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Year 3 > Foot and Ankle Problems > Flashcards

Foot and Ankle Problems Flashcards

1
Q

name the common forefoot problems

A 
hallux valgus
hallux rigidus
Lesser toe deformities - claw toes, hammer toe, mallet toe 
morton's neuroma
metatarsalgia 
rheumatoid forefoot
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2
Q

what is hallux valgus also known as?

A

bunions

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3
Q

aetiology og hallux valgus

A

genetic
shoes
female

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4
Q

symptoms hallux valgus

A

pressure symptoms from shoe
pain from crossing over of toes
metatarsalgia

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5
Q

pathogenesis of hallux valgus

A

lateral angulation of great toe
tendon pull realigned to lateral of centre of rotation of toe, worsening deformity
vicious cycle of increased pull creating increased deformity
sesamoid bones sublux and less weight goes through great toe
as deformity progresses abnormalities of lesser toes occur

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6
Q

diagnosis hallux valgus

A

clinical

x-rays

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7
Q

management of hallux valgus non operative

A

shoe wear modification (wide and high toe box)
orthotics to offload pressure/correct deformity
activity modification
analgesia

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8
Q

management of hallux valgus operative

A

release lateral soft tissues

osteotomy 1st metatarsal +/- prox phalanx

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9
Q

outcome of surgical management og hallux valgus

A

good but recurrence inevitable

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10
Q

other names for hallux rigidus

A

stiff big toes
hallux limitus
hallux non-extensus

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11
Q

what causes hallux rigidus?

A

OA of 1st MTP

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12
Q

aetiology of hallux rigidus

A

unknown
possibly genetic
possibly multiple microtrauma

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13
Q

hallux rigidus symptoms

A

many asymptomatic
pain - often at extreme of dorsiflexion
limitation of range of movement

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14
Q

hallux rigidus diagnosis

A

clinical

radiographs

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15
Q

non-operative management of hallux rigidus

A

activity modification
shoe wear with rigid sole
analagesia

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16
Q

operative management of hallux rigidus

A

cheilectomy
arthrodesis
arthroplasty

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17
Q

what joints are affected in: hammer toe

A

prox IPJ

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18
Q

what joints are affected in: claw toe

A

prox and distal IPJ

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19
Q

what joints are affected in: mallet toe

A

distal IPJ

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20
Q

causes of lesser toe deformities

A 
imbalance between flexors/extensors
shoewear
neurological
RA
idiopathic
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21
Q

symptoms of lesser toe deformities

A

deformity
pain from dorsum
pain from plantar side

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22
Q

non-operative treatment of lesser toe deformities

A

activitiy modification
shoe wear - flat with high toe box
orthotic insoles - metatarsal bar/dome support

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23
Q

operative treatment of lesser toe deformities

A

flexor to extensor transfer
fusion of interphalangeal joint
release metatarsophalangeal joint
shortening osteotomy of metatarsal

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24
Q

morton’s neuroma causes

A

mechanically induce degenerative neuropathy
high heeled shoes
common digital nerve relatively teathered to one metatarsal and movement in adjacent metatarsal causing shear

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25
Q

morton’s neuroma gender and age

A

femaes 40-60

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26
Q

symptoms morton’s neuroma

A

3rd then 2nd webspace
neuralgic burning in toes
intermittent
altered sensation in webspace

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27
Q

diagnosis morton’s neuroma

A

clinical
mulder’s click
USS/MRI

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28
Q

management morton’s neuroma

A

injection for small lesions

surgery - excision of lesion inc section of normal nerve

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29
Q

what may cause metatarsalgia

A 
synovitis
bursitis
arthritis
neuralgia
neuromata
Freiberg's disease
tight gastrocnemius
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30
Q

treatment of rheumatoid forefoot non-operative

A

shoes
orthotics
activity

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31
Q

treatment of rheumatoid forefoot operative

A

1st MTPJ arthrodeisis

2nd-5th toe excision arthroplasty

32
Q

name the common midfoot problems

A

dorsal foot ganglia
midfoot arthritis
plantar fibromatosis

33
Q

from where do dorsal foot ganglia arise?

A

joint or tendon shealth

34
Q

cause of dorsal foot ganglia

A

idiopathic
underlying arthritis
underlying tendon pathology

35
Q

symptoms dorsal foot ganglia

A

pain from pressure from shoes

pain from underlying problem

36
Q

treatment of dorsal foot ganglia

A

nonoperative - aspiration, book

operative - excision

37
Q

recurrence rate of dorsal foot ganglia

A

50%

38
Q

what kind of arthritis may come in the midfoot?

A

post traumatic arthritis
OA
RA

39
Q

treatment of midfoot arthritis non operative

A

acitivty
shoes
orthotics
injection - xray guided

40
Q

treatment of midfoot arthritis operative

A

fusion

41
Q

plantar fibromatosis symptoms

A

progressive

usually asymptomatic unless very large or weight baring area

42
Q

treatment plantar fibromatosis

A 
o Non-operative
§ Avoid pressure –
shoes/orthotics
o Operative
§ Excision (up to 80% risk of
recurrence)
o Radiotherapy (similar recurrence to
operative)
o Combination radiotherapy and surgery –
low risk recurrence/high risk
complications
43
Q

name common hindfoot problems

A 
achilles tendonitis/tendinosis 
plantar fasciitis 
ankle OA
tibialis posterior dysfunction 
cavovarus foot
44
Q

what is achilles tendonitis?

