foot conditions

Question 1

boa guide

Answer 1

Bunions, plantar fascititis, achilles tendinosis, mortons neuroma

Question 2

General treatment

Answer 2

weight loss, activity modification
footwear, orthotics, podiatrist
physiotherapist(? - only in some cases)
nsaids, steroid injection

If nothing working then
-surgery -> remove/fuse

Question 3

bunions around what joint?

Answer 3

MTP

Question 4

Why does Hallux Valgus (bunions) cause pain in the lateral foot?

Answer 4

Because the weight distribution is now distributed over the lateral aspect of the foot rather than through the toe

Question 5

Why do we get the angle in hallux valgus? What bones sublux?what is pigets angle? Arover what degrees is going to progress?

Answer 5

Initially the big toe deviates medially at the carpalmetacarpal joint. Then because all of the tendons are pulling it back into place from tge flexor hallucis longus and adductor hallucis longus, it causes lateral deviation from the mtp joint, which is where the 2 sesamoid bones sublux.

Pigets angle is the big angle made by the medial to lateral deviations in the foot. If this angle is above 29 degrees is likely to progeress

Question 6

Hallux valgus treatment.

Answer 6

Non operatively: shoes, orthotics, activity modification, nsaids

Operatively: release lateral soft tissues. Osteotomy

Question 7

What is hallux rigidus? Joint? (MTP) shape ofn xray? How picekd up? What causes the pan?

Answer 7

Stiff big toe. mtp joint. might have osteophytes, and lookn a bit like osteoarthritis. Picked up oftne incidentally on xray. Pian is caused by catching of osteophytes etc on dorsiflexion.

Question 8

Treatment of hallux rigidus? Gold standard?

Answer 8

Gold standard = fusion of the 1st metatarsal phalangeal joint.

can do cheilectomy (removing osteophytes) or hemiarthroplasty (high failure rate. Good if you don’t use foot much)

Question 9

does mortons neuralgia occur in the 1st webspace?

Answer 9

No

Question 10

What is mulders click??

Answer 10

Found in mortons neuroma (most of the time).

ifnd the inflammation in the nerve, and then push it through to bottom of the foot whilst pressing from underneeth. Should feel click and patient will be in agony.

Question 11

What is rheumatoid forefot and how do we treat them?Rheumatoid forefoot surgery

Answer 11

Rheumatoid in the foot. So can be very severe. Bunion like big toes, and the rest all kinda mangled.

Treatment: shoes, podiatrist
Surgery = arthrodeisisof big toe, and breaking the rest of them at the 1st phalangeal. (2-5th toe excision arthroplasty)

Question 12

midfoot arthritis: can be caused by what? How do we treat?

Answer 12

Arthritises (osteo/rheum) and trauma.
Usual treatment (nsaids, activity, shoewear, orthotics)
Can give xray guided injections (v good, can do multiple spots and also shows where to do next time if it works)
Operatively can fuse… Not v successful tho.

Question 13

What is Plantar fibromatosis? do we operate?

Answer 13

aka Ledderhose disease
basically fibrous lump. Best left and avoid surgery as v high recurrance, painful scars etc.

Question 14

paratendonopathy vs tendonopathy -> What are they and who do they ususallly affect? What are tjeu symptoms?

Answer 14

paratendenopathy –» inflammation of the membrane surrounding the achilles. Younger (30-40), athletic peeps.

Tendonopathy -> older peeps (40+), often peeps who have used steroids, deiabetes, obese. Non-athletic

Question 15

What achilles rupture tests can we do?

Answer 15

Simmonds squeeze,
Angle of the dangle
Matles (feet in air and look at angle)

Question 16

achilles tendinopathy treatment?

Answer 16

Non-operative Treatment
Activity modification
Weight loss
Shoe wear modification – slight heel
Physiotherapy – Eccentric stretching
Extra-corporeal shockwave treatment
Immobilisation (in below knee cast)
Operative Treatment
Gastrocnemius recession
Release and debridement of tendon

Question 17

cWhat is plantar fasciosis

Answer 17

Plantar fascitis. Because its not really an inflammation. V avascular. So could be due to trauma and just awol remodelling by the cells that are already there.

Question 18

How do we diagnose plantar fasciitis?

Answer 18

clinically, from symptoms. “Heel pain in the morning, first step out of bed” then slowly gets better.

Question 19

What are the newer 3rd line treatments? and normal treatments for achilles tendonitis

Answer 19

shock waves, heat, nitric oxide, plateet plasma.

The normal: Rest, change training
Stretching – Achilles +/- direct stretching
Ice
NSAIDs
Orthoses – Heel pads
Physiotherapy
Weight loss
Injections – corticosteroid (good in short term but may make condition worse long term)
Night Splinting

Question 20

anklle arthritis -> what is it and treatment?

Answer 20

pain and stiffness of the ankle (duh). use X ray for diagnosis.

Operative Management:
Anterior only = scrape it out (debridement)
Gold standard = arthrodesis (fusion)

High demand patients : joint replacement

Question 21

when does tibialis posterior occur?

Answer 21

in older people, it gets lazy and so they get flat feet.