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Foot Pathology Flashcards

1
Q

What is a common name for Hallux valgus

A

Bunions

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2
Q

Aetiology of bunions

A

Genetic
Foot what
Age
F>M (sig.)

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3
Q

Pathology of bunions

A

Lateral angulation of great toe.
Tendons pull realigned to lateral of centre of rotation of toe worsening deformity
Vicious cycle of increased pull creating increased deformity
Sesamoid bones sublux – less weight goes through great toe
As deformity progresses abnormalities of lesser toes occur

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4
Q

Clinical features of bunions

A

Lump from base of big toe
Pressure symptoms from footwear Redness over skin
Pain

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5
Q

Ix for bunions

A

Clinical Dx

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6
Q

Non-operative Rx bunions

A

Shoe wear modification
Analgesia
Activity modification
Orthotics

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7
Q

Operative Rx for bunions

A

Osteotomy 1st metatarsal +/- proximal phalanx

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8
Q

what is the gold standard Rx for bunions

A

There are none

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9
Q

What is surgery NOT indicated for in Hallux Valgus

A

Cosmetic reasons

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10
Q

When is operative Rx considered for Hallux Valgus

A

When non-operative management has failed or proved unacceptable to the patient

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11
Q

Complications Hallux Valgus

A

Secondary OA of the joint
Chronic pain
Recurrence

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12
Q

What is Hallux Rigidus

A

Stiff big toe

OA of 1st MTP joint

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13
Q

Aetiology of Hallux Rigidus

A

Unknown
Possibly genetic
Possibly micro trauma

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14
Q

Clinical features of Hallux Rigidus

A

Pain: often extreme at dorsiflexion
Stiffness
Limitation ROM

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15
Q

Ix for Hallux Rigidus

A

Clinical (O/E)

X-rays

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16
Q

Non-operative Rx Hallux Rigidus

A

Activity modification
Shoe wear modification
Analgesia

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17
Q

Surgery Rx Hallux Rigidus

A

Cheliectomy
Arthrodesis
Arthroplasty

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18
Q

Gold standard Rx for hallux rigidus

A

1st MTPJ fusion

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19
Q

What is Mortons Neuroma

A

Interdigital neuroma of the foot

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20
Q

Aetiology Mortons Neuroma

A

F>M
40-60ys
Frequently associated with wearing high heels

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21
Q

Pathology Morton’s Neuroma

A

Common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear

Thickening of tissue around digital nerve

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22
Q

Signs of Morton’s Neuroma

A

Mulder’s Click
Palpable swelling of nerve on base of foot
Altered sensation in 3rd webspace foot

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23
Q

Symptoms of Mortons Neuroma

A

Neuralgic pain in toes
Feeling of standing/walking on a stone
Intermittent mean
Altered sensation of foot

