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1. MSK > Foot/Ankle problems > Flashcards

Foot/Ankle problems Flashcards

1
Q

What is Pes Planus? What causes it?

A

flat floot

failure of the medial arch development in childhood - normally aged 7

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2
Q

What can Pes Planus be due to when it is acquired and not congenital?

A

due to tibialis posterior tendon stretch or rupture, rheumatoid arthritis or charcot foot

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3
Q

What is the biggest risk factor for Pes Planus?

A

increased ligamentous laxity

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4
Q

What does the tibialis posterior tendon do?

A

support the medial arch of the foot

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5
Q

When does tibialis posterior tendon dysfunction occur?

A

when the tendon is under repeated stress, degeneration can develop tendonitis and it can rupture

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6
Q

What is tibialis posterior tendonitis treated with?

A

a splint

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7
Q

What are the risk factors for tibialis posterior tendonitis?

A 
older women
obese
diabetes
hypertension
rheumatoid arthritis
steroid injections into tendon
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8
Q

What is the common presentation of tibialis posterior tendon dysfunction?

A

pain/swelling posterior to the medial malleolus
change in foot shape
noticable hallux valgus
more toes on the affected side when look at foot from behind

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9
Q

What are the types 1-4 of tibialis posterior tendon dysfunction?

A

1 - swelling, tenderness, slightly reduced muscle power
2 - planovalgus, midfoot abduction
3 & 4 - fixity and mortise signs

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10
Q

What is the treatment for tibialis posterior tendon dysfunction?

A

physiotherapy - special footwear
insoles
surgery

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11
Q

What is Pes Cavus?

A

high arched foot

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12
Q

When is Pes Cavus pathological?

A

if only one foot is involved

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13
Q

What are the pathological causes of Pes Cavus?

A

hereditary sensory and motor neuropathy
cerebral palsy
spina bifida

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14
Q

What is the presentation of Pes Cavus?

A

clawing of toes

high arch

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15
Q

What is the treatment of Pes Cavus?

A

soft tissue release
tendon transfer
calcaenal osteotomy
arthrodesis

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16
Q

What is plantar fascitis?

A

pain when walking is felt on the instep of the foot with localised tenderness

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17
Q

What are the causes of plantar fascitis?

A

diabetes
obesity
frequent walking on hard floors

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18
Q

What is the test to test for plantar fascitis?

A

Baxters nerve

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19
Q

What is the treatment for plantar fascitis?

A 
usually heals over 18-24 months
rest
achillis and plantar fascia stretching
NSAID injections
electrocarpal shocks
20
Q

What are hallux valgus?

A

“bunions” - inflammed base over the medial 1st metatarsal head

21
Q

What is the cause of hallux valgus?

A

some are hereditary

some due to increased laxity - females>males

22
Q

What are the problems that occur with hallux valgus?

A 
lesser toe impingement
transfer metatarsalgia
pain
deformity
shoe problems
23
Q

What is the management of hallux valgus?

A

non surgical shoe modifications - padding

surgical - osteotomies to realign bone and to tighten slack tissue and release tight tissue

24
Q

What is hallux rigidus?

A

osteoarthritis of the 1st metatarsalphalangeal (MTP) joint

25
Q

What can cause hallux rigidus?

A

could be degenerative or

secondary to oesteochondral injury

26
Q

What is the treatment for hallux rigidus?

A

gold: arthodesis (fusion)

stiff soled shoes and removal of osteophytes

27
Q

What is mortons neuroma?

A

irritated plantar interdigital nerves can become inflamed and swollen forming a neuroma

28
Q

What is the presentation of a mortons neuroma?

A

burning pain and tingling radiating to affected toes

29
Q

What is the main risk of mortons neuroma?

A

women > men due to high heel wearing

30
Q

How is mortons neuroma diagnosed?

A

ultrasound - shows a swollen nerve

Mulders click test

31
Q

What is the treatment of mortons neuroma?

A

conservative - metatarsal pad/offloading insole
steroid/anaesthetic injections
excise the neuroma

32
Q

What metatarsals are more prone to stress fractures?

A

2nd then 3rd

33
Q

Who do stress fractures commonly occur in?

A

runners

distance walkers

34
Q

What are the investigations for stress fractures?

A

1st: bone scan

Xray show it 3 weeks later

35
Q

What is the treatment for stress fractures?

A

rest and 6-12 weeks in a rigid sole boot

36
Q

What is Achillies tendonitis due to?

A

repetitive strain
Quinolone antibiotics
rheumatoid arthritis
gout

37
Q

What is the treatment of Achillies tendonitis?

A

rest
use of splint/boot

if unresponsive: tendon decompression and resection of paratendon

38
Q

What may Achillies tendonitis lead to?

A

RUPTURE

39
Q

Who is most prone to Achillies tendonitis rupture?

A

middle aged/older age groups - due to degenerative changes

40
Q

What leads to a Achillies tendonitis rupture?

A

sudden deceleration with calf muscle contraction

41
Q

What is the presentation of an Achillies tendonitis rupture?

A

pain down back of the calf
inability to weight bear
weakness of plantar flexion
palpable gap in tendon

42
Q

What is the investigation for Achillies tendonitis rupture? What is the treatment?

A

Thompsons test

some surgeons would repair the tendon, some would not

43
Q

Why do claw and hammer toes develop?

A

due to an imbalance between the flexor and extensor tendon

44
Q

What are claw toes?

A

hyperextended MTP joint

hyperflexed PIP and DIP joint

45
Q

What are hammer toes?

A

hyperextended MTP and DIP

hyperflexion at PIP

46
Q

What is the treatment of claw toes and hammer toes?

A

tenotomy - devision of overactive tendon
tendon transfer
arthrodesis
toe amputation

1. MSK (36 decks)

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