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Orthopaedics > Foot & Ankle > Flashcards

Foot & Ankle Flashcards

1
Q

Causes of ankle OA

A

idiopathic

consequence of previous injury

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2
Q

What movement of the ankle may result in anterior ankle damage and osteophyte formation

A

Repeated ankle dorsiflexion

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3
Q

Tx of anterior ankle osteophytes

A

Cheilectomy - removal of the anterior osteophytes

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4
Q

Surgical options for advanced OA

A

Arthrodesis

Ankle replacement

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5
Q

Advantage of ankle replacements over arthrodesis

A

Better functional outcome due to some preservation of motion

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6
Q

Disadvantage of ankle replacements compared to arthrodesis

A

Ankle replacements put high stress and shearing force across the small ankle bones, resulting in difficulties in fixation and early loosening.

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7
Q

What patient group should ankle replacements be reserved for and why

A

Elderly - once failure occurs the ankle will require fusion which produces a shortened limb

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8
Q

Advantage of arthrodesis over ankle replacement

A

re-operation rates are much lower

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9
Q

What is Hallux Valgus

A

medial deviation of the 1st metatarsal and lateral deviation of the toe itself

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10
Q

In what conditions is Hallux Valgus more common?

A

Inflammatory arthropathies

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11
Q

Presentation of hallux valgus

A

rubbing of foot on shoes - bursitis over the 1st metatarsal head (bunion)

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12
Q

What is transfer metatarsalgia

A

Seen in hallux valgus -
normally all the power goes through the large toe.
The function of the great toe is lost, so the power now goes through the other toes

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13
Q

Tx of hallux valgus

A

Non-operative:
Shoe accommodations
Spacer in 1st web space to stop rubbing

Operative:
Osteotomies to realign the bones
Soft tissue procedures to correct laxity or tightness of tissues

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14
Q

What is Hallux rigidus

A

OA of the first MTPj

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15
Q

Tx hallux rigidus

A

Arthrodesis

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16
Q

What do plantar interdigital nerves arise from

A

medial and lateral plantar nerves (which have arisen from tibial nerve)

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17
Q

What is Morton’s neuroma

A

irritated interdigital nerves that have become inflamed and swollen due to repeated trauma, and have formed a neuroma

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18
Q

Presentation of morton’s neuroma

A

burning pain and tingling radiating into the affected toes

forefoot pain (metatarsalgia)

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19
Q

What foot interspace nerve is most commonly affected in Morton’s neuroma

A

3rd interspace nerve

then 2nd

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20
Q

Ix for Morton’s Neuroma

A

Mulder’s click test - squeezing the forefoot reproduces symptoms or produces a characteristic click

USS - demonstrates swollen nerve

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21
Q

Tx Morton’s neuroma

A

Non-op:
insoles
Steroid and analgesia injections

Op:
Excision of neuroma

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22
Q

Most common MTP for stress #

A

2nd metatarsal

23
Q

Tx metatarsal stress #

A

rest and 6-12 weeks in rigid soled boot

24
Q

Causes of Achilles Tendonitis

A

Repetitive strain (From sports)
Quinolone Abx
Inflammatory arthropathies

25
Q

Tx of Achilles Tendinitis

A

Rest
Physio
Heel raise in shoe to offload tendon
Splint/boot use

26
Q

Why should steroids not be used for Tx of achilles tendonitis

A

Risk of rupturing the tendon

27
Q

Causes of Achilles Tendon rupture

A

degenerative changes within in the tendon

recent tendonitis

28
Q

Test for confirming Achilles Tendon rupture

A

Simmonds test

no plantar flexion of the foot seen when squeezing the calf

29
Q

Presentation of Achilles Tendon rupture

A

unable to weight bear
sudden pain
palpable gap in the tendon

30
Q

Tx of Achilles Tendon rupture

A

Non-op:
series of casts in the equinous position - the ankle plantarflexed with toes pointing down, as this closes the gap in the torn tendon

Operative:
suture repair of tendon, fixed with casts for 8 weeks

31
Q

Origin of the plantar aponeurosis

A

distal plantar aspect of the calcaneal tuberosity

32
Q

What is plantar fasciitis

A

inflammation of the thick supporting arch tissue on the sole of the foot

33
Q

Causes of plantar fasciitis

A

diabetes
obesity
poor cushioning in shoes
repetitive stress (sports)

34
Q

Presentation of plantar fasciitis

A

start up pain after rest

localised tenderness on palpation of origin of plantar aponeurosis

35
Q

Tx of plantar fasciitis

A

rest
NSAIDs
stretching exercises
gel filled heel pad

36
Q

how long can symptoms of plantar fasciitis take to resolve

A

up to 2 years

37
Q

what is pes planus

A

adult flat foot - medial arch does not develop

38
Q

causes of pes planus

A

developmental - ligament laxity

acquired - tibialis posterior tendon stretch or rupture, RA, diabetes with Charcot foot

39
Q

insertion of the tibialis posterior tendon

A

medial navicular

40
Q

function of the tibialis posterior tendon

A

support the medial arch of the foot
plantarflexes the foot
inverts the foot

41
Q

stress of the tibialis posterior tendon leads too..?

A

tendonitis, elongation and eventual rupture

42
Q

Tx of tibialis posterior tendonitis?

A

splint of medial arch - aim is to avoid rupture

if this fails - surgical decompression + tenosynovectomy

43
Q

Symptoms of tibialis posterior tendon elongation

A

Loss of medial arch

valgus of the heel (“too many toes” showing on lateral border when looking from behind)

flattening of the medial arch of the foot

44
Q

Potential consequence of tibialis posterior tendon elongation (with regards to the foot)

A

degenerative OA of the hindfoot and midfoot

45
Q

Tx of tibialis posterior tendon elongation

a) without OA present
b) with OA present

A

a) tendon transfer

b) arthrodesis

46
Q

Most common group to have tibialis posterior tendon dysfunction

A

Obese middle aged females
hypertensives
diabetes

47
Q

What is pes cavus

A

Abnormally high arch of the foot

48
Q

Causes of pes cavus

A

Idiopathic

Neuromuscular conditions - 
hereditary sensory and motor neuropathy 
cerebral palsy 
polio 
spina bifida occulta
49
Q

What other foot abnormality commonly accompanies pes cavus

A

claw toes

50
Q

Tx of pes cavus

A

If supple -
Soft tissue releases
tendon transfer

If rigid -
Calcaneal osteotomy

If severe -
arthrodesis

51
Q

Cause of claw toes and hammer toes

A

acquired imbalance between the flexor and extensor tendons

52
Q

what are claw toes

A

hyperextension at the MTPj with hyperflexion at the PIPj and DIPj

53
Q

what are hammer toes

A

hyperextension at the MTPj with hyperflexion at the PIPj and hyperextension at the DIPj

54
Q

Tx of claw and hammer toes

A

Non-operative:
toe sleeves
corn plasters

Operative:
Tenotomy (division of overactive tendon) 
Tendon transfer 
Arthrodesis 
?toe amputation

Orthopaedics (16 decks)

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