is straight or hyperextended

35
Q

Causes of mallet toe

A 
Imbalance between flexors/extensors
Shoe wear (long 2nd toe being pushed down in shoe)
neurological 
RA
idiopathic
36
Q

Symptoms of mallet toe

A 
Deformity
Pain from dorsum 
- from joint
- from where toe sticks up rubbing on shoe
Pain from plantar side
- metatarsalgia
37
Q

Treatment of mallet toe

A 
activity modification 
shoe wear
- flat shoes with high toe box to accommodate deformity 
orthotic insoles
operative
- flexor to extensor transfer
- fusion of interphalangeal joint
- release of metatarsophalangeal joint
- shortening of osteotomy of metatarsal
38
Q

What is mortons neuroma?

A

common digital nerve branches become individual nerves in between the metatarsal heads - interdigital neuralgia

39
Q

symptoms of Mortons neuroma

A 
Typically affects 3rd and 2nd webspaces
pain 
- neuralgic burning pain 
- pain in between metatarsal heads 
- pain on the plantar side 
Inflammation and swelling
severe numbness 
intermittent - especially if barefooted 
altered sensation in webspace
40
Q

Who does mortons neuropathy tend to affect?

A

females aged 40-60

41
Q

What is mortons neuroma frequently associated with?

A

Wearing high heeled shoes

42
Q

investigations of mortons neuroma

A

clinical
mulders click
USS - BEST CHOICE
MRI

43
Q

What is mulder’s click?

A

squeeze the metatarsal heads together and you will feel a CLICK

44
Q

Treatment of mortons neuroma

A

injections for small lesions
exicision of lesion including a section of normal nerve
- ALWAYS leads to NUMBNESS

45
Q

Mean presentation of ankle arthritis

A

46 y/o

46
Q

Causes of ankle arthritis

A

Commonly post traumatic

idiopathic

47
Q

Symptoms of ankle arthritis

A

Pain

stiffness

48
Q

Diagnosis of ankle arthritis

A

clinical
radiographs
CT scan - to exclude other adjacent joint arthritis

49
Q

treatment of ankle arthritis

A 
weight loss
activity modification 
analgesia
physio 
steroid injections
arthrodesis - GOLD STANDARD
joint replacement
50
Q

What is posterior tibial tendon dysfunction?

A

Acquired adult flat foot planovalgus

51
Q

Diagnosis of posterior tibial tendon dysfunction?

A 
Clinical = double or single heel rise
MRI = to assess tendon
52
Q

Presentation of posterior tibial dysfunction

A

flat foot planovalgus

medial or lateral pain

53
Q

In double/single heel rise, what should happen to the heels?

A

Should swing from valgus to varus as heal rises

54
Q

Treatment of posterior tibial tendon dysfunction

A

orthotics - medial arch support
reconstruction of tendon
triple fusion
- subtalar, talonavicular, calcaneouboid

55
Q

Treatment of rheumatoid forefoot

A 
shoewear
orthotics 
activity modification 
gold standard 
- MTPJ arthrodesis
- 2-5th toe excision arthroplasty
56
Q

Where do dorsal foot ganglion arise from?

A

Joint

tendon sheath

57
Q

Causes of dorsal foot ganglia

A

Idiopathic
underlying arthritis
underlying tendon pathology

58
Q

Symptoms of dorsal foot ganglia

A

condition itself doesn’t present with pain but can get pain from

  • pressure of shoewear
  • underlying problem
59
Q

Treatment of dorsal foot ganglia

A

Aspiration

operative excision

60
Q

Recurrence rate of dorsal foot ganglia

A

high - 50%

61
Q

What is plantar fibromatosis also known as?

A

Ledderhose disease and

Dupytrens of the foot

62
Q

Pathology of plantar fibromatosis

A

progressive thickening if the foots deep connective tissue (fascia)

63
Q

Presentation of plantar fibromatosis

A

Usually asymptomatic unless

  • very large
  • weight bearing area
64
Q

Treatment of plantar fibromatosis

A

Avoid pressure - shoewear/orthotics
Operative excision
radiotherapy

65
Q

Recurrence rate of plantar fibromatosis

A

very high - up to 80%

66
Q

Causes of diabetic foot ulcer

A 
diabetic neuropathy (unaware of trauma)
diabetic autonomic neuropathy 
- lack of sweating/normal sebum production leading to dry cracked skin and skin being more sensitive to minor trauma 
poor vascular supply
lack of patient education
67
Q

Treatment of diabetic foot ulcer

A 
prevention 
modify detriments to healing 
- diabetic control 
- smoking
- vascular supply
- external pressure (splints/shoe/weight bearing)
- internal pressure (deformity) 
- infection 
- nutrition 
surgery 
- improve vascular supply
- debride ulcers
- correct any deformity to offload area
- amputation
68
Q

How many diabetic patients will develop ulceration?

A

15%

69
Q

How many diabetic patients with ulcers will go onto amputation?

A

25%

70
Q

5 year mortality of diabetic patients with ulcers

A

50%

71
Q

Pathology of charcot’s neuroathropathy

A

Neurotraumatic
- lack of proprioception and protective pain sensation
Neurovascular
- abnormal autonomic nervous system results in increased vascular supply and bone resorption
Rapid bone destruction occurring in 3 stages
1. fragmentation
2. coalescence
3. remodelling

72
Q

Causes of charcot’s neuroarthropathy

A

any cause of neuropathy
diabetes
syphillius

73
Q

Presentation of charcots neuroarhropathy

A 
not painful
swelling
erythematous foot
neuropathy 
fractures/dislocations from minimal or no known trauma
74
Q

Diagnosis of charcots neuroarthropathy

A

clinical
radiographs
MRI

75
Q

Treatment of charcot’s neuroarthropathy

A

prevention
immobilisation/non weight bearing until acute fragmentation resolved
correct deformity

76
Q

What is used to look for evidence of achilles tendon rupture?

A

Simmonds triad

  1. Palpation
  2. Examining the angle of declination at rest
  3. Calf squeeze test
77
Q

What drug can have S/Es of new onset achilles tendon disorders?

A

Ciprofloxacin

MSK (25 decks)

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