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Musculoskeletal > Foot & Ankle Problems > Flashcards

Foot & Ankle Problems Flashcards

1
Q

what surgical options exist for advanced ankle OA

A

arthrodesis (more reliable) ankle replacement (reserved for older patients as can get major malalignment)

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2
Q

what ligaments typically involved in ankle sprain

A

ATFL (anterior talofibular ligament) CFL (calcaneofibular ligament)

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3
Q

what symptoms of ankle sprain

A

pain, bruising and tenderness

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4
Q

how is ankle sprain severity measured

A

grade 1-3, 3 is complete tear of ligament

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5
Q

what is non-operative management of ankle sprain

A

RICE = rest, ice, compression and elevation physiotherapy = strength, stability, proprioception

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6
Q

what is operative management of ankle sprain

A

brostrum gould chrisman snook

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7
Q

what are the the different classification of ankle fractures

A

Weber classification

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8
Q

what is a stable ankle fracture

A

distal fibula fracture with no medial malleolus fracture or deltoid ligament rupture

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9
Q

what is an unstable ankle fracture

A

distal fibula fracture with medial malleolus fracture or deltoid ligament rupture

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10
Q

what is hallux valgus

A

deformity of great toe due to medial deviation of 1st metatarsal and lateral deviation of toe itself bunion

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11
Q

who is it more common in

A

females incidence increases with age commoner inflammatory arthropathies and some neuromuscular diseases (MS, cerebral palsy)

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12
Q

what are consequences of hallux valgus

A

painful due to joint incongruence inflamed bursa due to rubbing on shoes (this is the bunion) great toe and second toe may rub causing ulceration severe cases = hallux may override second toe

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13
Q

what is conservative treatment of hallux valgus

A

wearing of more accommodating shoes to prevent painful bunions and use of spacer in first web to stop rubbing between toes

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14
Q

what is surgical management of hallux valgus but why should caution be applied with this

A

osteotomies to realign bones and soft tissue procedures to tighten slack tissues and release tight tissue caution as often unhappy cosmetically and some complain of metatarsalgia (pain) after surgery

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15
Q

what is hallux rigidus

A

OA of first MTPJ

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16
Q

what are conservative treatments of hallux rigidus

A

wearing stiff soled shoe to limit motion to MTPJ, a metal bar can be inserted into sole of shoe

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17
Q

what surgery can take place in early cases of hallux rigidus where dorsal osteophytes impinge during dorsiflexion

A

removal of osteophytes (cheilectomy)

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18
Q

what is the gold standard surgical treatment of hallux rigidus

A

arthrodesis (alleviate pain with small sacrifice of no motion) SE: prevents women wearing heels 1st MTP joint replacement is in place but failure rate quite high n when it does fail salvage surgery is difficult

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19
Q

what is morton’s neuroma

A

plantar interdigital nerves (from medial and lateral plantar nerves) overlying the intermetatarsal ligaments can be subject to repeated trauma and irritated nerves can become inflamed and swollen forming a neuroma

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20
Q

who is mortons neuroma more common in

A

women 4x more common since wearing of high heels been implicated as cause

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21
Q

what nerve is most commonly involved in mortons neuroma

A

third interspace nerve followed by second

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22
Q

what are symptoms of mortons neuroma

A

burning pain and tingling radiating into affected toes

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23
Q

what may clinical examination reveal in mortons neuroma

A

loss of sensation in affected web space Mulder’s test = medio-lateral compression of the metatarsal heads (squeezing forefoot with your hand) may reproduce symptoms or produce click

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24
Q

how is morton’s neuroma

A

ultrasound = demonstrates swollen nerve

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25
Q

what is treatment of morton’s neuroma

A

conservative = metatarsal pad or offloading insole. Steroid and local anaesthetic injections may relieve symptoms and aid diagnosis A neuroma can be excited but some patients still get pain etc

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26
Q

in which metatarsal does stress fracture most commonly occur and in which conditions do they commonly occur

A

2nd, followed by 3rd occur in runners, in solders on prolonged marches, in dancers or distance walking in people not used to it

27
Q

how is metatarsal stress fracture diagnosed

A

xray may not demonstrate fracture for about 3 weeks until reabsorption at fracture end occurs or callus begins to appear, bone scan may be useful to confirm diagnosis

28
Q

how is metatarsal stress fracture treated

A

prolonged rest for 6-12 weeks in a rigid soled boot

29
Q

what causes tendonitis of achilles tendon

A

repetitive strain (from sports) which leads to a peritendonitis or due to degenerative process with intrasubstance microtears

30
Q

what are risk factors for achilles tendonitis

A

quinolone antibiotics (ciprofloxacin etc), RA, other inflammatory arthropathies and gout

31
Q

what are the symptoms of achilles tendonitis

A

pain either in achilles tendon or its insertion in calcaneus also lost outline of achilles tendon

