Foot + Ankle Problems

Question 1

what is a cheilectomy

Answer 1

removal of anterior osteophytes causing pain on dorsiflexion of foot

Question 2

what are the two surgical options for patients with significant pain from ankle OA

Answer 2

Arthrodesis Ankle replacement

Question 3

what does ankle arthrodesis involve

Answer 3

fusion of affected joints

Question 4

what is hallux valgus

Answer 4

medial deviation of 1st metatarsal

lateral deviation of the toe

Question 5

who gets Hallux Valgus

Answer 5

more common in females and with increasing age

RA patients

Neuromusclar disease e.g. MS, cerebral palsy

Question 6

what is the name given to an inflamed bursa over the 1st metatarsal head in hallux valgus

Answer 6

a bunion

Question 7

treatment options for hallux valgus

Answer 7

wider more accomodating footwear

use of spacer in 1st web space – prevents ulceration

osteotomies to realign bones

Question 8

what is hallux rigidis

Answer 8

OA of 1st MTP joint

Question 9

gold standard treatment of hallux rigidis

Answer 9

arthrodesis

• fusion of joint

Question 10

conservative management of hallux rigidis

Answer 10

wearing stiff soled shoes to limit movement at MTP joint

cheilectomy

Question 11

pathophysiology of Mortons Neuroma

Answer 11

repeated trauma to plantar interdigital nerves – nerves become irritated – inflammation + swelling – neuroma formation

Question 12

symptoms of mortons neuroma

Answer 12

burning pain + tingling radiating to affected toes

Question 13

where in the foot does Mortons neuroma most commonly occur

Answer 13

3rd web space

Question 14

which gender is more commonly affected by Mortons neuroma? why?

Answer 14

Females. wearing of high heels has been implicated

Question 15

what is a positive Mulders click test?

what condition does it indicate?

Answer 15

squeezing the forefoot causes a “click” / symptoms of burning + tinging into affected toe

• Mortons Neuroma

Question 16

what imaging can be used to diagnose a neuroma

Answer 16

Ultrasound

Question 17

management of Mortons neuroma

Answer 17

use of metatarsal pad/ offloading insole

steroid/ local anaesthetic injections may relieve symptoms

neuromas can be excised, however, pain may continue

Question 18

where do metatarsal stress fractures most commonly occur

Answer 18

2nd metatarsal

• occur in runners, soilders, dancers

Question 19

what imaging is useful in metatarsal stress fractures

Answer 19

bone scan

• Xray may not show fracture until up to 3 weeks after when callus formation begins

Question 20

management of metatarsal stress fractures

Answer 20

rest in a rigid soled boot for 6-12 weeks

Question 21

treatment of achilles tendonitis

Answer 21

rest

physio

heel raise to offload the tendon

splint/boot

Question 22

achilles tendon rupture occurs in which age group

Answer 22

middle aged- older patients

• usually due to degenerative changes within the tendon

Question 23

which type of action may result in an achilles tendon rupture

Answer 23

sudden deceleration with resisted calf muscle

• e.g. lunging in squash

Question 24

presentation of achilles tendon rupture

Answer 24

sudden pain, difficulty weightbearing

weakness of plantar flexion

palpable tendon gap

+ve simmonds test

Question 25

what is a positive Simmonds test

Answer 25

no plantarflexion of foot is seen when calf is squeezed

• indicates achilles tendon rupture

Question 26

management options for ruptured achilles tendon

Answer 26

surgical repair

series of casts over 8 weeks in equinos position: ankle plantarflexed with toes pointing down

Question 28

what is plantar fasciitis

Answer 28

inflammation of the plantar fascia due to repetitive stress / degeneration

Question 29

symptoms of plantar fasciitis

Answer 29

instep pain when walking with localised tenderness on palpation of this site

Question 30

treatment of plantar fasciitis

Answer 30

rest, stretching exercises, gel filled heel pad, steroid injections

Question 31

what is pes planus

Answer 31

flat feet

Question 32

people with pes planus may be at a higher risk of what?

Answer 32

tibialis posterior tendonitis

Question 33

where does the tibialis posterior tendon insert? what is its function?

Answer 33

onto the medial navicular - supports medial arch of the foot

Question 34

how should tibialis posterior tendonitis be managed

Answer 34

splint with medial arch support to avoid rupture

Question 35

what is an abnormally high arch of the foot called

Answer 35

Pes cavus

Question 36

treatment options if pes cavus is causing pain

Answer 36

soft tissue releases

tendon transfer (of tibialis anterior)

calcaneal osteotomy

arthrodesis if very severe

Question 37

what toe deformity is often present in pes cavus

Answer 37

claw toes

Question 38

difference between claw toes and hammer toes

Answer 38

claw = hyperextension at MTP, hyperflexion at PIP + DIP

hammer = hyperextension at MTP, hyperflexion at PIP, hyperextension at DIP