foot & ankle Flashcards
what is pes planus?
normal variant, associated with ligamentous laxity. It’s the loss of the medial longitudinal arch of the foot.
Jack’s test
push big toe in the air of child & a nice arch should appear
what is tibialis posterior dysfunction the most common cause of?
acquired flatfoot deformity in adult
what is the tibialis posterior the primary dynamic stabiliser of?
medial longitudinal arch - elevates arch
also an invertor & plantar-flexor
what is tibialis posterior due to?
tendinosis of unknown aetiology
what is seen clinically in tibias posterior dysnfunction?
Pain and/or swelling posterior to medial malleolus – very specific Change in foot shape Diminished walking ability/balance Dislike of uneven surfaces More noticeable hallux valgus Lateral wall “impingement” pain
how do you treat tibialis posterior dysfunction?
Physiotherapy Insole to support medial longitudinal arch NO steroid injections Orthoses to accommodate foot shape Bespoke footwear Surgery
what is pes cavus?
human foot type in which the sole of the foot is distinctly hollow when bearing weight, often with clawing of toes
what kind of pain is seen in plant fasciitis?
start up pain after rest, can be worse after exercise
what’s seen on the plantar medial aspect of the heel?
fullness/swelling
what test is positive in plantar fasciitis?
Tinel’s test positive for Baxter’s nerve
tinel’s test
a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or “pins and needles” in the distribution of the nerve
how would you treat plantar fasciitis?
NSAIDS
Night splints
Taping
Heel cups or medial arch supports
Physiotherapy – eccentric exercise programme
Steroid injection
Surgery – 50% success, better if acute onset
what is hallux valgus
often referred to as a “bunion” is a deformity of the big toe
what problems can occur with hallux valgus
Transfer metatarsalgia
Lesser toe impingement
Pain, deformity, cosmesis
Shoe difficulties
how is hallux values managed?
operative - osetotomies
non-operative - shoe modifications
what is hallux rigidus?
OA of 1st MTPJ
wha is the operative management of hallux rigidus?
joint replacement
fusion
what is a morton’s neuroma?
Degenerative fibrosis of digital nerve near it’s bifurcation
what would a patient feel in morton’s neuroma?
Get forefoot pain (metatarsalgia)
Burning and tingling in toes
when do people usually get morton’s neuroma?
45-50
what is tendo-achilles tendinosis?
Repetitive microtrauma, failure of collagen repair with loss of fibre alignment/structure, hypovascular region 2-6cm proximal to insertion
how is tendo-achilles tendinosis managed?
Activity modifications/analgesia NSAIDS Shockwave therapy Orthotics Physio Surgery
what kind of mechanism would cause tendo-achilles rupture?
sudden deceleration with resisted calf contraction
what would be seen clinically in tendso-achilles rupture
Unable to bear weight
Weak plantar flexion
Palpable painful gap
Positive calf squeeze (Simmonds) test
