Foot + Ankle Problems Flashcards
what is a cheilectomy
removal of anterior osteophytes causing pain on dorsiflexion of foot
what are the two surgical options for patients with significant pain from ankle OA
Arthrodesis Ankle replacement
what does ankle arthrodesis involve
fusion of affected joints
what is hallux valgus
medial deviation of 1st metatarsal
lateral deviation of the toe
who gets Hallux Valgus
more common in females and with increasing age
RA patients
Neuromusclar disease e.g. MS, cerebral palsy
what is the name given to an inflamed bursa over the 1st metatarsal head in hallux valgus
a bunion
treatment options for hallux valgus
wider more accomodating footwear
use of spacer in 1st web space – prevents ulceration
osteotomies to realign bones
what is hallux rigidis
OA of 1st MTP joint
gold standard treatment of hallux rigidis
arthrodesis
- fusion of joint
conservative management of hallux rigidis
wearing stiff soled shoes to limit movement at MTP joint
cheilectomy
pathophysiology of Mortons Neuroma
repeated trauma to plantar interdigital nerves – nerves become irritated – inflammation + swelling – neuroma formation
symptoms of mortons neuroma
burning pain + tingling radiating to affected toes
where in the foot does Mortons neuroma most commonly occur
3rd web space
which gender is more commonly affected by Mortons neuroma? why?
Females. wearing of high heels has been implicated
what is a positive Mulders click test?
what condition does it indicate?
squeezing the forefoot causes a “click” / symptoms of burning + tinging into affected toe
- Mortons Neuroma
what imaging can be used to diagnose a neuroma
Ultrasound
management of Mortons neuroma
use of metatarsal pad/ offloading insole
steroid/ local anaesthetic injections may relieve symptoms
neuromas can be excised, however, pain may continue
where do metatarsal stress fractures most commonly occur
2nd metatarsal
- occur in runners, soilders, dancers
what imaging is useful in metatarsal stress fractures
bone scan
- Xray may not show fracture until up to 3 weeks after when callus formation begins
management of metatarsal stress fractures
rest in a rigid soled boot for 6-12 weeks
treatment of achilles tendonitis
rest
physio
heel raise to offload the tendon
splint/boot
achilles tendon rupture occurs in which age group
middle aged- older patients
- usually due to degenerative changes within the tendon
which type of action may result in an achilles tendon rupture
sudden deceleration with resisted calf muscle
- e.g. lunging in squash
presentation of achilles tendon rupture
sudden pain, difficulty weightbearing
weakness of plantar flexion
palpable tendon gap
+ve simmonds test
what is a positive Simmonds test
no plantarflexion of foot is seen when calf is squeezed
- indicates achilles tendon rupture
management options for ruptured achilles tendon
surgical repair
series of casts over 8 weeks in equinos position: ankle plantarflexed with toes pointing down
what is plantar fasciitis
inflammation of the plantar fascia due to repetitive stress / degeneration
symptoms of plantar fasciitis
instep pain when walking with localised tenderness on palpation of this site
treatment of plantar fasciitis
rest, stretching exercises, gel filled heel pad, steroid injections
what is pes planus
flat feet
people with pes planus may be at a higher risk of what?
tibialis posterior tendonitis
where does the tibialis posterior tendon insert? what is its function?
onto the medial navicular - supports medial arch of the foot
how should tibialis posterior tendonitis be managed
splint with medial arch support to avoid rupture
what is an abnormally high arch of the foot called
Pes cavus
treatment options if pes cavus is causing pain
soft tissue releases
tendon transfer (of tibialis anterior)
calcaneal osteotomy
arthrodesis if very severe
what toe deformity is often present in pes cavus
claw toes
difference between claw toes and hammer toes
claw = hyperextension at MTP, hyperflexion at PIP + DIP
hammer = hyperextension at MTP, hyperflexion at PIP, hyperextension at DIP
