Foot Injuries Flashcards
What is posterior tibial tendon dysfunction
Acquired adult flat foot due to inflammation / torn tendon
Medial or lateral pain due to impingement
How do you know when flat feet is pathological?
If no arch reforms on tiptoes
How do you Dx posterior tibial tendon dysfunction?
MRI to assess tendon
Clinical
How do you treat posterior tibial dysfunction
Orthotics
Reconstruction of tendon
Triple fusion
What is hallux valgus?
Lateral angulation of hallux
Medial deviation of 1st metatarsal
Sesamoid sublux to less pressure on 1st toe
What are the symptoms of hallux valgus
Bunion on 1st metatarsal due to pressure
Pain from pressure
Pain from toes crossing over
Metatarsalgia
How do you Dx hallux valgus
Clinical
X-Ray to show severity and exclude other causes
How do you treat hallux valgus
Shoe wear - wide + low heel Bunion pads Orthotics Analgesia Osteotomy 1st metatarsal + proximal phalanx
What are RF of hallux valgus
Female Age Footwear FH Joint hypermobiltiy Neuromuscular disorder
What are complications of hallux
Secondary OA
Deformities lesser toes - hammer etc
Recurrence
What is hallux rigid
OA of 1st MTP
What are the symptoms
Pain Stiffness Limited ROM Swelling Worse on dorsiflexion
How do you Dx
Clinical
X-ray showing osteophytes, lack of joint space, cysts + sclerosis
May also show lesser toe deformity
How do you treat hallux rigid
Shoe wear Analgesia Cheilectomy to remove dorsal impingement Arthrodesis Arthroplasty = high failure but maintain ROM 1st MTP joint fusion
What is 1st line
1st MTP joint fusion
Lose ROM
What is metatarsalgia
Pain and inflammation in ball of foot (front - under metatarsals)
What are RF / causes
Tight gastrocnemius High heel Hammer toes Hallux valgus High BMI High impact sports
How do you treat
Rest
Orthotics
What causes lesser toe deformities
Imbalance between flexor and extensor Shoes Neurological RA DM Idiopathic
What are the symptoms
Deformity
Pain from dorsum or plantar side
Metatarsalgia
How do you Rx
Shoes with high toe box
Orthotics
Surgery
What surgery
Fusion of ITP
Release MTP
Osteotomy to shorten metatarsal
Flexor / extension transfer if full ROM
What is Talipes Equinovarus ‘Club foot’
Congenital inverted and plantar flexed foot
What is associated with club foot
Spina bifida
Cerebral palsy
Edward - 18
Oligohydramnios
How do you Rx
Manipulation + cast from birth
Correct at 6-10 weeks
Surgery
Night time braces until age 4
What causes Charcots Neuroarthropathy
Any cause of neuropathy
DM Most common
Alcoholic neuropathy
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
How do you Dx
X-ray
MRI
How do you treat
Immobilisation until fragmentation resolved
Correct deformity
What are complications of Charcot’s
Ulceration
Infection
What causes dorsal root ganglion (arise from joint or tendon sheath)
Idiopathic
Arthritis
Tendon pathology
What are the symptoms
None
Pain if pressure
How do you Rx
Aspiration
Excision
What is plantar fasciitis
Enthesisitis (inflammation at insertion of tendon / ligament into bone) of plantar fascia into calcaneum
What causes plantar fasciitis
HIIT Poor footwear Obesity Standing tight gastro-soleus
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
How do you diagnose plantar fasciitis
Clinical X-ray to exclude arthritis USS MRI Often no inflammatory cells
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
What is DDX
Nerve entrapment
Arthritis
Calcaneal pathology
What is plantar fibromatosis
Dupuytren’s of the foot
Asymptomatic unless large
Swelling under arch
How do you Rx
Orthotics / shoes
Excision but reoccurs
RT / shockwave
What causes achilles tendinitiis
Degeneration
Overuse
Some drugs
What types can you get
Insertional within 2cm of insertion
Non-insertion - proximal along tendon
What is behind achilles tendon
Retrocalcaneal and superficial bursae
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
What is important not to miss
RUPTURE
Who is at risk of tendinosis
Obese Steroid DM Non-athleetic Ciprofloxacin Hypercholesterol
Who is at risk of true inflammation
Athletes
How do you Dx
Simmonds to look for rupture - squeeze calf and foot should plantar flex
USS
How do you Rx
RICE Analgesia Weight loss Footwear Physio Can immobilise and surgery for gastrocnemius recession or release tendon
Why do you not to steroid injection
Risk of rupture
What is Cavovarus foot
Very high arch Heel slants inward Pain Calluses Ankle sprains
What causes Popliteal cyst
Primary
- Distension of gastrocnemius / semimembranous bursa
Secondary to OA / trauma / gout
What should you always consider and what is diagnostic of cyst
DVT
How do you Rx
Most resolve
Analgesia
What does rupture of cyst present like
DVT
Red
Pain
Swelling in calf
What is Morton’s neuroma
Mechanically induced degenerative neuropathy
Usually between 3+4th metatarsal
How does it present
Pain between heads - usually palmar Burning into toes Numbness Altered sensation Intermittent Worse when walking
What predisposes
High heels
How do you Dx
Mulder’s click - squeeze metatarsals and hear a click
USS = 1st line
MRI
How do you Rx
Wide shoes
Metatarsal pad
Steroid injection
Refer for surgery after 3 months
