foot conditions Flashcards
boa guide
Bunions, plantar fascititis, achilles tendinosis, mortons neuroma
General treatment
weight loss, activity modification
footwear, orthotics, podiatrist
physiotherapist(? - only in some cases)
nsaids, steroid injection
If nothing working then
-surgery -> remove/fuse
bunions around what joint?
MTP
Why does Hallux Valgus (bunions) cause pain in the lateral foot?
Because the weight distribution is now distributed over the lateral aspect of the foot rather than through the toe
Why do we get the angle in hallux valgus? What bones sublux?what is pigets angle? Arover what degrees is going to progress?
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
Hallux valgus treatment.
Non operatively: shoes, orthotics, activity modification, nsaids
Operatively: release lateral soft tissues. Osteotomy
What is hallux rigidus? Joint? (MTP) shape ofn xray? How picekd up? What causes the pan?
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.
Treatment of hallux rigidus? Gold standard?
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)
does mortons neuralgia occur in the 1st webspace?
No
What is mulders click??
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.
What is rheumatoid forefot and how do we treat them?Rheumatoid forefoot surgery
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)
midfoot arthritis: can be caused by what? How do we treat?
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.
What is Plantar fibromatosis? do we operate?
aka Ledderhose disease
basically fibrous lump. Best left and avoid surgery as v high recurrance, painful scars etc.
paratendonopathy vs tendonopathy -> What are they and who do they ususallly affect? What are tjeu symptoms?
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
What achilles rupture tests can we do?
Simmonds squeeze,
Angle of the dangle
Matles (feet in air and look at angle)
achilles tendinopathy treatment?
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
cWhat is plantar fasciosis
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.
How do we diagnose plantar fasciitis?
clinically, from symptoms. “Heel pain in the morning, first step out of bed” then slowly gets better.
What are the newer 3rd line treatments? and normal treatments for achilles tendonitis
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
anklle arthritis -> what is it and treatment?
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
when does tibialis posterior occur?
in older people, it gets lazy and so they get flat feet.