A

degenerative/overuse condition with little inflammation

45
Q

what is the only way you can make a diagnosis of achilles tendinosis?

A

histopathological

46
Q

what is insertional achilles tendinopathy?

A

within 2cm of insertion

47
Q

what is non-insertional/mid-substance achilles tendinopathy?

A

2-7cm of insertion

48
Q

where may bursitis occur around the achilles?

A

retrocalcaneal

superficial calcaneal

49
Q

what is paratendinopathy achilles?

A

true inflammatory problem showing paratendonitis histologically

50
Q

who gets achilles paratendonopathy?

A

athletes
age 30-40
M:F 2:1

51
Q

who gets achilles tendinopathy?

A 
non-athletic
>40
obesity
steroids
diabetes
52
Q

symptoms of achilles tendonitis

A 
pain during exercise
pain following exercise
recurrent episodes
difficulty fitting shoes (insertional)
rupture
53
Q

diagnosis of achilles tendonitis

A

clinical - tenderness, rupture

54
Q

investigations for achilles tendonitis

A

USS

MRI

55
Q

non-operative treatment of achilles tendonitis

A 
activity modification
weight loss
shoe modification - slight heel
physio - eccentric
extra-corporeal shockwave treatment
immobilisation
56
Q

operative treatment of achilles tendonitis

A

gastrocnemius recession

release and debridement of tendon

57
Q

what is plantar fasciosis?

A

Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen, avascularity

58
Q

what causes plantar fasciosis?

A 
can't make ECM required for repair and remodelling
microtears
not know
athletes - high intensity/rapid increase
running with poorly padded shoes/hard surfaces
obesity
occupations with long standing
foot/LL rotational deformities
tight gastro-soleus complex
59
Q

symptoms plantar fasciosis

A

pain in morning
pain on weight bearing after rest
pain at origin of plantar fascia
long lasting > 2 years

60
Q

plantar fasciosis DDx

A

nerve entrapment syndrome
arthritis
calcaneal pathology

61
Q

plantar fasciosis diagnosis

A

mainly clinical

occassionally xray, USS, MRI

62
Q

plantar fasciosis treatment

A 
o Rest, change training
o Stretching – Achilles +/- direct stretching
o Ice
o NSAIDs
o Heel pads
o Physio
o Weight loss
o Injections – corticosteroid (may make worse in long term)
o Night splinting
o Newer/3rd line
§ Extracorporeal shockwave therapy
§ Topaz plasma coblation
§ Nitric oxide
§ Platelet rich plasma
§ Endoscopic surgery
63
Q

cause of ankle OA

A

commonly post traumatic

idiopathic

64
Q

mean age of presentatio with ankle OA?

A

46

65
Q

symptoms of ankle OA

A

pain

stiffness

66
Q

diagnosis of ankle OA

A

clinical
radiographs
CT - exclude adjacent joint arthritis

67
Q

non-operative management of ankle OA

A 
weight loss
activity modification
analgesia
PT
steroid injections
68
Q

operative management of ankle OA

A 
If symptoms are exclusively anterior, then arthroscopic anterior debridement
§ Arthrodesis
• Open or arthroscopic
• Gold standard
• Good long-term outcome
§ Joint replacement
• Maintain range of movement
• Questionable long-term outcome especially in high demand patients
• Not easy to revise even to fusion
69
Q

discuss tibialis posterior dysfunction

A 
• Acquired adult flat foot planovalgus
• Relatively common
• Under-recognised
• 4 stages
• Largely clinical diagnosis – double and
single heel raise
• Medial or lateral pain
• Diagnosis
o Clinical
o MRI to assess tendon
• Management
o Orthotics – medial arch support
o Reconstruction of tendon (tendon transfer)
70
Q

diabetic foot: aetiology

A

diabetic neuropathy
diabetic autonomic neuropathy
poor vascular supply
lack of patient education

71
Q

diabetic foot: treatment

A 
o Prevention
o Modify the main detriments to healing
§ Diabetic control
§ Smoking
§ Vascular supply
§ External pressure (splints/shoes/weight bearing)
§ Internal pressure (deformity)
§ Infection
§ Nutrition
o Operative
§ Improve vascular supply
§ Debride ulcers and get deep samples for microbiology
§ Correct any deformity to offload area
72
Q

diabetic foot: prognosis

A

o 15% of all diabetics will develop ulceration
o 85% of all amputations for diabetics are preceded by foot ulceration
o 25% of patients with diabetic ulcers go on to amputation
o 5-year patient mortality 50%

73
Q

charcot neuroarthropathy: aetiology

A

o Any cause of neuropathy
o Diabetes commonest cause
o Historically originally described and most common with syphilis

74
Q

charcot neuroarthropathy: pathophysiology 2 theories

A

o Neurotraumatic
§ Lack of proprioception and protective pain sensation
o Neurovascular
§ Abnormal autonomic NS results in increased vascular supply and bone resorption

75
Q

charcot neuroarthropathy: is characterised by rapid bone destruction occuring in 3 stages

A

fragmentation
coalescence
remodelling

76
Q

charcot neuroarthropathy: diagnosis

A

o High index of suspicion
o Consider in any diabetic with acutely swollen erythematous foot especially with neuropathy
o Greater than 3-degree difference between limbs
o Frequently not painful
o Radiographs
o MRI

77
Q

charcot neuroarthropathy: management

A

o Prevention
o Immobilisation/non-weight bearing until acute fragmentation resolved
o Correct deformity
§ Deformity leads to ulceration à infection à amputation

Year 3 (164 decks)

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