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MSK > Foot Injuries > Flashcards

Foot Injuries Flashcards

1
Q

What is posterior tibial tendon dysfunction

A

Acquired adult flat foot due to inflammation / torn tendon

Medial or lateral pain due to impingement

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2
Q

How do you know when flat feet is pathological?

A

If no arch reforms on tiptoes

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3
Q

How do you Dx posterior tibial tendon dysfunction?

A

MRI to assess tendon

Clinical

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4
Q

How do you treat posterior tibial dysfunction

A

Orthotics
Reconstruction of tendon
Triple fusion

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5
Q

What is hallux valgus?

A

Lateral angulation of hallux
Medial deviation of 1st metatarsal
Sesamoid sublux to less pressure on 1st toe

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6
Q

What are the symptoms of hallux valgus

A

Bunion on 1st metatarsal due to pressure
Pain from pressure
Pain from toes crossing over
Metatarsalgia

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7
Q

How do you Dx hallux valgus

A

Clinical

X-Ray to show severity and exclude other causes

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8
Q

How do you treat hallux valgus

A 
Shoe wear - wide + low heel 
Bunion pads 
Orthotics 
Analgesia
Osteotomy 1st metatarsal + proximal phalanx
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9
Q

What are RF of hallux valgus

A 
Female
Age
Footwear 
FH
Joint hypermobiltiy 
Neuromuscular disorder
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10
Q

What are complications of hallux

A

Secondary OA
Deformities lesser toes - hammer etc
Recurrence

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11
Q

What is hallux rigid

A

OA of 1st MTP

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12
Q

What are the symptoms

A 
Pain 
Stiffness
Limited ROM
Swelling 
Worse on dorsiflexion
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13
Q

How do you Dx

A

Clinical
X-ray showing osteophytes, lack of joint space, cysts + sclerosis
May also show lesser toe deformity

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14
Q

How do you treat hallux rigid

A 
Shoe wear
Analgesia
Cheilectomy to remove dorsal impingement
Arthrodesis 
Arthroplasty = high failure but maintain ROM
1st MTP joint fusion
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15
Q

What is 1st line

A

1st MTP joint fusion

Lose ROM

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16
Q

What is metatarsalgia

A

Pain and inflammation in ball of foot (front - under metatarsals)

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17
Q

What are RF / causes

A 
Tight gastrocnemius 
High heel
Hammer toes
Hallux valgus 
High BMI
High impact sports
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18
Q

How do you treat

A

Rest

Orthotics

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19
Q

What causes lesser toe deformities

A 
Imbalance between flexor and extensor 
Shoes 
Neurological 
RA
DM 
Idiopathic
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20
Q

What are the symptoms

A

Deformity
Pain from dorsum or plantar side
Metatarsalgia

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21
Q

How do you Rx

A

Shoes with high toe box
Orthotics
Surgery

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22
Q

What surgery

A

Fusion of ITP
Release MTP
Osteotomy to shorten metatarsal
Flexor / extension transfer if full ROM

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23
Q

What is Talipes Equinovarus ‘Club foot’

A

Congenital inverted and plantar flexed foot

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24
Q

What is associated with club foot

A

Spina bifida
Cerebral palsy
Edward - 18
Oligohydramnios

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25
How do you Rx
Manipulation + cast from birth Correct at 6-10 weeks Surgery Night time braces until age 4
26
What causes Charcots Neuroarthropathy
Any cause of neuropathy DM Most common Alcoholic neuropathy
27
How does Charcot present
``` Swollen erythematous foot - may think cellulitis but colour drain when raise due to poor vascular Not as painful as neuropathy Rapid bone destruction Fragmentation and collapse Remodelling over time ```
28
How do you Dx
X-ray | MRI
29
How do you treat
Immobilisation until fragmentation resolved | Correct deformity
30
What are complications of Charcot's
Ulceration | Infection
31
What causes dorsal root ganglion (arise from joint or tendon sheath)
Idiopathic Arthritis Tendon pathology
32
What are the symptoms
None | Pain if pressure
33
How do you Rx
Aspiration | Excision
34
What is plantar fasciitis
Enthesisitis (inflammation at insertion of tendon / ligament into bone) of plantar fascia into calcaneum
35
What causes plantar fasciitis
``` HIIT Poor footwear Obesity Standing tight gastro-soleus ```
36
What are the symptoms off plantar fasciitis
Commonest cause of heel pain on sole of foot Pain in morning and on weight bearing Worse on tip toes Long lasting >2 years
37
How do you diagnose plantar fasciitis
``` Clinical X-ray to exclude arthritis USS MRI Often no inflammatory cells ```
38
How do you Rx plantar fasciitis
``` RICE Analgesia Can wear heel pads Reduce walking Physio for stretch exercise Steroid injection= main stay Night splinting in dorsiflexion Extra-corpeal shock wave Can refer to ortho after 6-12 months for consideration of surgery ```
39
What is DDX
Nerve entrapment Arthritis Calcaneal pathology
40
What is plantar fibromatosis
Dupuytren's of the foot Asymptomatic unless large Swelling under arch
41
How do you Rx
Orthotics / shoes Excision but reoccurs RT / shockwave
42
What causes achilles tendinitiis
Degeneration Overuse Some drugs
43
What types can you get
Insertional within 2cm of insertion | Non-insertion - proximal along tendon
44
What is behind achilles tendon
Retrocalcaneal and superficial bursae
45
What are the symptoms of achilles tendinitis
``` Pain behind heel and leg Swelling Tender during and after exercise Difficulty putting on shoes Morning pain Stiffness ```
46
What is important not to miss
RUPTURE
47
Who is at risk of tendinosis
``` Obese Steroid DM Non-athleetic Ciprofloxacin Hypercholesterol ```
48
Who is at risk of true inflammation
Athletes
49
How do you Dx
Simmonds to look for rupture - squeeze calf and foot should plantar flex USS
50
How do you Rx
``` RICE Analgesia Weight loss Footwear Physio Can immobilise and surgery for gastrocnemius recession or release tendon ```
51
Why do you not to steroid injection
Risk of rupture
52
What is Cavovarus foot
``` Very high arch Heel slants inward Pain Calluses Ankle sprains ```
53
What causes Popliteal cyst
Primary - Distension of gastrocnemius / semimembranous bursa Secondary to OA / trauma / gout
54
What should you always consider and what is diagnostic of cyst
DVT
55
How do you Rx
Most resolve | Analgesia
56
What does rupture of cyst present like
DVT Red Pain Swelling in calf
57
What is Morton's neuroma
Mechanically induced degenerative neuropathy | Usually between 3+4th metatarsal
58
How does it present
``` Pain between heads - usually palmar Burning into toes Numbness Altered sensation Intermittent Worse when walking ```
59
What predisposes
High heels
60
How do you Dx
Mulder's click - squeeze metatarsals and hear a click USS = 1st line MRI
61
How do you Rx
Wide shoes Metatarsal pad Steroid injection Refer for surgery after 3 months

MSK (21 decks)

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