Foot + Ankle Problems

Question 1

What is hallux valgus?

Answer 1

Deformity of the great toe due to medial deviation of 1st metatarsal + lateral deviation of toe

Question 2

Which complication can occur as a result of hallux valgus?

Answer 2

Rubbing –> inflamed bursa over medial 1st metatarsal head

= bunion

Question 3

What are the management options for hallux valgus?

Answer 3

Conservative: wider + deeper shoes, spacer in 1st web space to prevent rubbing
Surgery: osteotomies to realign bones
- not recommended purely for cosmetic reasons as many patients dissatisfied post surgery

Question 4

What is hallux rigidus?

Answer 4

Osteoarthritis of the 1st MTP joint

Question 5

What is the gold standard management for hallux rigidus?

Answer 5

Arthrodesis –> fusion of the bone

• little functional impairment as big toe doesn’t move much anyway
• can’t wear high heels

Question 6

What is Morton’s neuroma and name a risk factor for developing it?

Answer 6

Irritated plantar interdigital nerves become inflamed + swollen –> neuroma

Wearing high heels

Question 7

What are the clinical features of Morton’s neuroma?

Answer 7

Burning pain + tingling radiating to the affected toes
Loss of sensation in web space
Mulder’s click test

Question 8

What are the management options for Morton’s neuroma?

Answer 8

Conservative: pad/insole, steroid + local anaesthetic injections
Can be excised

Question 9

Which type of patient may get a metatarsal stress fracture?

Answer 9

Runners
Soldiers on marches
Dancers
Distance walking if inexperienced

Question 10

Which investigation should be done for a suspected metatarsal stress fracture?

Answer 10

Xray - but be aware it may not show for up to 3 weeks

Question 11

How is a metatarsal stress fracture managed?

Answer 11

Rest for 6-12 weeks in a rigid soled boot

Question 12

What are some possible causes of Achilles tendonitis?

Answer 12

Sports
Degeneration
RA
Ciprofloxacin
Gout
Spondylarthropathy e.g. ankylosing spondylitis

Question 13

How does Achilles tendonitis present?

Answer 13

Pain in tendon or in insertion in calcaneous

Question 14

How is Achilles tendonitis managed?

Answer 14

Rest
Physio
Heel/splint/boot

Question 15

Which treatment should NOT be given for Achilles tendonitis?

Answer 15

Steroid injection –> risk of rupture if injection given around Achilles tendon

Question 16

Why does an Achilles tendon rupture usually occur?

Answer 16

Usually due to degeneration or recent tendonitis

–> sudden deceleration + resisted calf contraction

Question 17

What are the clinical features of an Achilles tendon rupture?

Answer 17

Sudden pain + difficulty weight baring
Weakness of plantar flexion
Palpable gap in tendon

Question 18

How is an Achilles tendon rupture managed?

Answer 18

Splinted in plaster in full equinus (ankle + toes fully pointed) to allow healing

Question 19

What are the clinical features of plantar fasciitis?

Answer 19

Pain on instep when walking

Tenderness at distal plantar aspect of calcaneal tuberosity

Question 20

What is the management for plantar fasciitis?

Answer 20

Rest, stretches, heel pad, steroid injection

May take up to two years to resolve

Question 21

What is per cavus?

Answer 21

Abnormally high arch of the foot

Often related to neuromuscular conditions

Question 22

What is claw toe?

Answer 22

Hyperextension at MTPJ + hyperflexion at PIP and DIP

Question 23

What is hammer toe?

Answer 23

Similar to claw toe but hyperextension at DIP

Question 24

What are the management options for claw + hammer toes?

Answer 24

Toe sleeves/plasters to prevent pain + skin breakdown from rubbing
Surgery: tenotomy, tendon transfer, arthrodesis of PIP, toe amputation