Foot + Ankle Problems Flashcards
what ligament in the foot is most commonly sprained
anterior talofibular ligament
ATFL
muscle power in the ankle/foot
Tibialis Posterior Tibialis Anterior Peroneus Longus Peroneus Brevis EHL, FHL EDL, FDL
what is pes planus
flat feet
what is pen planus associated with and what is the difference between flexible and fixed flat feet
associated with ligamentous laxity
flexible flat feet form an arch when patients goes on tip-toes
what is the most common cause of acquired flat foot in adults
tibialis posterior dysfunction
Features of tibias posterior dysfunction
obese, middle age, female increases with age hypertension/diabetes steroid injection seronegative arthropathies
symptoms/signs of TPD
pain and/or swelling posterior to medial malleolus
change in foot shape
diminished walking ability
Tx of TPD
physiotherapy
insole to support medial longitudinal arch
surgery
what is not recommended in TPD Tx
NO steroid injections
what is pes cavus
high arched foot
often with clawing of toes
what causes pes cavus
most common idiopathic CP Polio Spina bifida Club foot
what is plantar fasciitis
thickening of the plantar fascia
what are signs/symptoms of PF
start-up pain after rest
worse after exercise
swelling of plantar medial aspect of heel
tenderness over plantar aspect of heel
where is pain felt in PF
heel and bottom of the foot
what test is positive of PF
Tinel’s test positive for Baxter’s nerve
lightly tap over nerve to cause pins and needles sensation
causes of PF
physical overload
seronegative arthropathy
diabetes
abnormal foot shape
Tx of plantar fasciitis
Usually self-limiting, 18-24 months
NSAIDs Night splints Taping Physio Steroid injection
what is hallux valgus
lateral deviation of the big toes and the subsequent affect it has on the forefoot
incidence of Hallux valgus
increases with age
usually bilateral
F > M
who commonly gets Hallux valgus
RA
CTDs
what are indications for hallux valgus operative Mx
failure of non-op pain lesser toe deformities overlapping ulceration
what is the aim of surgery of HV
aim to realign the hallux
decrease the HV angle
correct any lesser toes deformities at the same time
what is hallux rigidus
OA of 1st MTPJ
Mx of HR
Non-op
Op
- joint replacement
- fusion (arthrodesis)
what are features of the Rheumatoid foot
subluxed MTPJs
Hallux valgus
Clawed toes
Painful plantar calluses
problems in the hindfoot in RA
Unstable subtalar joint, calcaneus drifts into valgus
Medial arch collapses, flat feet
what is Morton’s neuroma
Degenerative fibrosis of digital nerve near it’s bifurcation
what signs and symptoms of Morton’s neuroma
get forefoot pain (metatarsalgia)
burning and tingling in toes
what Ix is first line for Morton’s neuroma
USS
Mx of Morton’s neuroma
Non-op - insoles, injections
Op - excise nerve but gives them numbness between toes
what causes pain, morning stiffness in (most commonly) men feet/ankles and eases with heat/walking
Tendo-Achilles Tendinosis
what is Tendo-Achilles Tendinosis
Repetitive microtrauma, failure of collagen repair with loss of fibre alignment/structure
what can cause Tendo-Achilles Tendinosis
over training
steroids
ciprofloxacin
CTDs
Ix for Tendo-Achilles Tendinosis
Clinical
USS
Mx for Tendo-Achilles Tendinosis
Analgesia NSAIDs Shockwave therapy Physio Surgery
what is features of Tendo-Achilles rupture
Usually over 40s
Often pre-existing tendinosis
very painful - patient thinks they’ve been hit
clinical appearance of tendo-achilles rupture
unable to bear weight weak plantar flexion cannot stand on toes palpable painful gap sudden deceleration with resisted calf contraction
what test will be positive in tendon-achilles rupture
Simmonds test
i.e. positive calf squeeze
what causes claw/hammer/mallet toes
acquired imbalance between flexors and extensors
what can claw/hammer/mallet toes cause
painful callus/corns with skin breakdown
surgical options of claw/hammer/mallet toes
tenotomies (division of tendons), tendon transfer, fusions (PIP) or amputation
MOI of ankle sprains
Twisting forces (commonly inversion or twisting forces on a planted foot)
ankle sprains heal quicker than ankle fractures - true or false
false
fractures heal quicker
Mx of ankle sprains
Non-op
- RICE
- Physio
Op
- Brostrum Gould
- Chrisman Snook
what classification is used Ankle Fracture
Weber Classification
Weber A/B/C
what type of fracture in the foot are very common
5th metatarsal fractures
inversion injury
what are the 3 MOI of 5th metatarsal fracture
- Avulsion by peroneus brevis tendon (heal predictably in moonboot, do well)
- Jones fracture, poor blood supply, 25% risk non-union
- Proximal shaft (common site for stress fracture)
what is Jones fracture
fracture in the meta-diaphyseal junction of the fifth metatarsal of the foot
what is Lisfranc fracture
injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus
MOI of calcaneus fracture
Fall from height, look for other injuries esp spinal, often intra-articular, significant swelling, risk compartment syndrome
MOI of Talus fracture
Forced dorsiflexion/rapid deceleration
what are possible complications of a Talus fracture
Talus has reverse blood supply
risk of AVN and OA
