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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
Q

How do you Rx

A

Manipulation + cast from birth
Correct at 6-10 weeks
Surgery
Night time braces until age 4

26
Q

What causes Charcots Neuroarthropathy

A

Any cause of neuropathy
DM Most common
Alcoholic neuropathy

27
Q

How does Charcot present

A 
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
Q

How do you Dx

A

X-ray

MRI

29
Q

How do you treat

A

Immobilisation until fragmentation resolved

Correct deformity

30
Q

What are complications of Charcot’s

A

Ulceration

Infection

31
Q

What causes dorsal root ganglion (arise from joint or tendon sheath)

A

Idiopathic
Arthritis
Tendon pathology

32
Q

What are the symptoms

A

None

Pain if pressure

33
Q

How do you Rx

A

Aspiration

Excision

34
Q

What is plantar fasciitis

A

Enthesisitis (inflammation at insertion of tendon / ligament into bone) of plantar fascia into calcaneum

35
Q

What causes plantar fasciitis

A 
HIIT
Poor footwear
Obesity 
Standing
tight gastro-soleus
36
Q

What are the symptoms off plantar fasciitis

A

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
Q

How do you diagnose plantar fasciitis

A 
Clinical 
X-ray to exclude arthritis 
USS
MRI 
Often no inflammatory cells
38
Q

How do you Rx plantar fasciitis

A 
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
Q

What is DDX

A

Nerve entrapment
Arthritis
Calcaneal pathology

40
Q

What is plantar fibromatosis

A

Dupuytren’s of the foot
Asymptomatic unless large
Swelling under arch

41
Q

How do you Rx

A

Orthotics / shoes
Excision but reoccurs
RT / shockwave

42
Q

What causes achilles tendinitiis

A

Degeneration
Overuse
Some drugs

43
Q

What types can you get

A

Insertional within 2cm of insertion

Non-insertion - proximal along tendon

44
Q

What is behind achilles tendon

A

Retrocalcaneal and superficial bursae

45
Q

What are the symptoms of achilles tendinitis

A 
Pain behind heel and leg
Swelling
Tender during and after exercise
Difficulty putting on shoes
Morning pain
Stiffness
46
Q

What is important not to miss

A

RUPTURE

47
Q

Who is at risk of tendinosis

A 
Obese
Steroid
DM
Non-athleetic
Ciprofloxacin
Hypercholesterol
48
Q

Who is at risk of true inflammation

A

Athletes

49
Q

How do you Dx

A

Simmonds to look for rupture - squeeze calf and foot should plantar flex
USS

50
Q

How do you Rx

A 
RICE
Analgesia
Weight loss
Footwear
Physio 
Can immobilise and surgery for gastrocnemius recession or release tendon
51
Q

Why do you not to steroid injection

A

Risk of rupture

52
Q

What is Cavovarus foot

A 
Very high arch
Heel slants inward
Pain
Calluses
Ankle sprains
53
Q

What causes Popliteal cyst

A

Primary
- Distension of gastrocnemius / semimembranous bursa

Secondary to OA / trauma / gout

54
Q

What should you always consider and what is diagnostic of cyst

A

DVT

55
Q

How do you Rx

A

Most resolve

Analgesia

56
Q

What does rupture of cyst present like

A

DVT
Red
Pain
Swelling in calf

57
Q

What is Morton’s neuroma

A

Mechanically induced degenerative neuropathy

Usually between 3+4th metatarsal

58
Q

How does it present

A 
Pain between heads - usually palmar
Burning into toes
Numbness
Altered sensation
Intermittent 
Worse when walking
59
Q

What predisposes

A

High heels

60
Q

How do you Dx

A

Mulder’s click - squeeze metatarsals and hear a click
USS = 1st line
MRI

61
Q

How do you Rx

A

Wide shoes
Metatarsal pad
Steroid injection
Refer for surgery after 3 months

MSK (21 decks)

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