32
Q

how is achilles tendonitis treated

A

self limiting = rest, physiotherapy, use of heel raise to offload tendon and use of splint or boot resistant causes may benefit from tendon decompression and resection of paratenon

33
Q

why should steroids NOT be administered around achilles tendon

A

risk of rupture

34
Q

who does achilles tendon rupture usually occur in

A

middle aged or older groups as it is usually due to degenerative changes within tendon or recent tendonitis

35
Q

what is symptoms of an achilles tendon rupture

A

sudden deceleration with resisted calf muscle contraction (eg lunging at squash) leads to sudden pain (like kick in back of leg) and difficult weight bearing

36
Q

what clinical signs are seen i achilles tendon rupture

A

weakness of plantar flexion and a palpable gap in tendon simmond’s test = no plantarflexion of foot is seen when squeezing calf

37
Q

some surgeons recommend surgical treatment of achilles tendon rupture, what does this entail

A

repair of damaged tendon to restore tension of tendon more accurately and reduce risk of re-rupture repair is protected by around 8 weeks in a series of casts

38
Q

other surgeons recommend non-operative management, what does this entail

A

a series of casts in equinous position (ankle plantarflexed with toes pointing down as this closes gap in torn tendon - again 8 weeks or so) this avoids potential for wound problems and good functional outcome can be expected

39
Q

what is process of tibialis posterior dysfunction

A

tenosynovitis -> progressive elongation -> rupture complication - OA of hindfoot and midfoot may occur

40
Q

what is type 1 tibialis posterior dysfunction

A

swelling, tenderness, slightly weak power

41
Q

what is type 2 tibialis posterior dysfunction

A

planovalgus, midfoot abduction, passively correctable

42
Q

what is type 3 and 4 tibialis posterior dysfunction

A

fixity and mortise signs

43
Q

what are symptoms of tibialis posterior dysfunction

A

progressive flat foot and valgus hindfoot

44
Q

how is tibialis posterior dysfunction treated

A

NSAIDS, insole / splints with a medial arch support to avoid rupture if this fails = surgical decompression and tenosynovectomy may prevent rupture NO STEROID INJECTION

45
Q

what are risk factors for tibialis posterior dysfunction

A

obese middle aged female, flat foot, hypertension, diabetes, steroid injection, seronegative arthropathies, idiopathic tendonosis

46
Q

what is plantar fasciitis

A

another self limiting repetitive stress or degenerative condition of foot

47
Q

what are risk factors for plantar fasciitis

A

diabetes, obesity and frequent walking on hard floors with poor cushioning in shoes (more frequent as older since cushioning heel fat pad atrophies with age)

48
Q

what are the symptoms of plantar fasciitis

A

pain with walking is felt on the instep of foot (at origin of plantar aponeurosis on the distal plantar aspect of calcaneal tuberosity) with localised tenderness on palpation of this site pain also felt on heel pad

49
Q

how is plantar fasciitis diagnosed

A

tinel’s test positive for baxters nerve

50
Q

how is plantar fasciitis treated

A

NSAIDs, rest, gel filled heel pad, night splint, corticosteroid injection, achilles and plantar fascia stretching exercises

51
Q

how long can plantar fasciitis take to resolve

A

2 years surgical release of plantar fascia not of any value

52
Q

what is pes planus

A

flat feet - can be a normal variation affecting up to 20% of population where medial arch does not develop in childhood

53
Q

what is risk factors of flat foot

A

familial tendency and patients with generalised ligamentous laxity are more likely to have flat feet

54
Q

are flat feet treated

A

no, dont really result in any problems

55
Q

what are complications of flat foot

A

higher risk of tendonitis of tibialis posterior tendon

56
Q

what may cause acquired flat foot

A

tibialis posterior tendon stretch or rupture, RA or diabetes with charcot foot (neuropathic joint destruction)

57
Q

what is pes cavus

A

abnormally high arch of foot

58
Q

what causes pes cavus

A

can be idiopathic but often related to neuromuscular conditions including hereditary sensory and motor neuropathy, cerebal palsy, polio (unilateral) and spinal cord tethering from spinal bifida occults

59
Q

what are symptoms of pes cavus

A

obvious high arch, claw toes often accompany pes cavus

60
Q

what is treatment of pes cavus

A

often dont need it pain from pes cavus may be treated with soft tissue releases and tendon transfer (lateral transfer of tibialis anterior) if supple, or calcaneal osteotomy if more rigid severe cases may require arthrodesis

61
Q

why do claw toes and hammer toes occur

A

imbalance between flexor and extensor tendons

62
Q

what are symptoms of claw and hammer toes

A

claw toes = hyperextension at MTPJ with hyperflexion at PIPJ and DIPJ

hammer toes = similar but have hyperextension at DIPJ

63
Q

how are claw and hammer toes treated

A

toe sleeves and corn plasters can prevent skin problems (toes rubbing on footwear causing corns and skin breakdown) surgical solution = tenotomy, tendon transfer, arthrodesis (PIPJ) or amputation

Musculoskeletal (55 decks)

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