Foot Conditions Flashcards
What is the Achilles tendon?
Connects the gastrocnemius and soleus to the calcaneus bone
What is Achilles tendinopathy?
Damage, swelling, inflammation and reduced function in the Achilles tendon
What are the 2 types of Achilles tendinopathy?
Insertion
Mid-portion
What is insertion tendinopathy?
Within 2 cm of the insertion point on the calcaneus
What is mid-portion tendinopathy?
2-6cm above the insertion point
What are risk factors for Achilles tendinopathy?
Sports that stress the Achilles
Inflammatory conditions
Diabetes
Raised cholesterol
FH
Fluroquinolone antibiotics e.g. ciprofloxacin levofloxacin
What is the presentation of Achilles tendinopathy?
Pain or aching in Achilles tendon or heel, with activity
Stiffness
Tenderness
Swelling
Nodularity on palpation of the tendon
What is essential to exclude in Achilles tendinopathy?
Achilles tendon rupture
What is the management of Achilles tendinopathy?
Rest, altered activities
Ice, analgesia
Physio
Orthotics
Extra-corporeal shock wave therapy (ESWT)
What is avoided in Achilles tendinopathy?
Steroid injections due to risk fo tenon rupture
What is Achilles rupture?
Sudden onset injury resulting in rupture of tendon and loss of connection between calf muscles and heel
What is the presentation of Achilles rupture?
Sudden onset of pain
Snapping sound and sensation
What are the signs on examination of ruptured Achilles tendon?
Ankle rests in dorsiflexed position
Tenderness to area
Palpable gap in Achilles tendon
Weakness of plantar flexion
Unable to stand on tip toes
Positive Simmond’s calf squeeze test
What is Simmond’s test?
Patient is positioned prone with feet hanging freely off bed
Squeezing of calf with normal Achilles tendon will cause plantar flexion
Lack of plantar flexion is a positive test
What test confirms diagnosis of Achilles rupture?
Ultrasound
What are the management options for Achilles rupture?
Same day ortho revie
Rest and immobilisation, ice, elevation, analgesia
What are the general non-surgical management options for foot conditions?
- Analgesia
- Shoe wear modification
- Activity modification
- Weight loss
- Physio
- Orthotics- insoles, bracing
When is non-op management used?
Only when conservative fails
What are forefoot problems?
Hallux valgus
Hallux rigidus
Lesser toe deformities- claw toes, hammer toe, mallet toes
Morton’s neuroma
Metatarsalgia
Rheumatoid forefoot
What is the more common name for Hallux Valgus?
Bunions
What is a bunion?
Bony lump created by deformity at MTP at the base of the big toe
1st metatarsal becomes angled medially
Big toe becomes angled laterally
MTP joint becomes inflamed and enlarged
What are surgical options for bunions?
Lateral soft tissue release
Osteotomy 1st metatarsal
What is hallux rigidus?
OA of 1st MTP joint
Stiffness, limited ROM
Pain at extreme dorsiflexion
What are the surgical options for hallux rigidus?
Cheilectomy- remove dorsal osteophytes to stop impingement on dorsiflexion
Arthrodesis- 1st MTP joint fusion
Hemiarthoplasty
What is claw toe?
Flexion at PIP and DIP
What is Hammer toe?
Flexion at PIP, extension at DIP
What is mallet toe?
Flexion at DIP
What are the surgical options for claw/hammer/mallet toe?
Flexor to extensor transfer
Fusion of IP joint
Release of MTP joint
Shortening osteotomy of metatarsal
What is Morton’s neuroma?
Irritation of nerve in intermetatarsal space (between3 and 4)
Exacerbated by high heels
Pain, burning, numbness, pins and needles
Metatarsalgia
What is metatarsalgia?
Pain in the ball of the foot
How is Morton’s neuroma diagnosed?
Metatarsal squeeze test- causes pain
Mulder’s sign- painful click when manipulating the metatarsal heads to rub the neuroma
Ultrasound/MRI
What are the surgical options for Morton’s neuroma?
Excise lesion and a section of the normal nerve
Dorsal approach
What are the surgical options for rheumatoid arthritis?
1st MTP joint arthrodesis
Excision arthroplasty of 2nd-5th toes
What are midfoot problems?
Ganglia
OA
Plantar fibromatosis
What is a dorsal foot ganglia?
Ganglia arising from joint or tendon sheath
Causes pain
What is the surgical option for ganglia?
Excise ganglion
What is plantar fibromatosis?
Lederhosen disease
Thickening of the plantar fascia
Asymptomatic unless very large or on weight bearing area
What is the surgical management of plantar fibromatosis?
Excision
What are hindfoot problems?
Achilles tendinopathy/rupture
Plantar fasciitis
Ankle OA
Tibialis posterior dysfunction
Cavovarus foot
What is plantar fasciitis?
Chronic degenerative changes
Fibroblast hypertrophy
Absence of inflammatory cells
Gradual onset of pain on the plantar aspect of the heel- worse with pressure and in morning
Tenderness on palpation
What groups does plantar fasciitis present in?
Athletes
Running with poor footwear
Obesity
Prolonged standing occupation
Tight gastro-soleus complex
What is the specialist management of plantar fasciitis?
ECSW- extracorporeal shock wave therapy
Surgery
What is posterior tibial dysfunction?
Planovalgus (flat foot)
Unable to stand in tiptoes
What is the management of flat feet?
Medial arch support
Reconstruction of tendon
Triple bone fusion
