Foot/Ankle problems Flashcards
What is Pes Planus? What causes it?
flat floot
failure of the medial arch development in childhood - normally aged 7
What can Pes Planus be due to when it is acquired and not congenital?
due to tibialis posterior tendon stretch or rupture, rheumatoid arthritis or charcot foot
What is the biggest risk factor for Pes Planus?
increased ligamentous laxity
What does the tibialis posterior tendon do?
support the medial arch of the foot
When does tibialis posterior tendon dysfunction occur?
when the tendon is under repeated stress, degeneration can develop tendonitis and it can rupture
What is tibialis posterior tendonitis treated with?
a splint
What are the risk factors for tibialis posterior tendonitis?
older women obese diabetes hypertension rheumatoid arthritis steroid injections into tendon
What is the common presentation of tibialis posterior tendon dysfunction?
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
What are the types 1-4 of tibialis posterior tendon dysfunction?
1 - swelling, tenderness, slightly reduced muscle power
2 - planovalgus, midfoot abduction
3 & 4 - fixity and mortise signs
What is the treatment for tibialis posterior tendon dysfunction?
physiotherapy - special footwear
insoles
surgery
What is Pes Cavus?
high arched foot
When is Pes Cavus pathological?
if only one foot is involved
What are the pathological causes of Pes Cavus?
hereditary sensory and motor neuropathy
cerebral palsy
spina bifida
What is the presentation of Pes Cavus?
clawing of toes
high arch
What is the treatment of Pes Cavus?
soft tissue release
tendon transfer
calcaenal osteotomy
arthrodesis
What is plantar fascitis?
pain when walking is felt on the instep of the foot with localised tenderness
What are the causes of plantar fascitis?
diabetes
obesity
frequent walking on hard floors
What is the test to test for plantar fascitis?
Baxters nerve
What is the treatment for plantar fascitis?
usually heals over 18-24 months rest achillis and plantar fascia stretching NSAID injections electrocarpal shocks
What are hallux valgus?
“bunions” - inflammed base over the medial 1st metatarsal head
What is the cause of hallux valgus?
some are hereditary
some due to increased laxity - females>males
What are the problems that occur with hallux valgus?
lesser toe impingement transfer metatarsalgia pain deformity shoe problems
What is the management of hallux valgus?
non surgical shoe modifications - padding
surgical - osteotomies to realign bone and to tighten slack tissue and release tight tissue
What is hallux rigidus?
osteoarthritis of the 1st metatarsalphalangeal (MTP) joint
What can cause hallux rigidus?
could be degenerative or
secondary to oesteochondral injury
What is the treatment for hallux rigidus?
gold: arthodesis (fusion)
stiff soled shoes and removal of osteophytes
What is mortons neuroma?
irritated plantar interdigital nerves can become inflamed and swollen forming a neuroma
What is the presentation of a mortons neuroma?
burning pain and tingling radiating to affected toes
What is the main risk of mortons neuroma?
women > men due to high heel wearing
How is mortons neuroma diagnosed?
ultrasound - shows a swollen nerve
Mulders click test
What is the treatment of mortons neuroma?
conservative - metatarsal pad/offloading insole
steroid/anaesthetic injections
excise the neuroma
What metatarsals are more prone to stress fractures?
2nd then 3rd
Who do stress fractures commonly occur in?
runners
distance walkers
What are the investigations for stress fractures?
1st: bone scan
Xray show it 3 weeks later
What is the treatment for stress fractures?
rest and 6-12 weeks in a rigid sole boot
What is Achillies tendonitis due to?
repetitive strain
Quinolone antibiotics
rheumatoid arthritis
gout
What is the treatment of Achillies tendonitis?
rest
use of splint/boot
if unresponsive: tendon decompression and resection of paratendon
What may Achillies tendonitis lead to?
RUPTURE
Who is most prone to Achillies tendonitis rupture?
middle aged/older age groups - due to degenerative changes
What leads to a Achillies tendonitis rupture?
sudden deceleration with calf muscle contraction
What is the presentation of an Achillies tendonitis rupture?
pain down back of the calf
inability to weight bear
weakness of plantar flexion
palpable gap in tendon
What is the investigation for Achillies tendonitis rupture? What is the treatment?
Thompsons test
some surgeons would repair the tendon, some would not
Why do claw and hammer toes develop?
due to an imbalance between the flexor and extensor tendon
What are claw toes?
hyperextended MTP joint
hyperflexed PIP and DIP joint
What are hammer toes?
hyperextended MTP and DIP
hyperflexion at PIP
What is the treatment of claw toes and hammer toes?
tenotomy - devision of overactive tendon
tendon transfer
arthrodesis
toe amputation
