Foot & Ankle

Question 1

Can tibialis posterior dysfunction be treated with steroids injections?

Answer 1

No

Question 2

What’s the commonest cause of acquired pes planus?

Answer 2

Tibialis posterior dysfunction

Question 3

What are the risk factors for tibialis posterior dysfunction? (4)

Answer 3

1) Flat feet 2) Hypertension 3) Diabetes 4) Steroid injections

Question 4

What’s the sign specific to tibialis posterior dysfunction?

Answer 4

Swelling posterior to the medial malleoulus

Question 5

Tinel’s test looks for what condition?

Answer 5

Plantar fasciitis

Question 6

Outline the treatment options for plantar fasciitis (3)

Answer 6

1) NSAIDs 2) Night splintage 3) Steroid injection

Question 7

Which nerve is implicated in plantar fasciitis?

Answer 7

Baxter’s nerve

Question 8

Hallux valgus is AKA

Answer 8

Bunion

Question 9

Hallux rigidis is specifically OA of which joint?

Answer 9

1st MTP

Question 10

Morton’s neuroma is a degenerative fibrosis of which nerve and where?

Answer 10

Digital nerve near its bifurcation

Question 11

What’s the end-stage treatment for Morton’s neuroma?

Answer 11

Surgical excision of the digital nerve

Question 12

Tendo-Achillies tendinosis can be caused by drugs such as (2)

Answer 12

1) Steroids 2) Ciprofloxacin

Question 13

Tendo-Achilles tendinosis can be treated with steroid injection, true or false?

Answer 13

False

Question 14

A positive Simmonds’ test indicates what?

Answer 14

Tendo-Achilles rupture

Question 15

Detail each toe deformity

Answer 15

A = Claw

B = Mallet

C = Hammer

D = Curly

Question 17

Stable ankle fractures are classed as those which…. How are they treated?

Answer 17

Stable = without medial malleolus fracture or deltoid ligament involvement. Treated with casting

Question 18

A Lisfranc fracture occurs where?

Answer 18

Tarsometatarsal

Question 19

Should Lisfranc fractures be fixed?

Answer 19

Yes, there is a risk of OA if not

Question 21

What constitutes the forefoot?

Answer 21

Metatarsals + phalanges

Question 22

What constitutes the midfoot?

Answer 22

Cuboid + navicular + cuneforms

Question 23

What constitutes the hindoot?

Answer 23

Talus + calcaneus

Question 24

Is pes planus always pathologic?

Answer 24

No, 20% of population has it and it has a familial / ligamentous laxity link

Question 25

Tibialis posterior tendon passes immediately posterior/anterior to the medial/lateral malleolus?

Answer 25

Posterior to medial malleolus (c.f. fibularis longus and brevis which are posterior to lateral malleolus)

Question 26

Where does tibialis posterior insert?

Answer 26

Navicular tuberosity

Question 27

How is tibialis posterior dysfunction managed? (3)

Answer 27

1) Physiotherapy
2) Orthoses to accomodate
3) Screws

NO steroid injections

Question 28

What is pes cavus

Answer 28

Clawing of toes

Question 29

How is hallux valgus treated?

Answer 29

Shoe modifications.

If pain severe or lifestyle limitations: multiple osteotomies & breaking and re-aligning the metatarsal.

Question 30

Rheumatoid foot affects what % of RA patients? When does this present?

Answer 30

90%

Presents early in the process

Question 31

Rheumatoid foot tends to affect which foot bones/ region?

Answer 31

Region = Hindfoot

Bones = talus, calcaneus. Causes a medial arch collapse.

Question 32

How is Morton’s Neuroma managed (non-surgical)?

Answer 32

Insoles/ steroid injections

Question 33

What is an unstable ankle fracture? How is it treated?

Answer 33

Distal fibula fracture WITH medial malleolus fracture or deltoid ligament rupture.

Treated with surgical fixation & plates

Question 34

Which bone is the commonest site of fracture?

Answer 34

5th metatarsal (inversion injury)

Question 35

What must you look for in calcaneus fractures?

Answer 35

Other injuries (e.g. spinal, swelling, compartment syndrome) as the injury is often high-energy. Treatment is controversial (surgery not proven beneficial).