Foot Conditions Flashcards by Kayla Halliwell

What is the Achilles tendon?

Connects the gastrocnemius and soleus to the calcaneus bone

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What is Achilles tendinopathy?

Damage, swelling, inflammation and reduced function in the Achilles tendon

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What are the 2 types of Achilles tendinopathy?

Insertion
Mid-portion

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What is insertion tendinopathy?

Within 2 cm of the insertion point on the calcaneus

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What is mid-portion tendinopathy?

2-6cm above the insertion point

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What are risk factors for Achilles tendinopathy?

Sports that stress the Achilles
Inflammatory conditions
Diabetes
Raised cholesterol
FH
Fluroquinolone antibiotics e.g. ciprofloxacin levofloxacin

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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

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What is essential to exclude in Achilles tendinopathy?

Achilles tendon rupture

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What is the management of Achilles tendinopathy?

Rest, altered activities
Ice, analgesia
Physio
Orthotics
Extra-corporeal shock wave therapy (ESWT)

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What is avoided in Achilles tendinopathy?

Steroid injections due to risk fo tenon rupture

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What is Achilles rupture?

Sudden onset injury resulting in rupture of tendon and loss of connection between calf muscles and heel

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What is the presentation of Achilles rupture?

Sudden onset of pain
Snapping sound and sensation

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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

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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

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What test confirms diagnosis of Achilles rupture?

Ultrasound

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What are the management options for Achilles rupture?

Same day ortho revie
Rest and immobilisation, ice, elevation, analgesia

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What are the general non-surgical management options for foot conditions?

Analgesia
Shoe wear modification
Activity modification
Weight loss
Physio
Orthotics- insoles, bracing

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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