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24
Q

Ix for Mortons Neuroma

A

Clinical Dx
USS best
MRI good

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25
Small lesion Rx for Nortons Neuroma
Steroid injection
26
Surgery Rx for Mortons Neuroma
Surgical excision | Inc. section of normal n.
27
Surgical complications of Mortons Neuroma
Numbness Recurrence Chronic pain
28
What is a dorsal foot ganglion
A ganglion cyst that arises on the dorsal aspect of the foot
29
What does a dorsal foot ganglion arise from
Joint or tendon sheath
30
Aetiology of dorsal foot ganglion
Idiopathic Underlying arthritis Underlying tendon pathology
31
Clinical features of dorsal foot ganglion
Soft cyst - non mobile Pain from pressure from footwear Pain from underlying problem
32
Ix for dorsal foot ganglion
Aspiration | USS
33
Rx for dorsal foot ganglion
Watchful waiting if not causing any issues Aspiration Excision
34
Prognosis for dorsal foot ganglion
High rate recurrence
35
What is ledderhouse disease also known as
Plantar fibromatosis
36
What is plantar fibromatosis
Non-malignant thickening of deep fascia within the foot
37
clinical features of plants fibromatosis
Usually asymptomatic unless very large or on weight bearing
38
Risk factors for planta fibromatosis
FH disease Increased in males DM Epilepsy
39
Rx for plantar fibromatosis
Avoid pressure Shower modification Orthotics Excision Radiotherapy
40
Complication of surgical Rx of plantar fibromatosis
Recurrence
41
Causes of Achilles tendon rupture
Jumping Running Falling
42
Clinical features of Achilles Tendon rupture
Impossible to raise heel (stand on tip toe) on affected leg May be pervade as having been kicked in the back of the leg Swelling Unable to weight bear Bruising
43
Clinical examination tests for Achilles Tendon Rupture
Simmonds Thompson's angle of the dangle sign
44
Ix for Achilles tendon rupture
O/E USS MRI
45
Conservative Rx Achilles Tendon Rupture
Casting Immobilisation Analgesia
46
Surgical Rx Achilles Tendon Rupture
Tendon repair
47
What is planta fasciitis a common cause
Plantar heel pain
48
Aetiology of plantar fasciitis
In athletes associated with high intensity or rapid increase in training Running with poorly padded shoes or hard surfaces Obesity Occupations involving prolonged standing Foot/lower limb rotational deformities Tight gastro-soleus complex
49
Pathology of Plantar Fasciitis
Not inflammatory | Arises from degenerative changes caused by micro traumas
50
Clinical features of Plantar Fasciitis
Pain in bottom of the heel Worst first thing in the morning Pain on weight bearing after rest (post-static dyskinesia)
51
When is the pain worst in Plantar Fasciitis
1st thing in the morning
52
Ix for Plantar Fasciitis
``` Mainly clinical Dx Occasionally: USS X-rays MRI ```
53
Newer/3rd line therapies for Plantar Fasciitis
``` Extra-corpeal Shockwave Therapy Topaz Plasma Coblation Nitric oxide Platelet rich plasma ``` Surgery
54
Conservative Rx for plantar fasciitis
``` 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 ```
55
Ddx for plantar fasciitis
Nerve entrapment syndrome Arthritis Calcaneal pathology q
56
What does Tibialis Posterior Tendon Dysfunction cause
Acquired flatfoot planovalgus
57
Clinical examination tests to assess for Tibialis Posterior Tendon Dysfunction
Double and Single Limb Heel Raise
58
Clinical features Tibialis Posterior Tendon Dysfunction
Collapsed arch Foot tilted medially Look at foot from posterior angle
59
Rx for Tibialis Posterior Tendon Dysfunction
``` Orthotics – medial arch support Reconstruction of tendon (tendon transfer) Triple fusion (subtalar, talonavicular and calcaneocuboid) ```
60
What is metararsalgia
Symptoms not a dx
61
Causes of metatarsalgia
``` Increased BMI High heel wearing Toe deformities Foot deformities High impact sports Inflammatory arthritis Morton's neuroma ```
62
Describe metatarsalgia
Pain on the ball of the foot
63
Rx for metatarsalgia
``` Weight loss Rest Shoe wear modification Physio. Analgesia ``` Other treatments depend on underlying cause
64
Describe claw toe
Flexion contracture of DIP and PIP joints | Hyperextension of MTP joint
65
Describe hammer toe
Flexion contracture in PIP joint
66
Describe mallet tow
Flexion contracture of DIP which can become fixed
67
Aetiology of lesser toe deformities
``` Imbalance between flexors and extensors Shoe wear Neurological RA Idiopathic Typically >60yr ```
68
Symptoms of lesser toe deformities
Deformity Pain from dorsum Pain from plantar side (metatarsalgia)
69
Non-Operative Rx lesser toe deformities
Activity modification Shoe wear Orthotic insoles
70
Operative Rx lesser toe deformities
Flexor to extensor transfer Fusion of interphalangeal joint Release of metararsophalangeal joint Shortening osteotomy of metatarsal
71
When is and isn't surgery indicated for lesser toe deformities
Is considered for painful reasons Is not considered for cosmetic reasons

Musculoskeletal (13 decks)

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