Foot Pathology Flashcards
What is a common name for Hallux valgus
Bunions
Aetiology of bunions
Genetic
Foot what
Age
F>M (sig.)
Pathology of bunions
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
Clinical features of bunions
Lump from base of big toe
Pressure symptoms from footwear Redness over skin
Pain
Ix for bunions
Clinical Dx
Non-operative Rx bunions
Shoe wear modification
Analgesia
Activity modification
Orthotics
Operative Rx for bunions
Osteotomy 1st metatarsal +/- proximal phalanx
what is the gold standard Rx for bunions
There are none
What is surgery NOT indicated for in Hallux Valgus
Cosmetic reasons
When is operative Rx considered for Hallux Valgus
When non-operative management has failed or proved unacceptable to the patient
Complications Hallux Valgus
Secondary OA of the joint
Chronic pain
Recurrence
What is Hallux Rigidus
Stiff big toe
OA of 1st MTP joint
Aetiology of Hallux Rigidus
Unknown
Possibly genetic
Possibly micro trauma
Clinical features of Hallux Rigidus
Pain: often extreme at dorsiflexion
Stiffness
Limitation ROM
Ix for Hallux Rigidus
Clinical (O/E)
X-rays
Non-operative Rx Hallux Rigidus
Activity modification
Shoe wear modification
Analgesia
Surgery Rx Hallux Rigidus
Cheliectomy
Arthrodesis
Arthroplasty
Gold standard Rx for hallux rigidus
1st MTPJ fusion
What is Mortons Neuroma
Interdigital neuroma of the foot
Aetiology Mortons Neuroma
F>M
40-60ys
Frequently associated with wearing high heels
Pathology Morton’s Neuroma
Common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear
Thickening of tissue around digital nerve
Signs of Morton’s Neuroma
Mulder’s Click
Palpable swelling of nerve on base of foot
Altered sensation in 3rd webspace foot
Symptoms of Mortons Neuroma
Neuralgic pain in toes
Feeling of standing/walking on a stone
Intermittent mean
Altered sensation of foot
Ix for Mortons Neuroma
Clinical Dx
USS best
MRI good
Small lesion Rx for Nortons Neuroma
Steroid injection
Surgery Rx for Mortons Neuroma
Surgical excision
Inc. section of normal n.
Surgical complications of Mortons Neuroma
Numbness
Recurrence
Chronic pain
What is a dorsal foot ganglion
A ganglion cyst that arises on the dorsal aspect of the foot
What does a dorsal foot ganglion arise from
Joint or tendon sheath
Aetiology of dorsal foot ganglion
Idiopathic
Underlying arthritis
Underlying tendon pathology
Clinical features of dorsal foot ganglion
Soft cyst - non mobile
Pain from pressure from footwear
Pain from underlying problem
Ix for dorsal foot ganglion
Aspiration
USS
Rx for dorsal foot ganglion
Watchful waiting if not causing any issues
Aspiration
Excision
Prognosis for dorsal foot ganglion
High rate recurrence
What is ledderhouse disease also known as
Plantar fibromatosis
What is plantar fibromatosis
Non-malignant thickening of deep fascia within the foot
clinical features of plants fibromatosis
Usually asymptomatic unless very large or on weight bearing
Risk factors for planta fibromatosis
FH disease
Increased in males
DM
Epilepsy
Rx for plantar fibromatosis
Avoid pressure
Shower modification
Orthotics
Excision
Radiotherapy
Complication of surgical Rx of plantar fibromatosis
Recurrence
Causes of Achilles tendon rupture
Jumping
Running
Falling
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
Clinical examination tests for Achilles Tendon Rupture
Simmonds
Thompson’s
angle of the dangle sign
Ix for Achilles tendon rupture
O/E
USS
MRI
Conservative Rx Achilles Tendon Rupture
Casting
Immobilisation
Analgesia
Surgical Rx Achilles Tendon Rupture
Tendon repair
What is planta fasciitis a common cause
Plantar heel pain
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
Pathology of Plantar Fasciitis
Not inflammatory
Arises from degenerative changes caused by micro traumas
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)
When is the pain worst in Plantar Fasciitis
1st thing in the morning
Ix for Plantar Fasciitis
Mainly clinical Dx Occasionally: USS X-rays MRI
Newer/3rd line therapies for Plantar Fasciitis
Extra-corpeal Shockwave Therapy Topaz Plasma Coblation Nitric oxide Platelet rich plasma
Surgery
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
Ddx for plantar fasciitis
Nerve entrapment syndrome
Arthritis
Calcaneal pathology q
What does Tibialis Posterior Tendon Dysfunction cause
Acquired flatfoot planovalgus
Clinical examination tests to assess for Tibialis Posterior Tendon Dysfunction
Double and Single Limb Heel Raise
Clinical features Tibialis Posterior Tendon Dysfunction
Collapsed arch
Foot tilted medially
Look at foot from posterior angle
Rx for Tibialis Posterior Tendon Dysfunction
Orthotics – medial arch support Reconstruction of tendon (tendon transfer) Triple fusion (subtalar, talonavicular and calcaneocuboid)
What is metararsalgia
Symptoms not a dx
Causes of metatarsalgia
Increased BMI High heel wearing Toe deformities Foot deformities High impact sports Inflammatory arthritis Morton's neuroma
Describe metatarsalgia
Pain on the ball of the foot
Rx for metatarsalgia
Weight loss Rest Shoe wear modification Physio. Analgesia
Other treatments depend on underlying cause
Describe claw toe
Flexion contracture of DIP and PIP joints
Hyperextension of MTP joint
Describe hammer toe
Flexion contracture in PIP joint
Describe mallet tow
Flexion contracture of DIP which can become fixed
Aetiology of lesser toe deformities
Imbalance between flexors and extensors Shoe wear Neurological RA Idiopathic Typically >60yr
Symptoms of lesser toe deformities
Deformity
Pain from dorsum
Pain from plantar side (metatarsalgia)
Non-Operative Rx lesser toe deformities
Activity modification
Shoe wear
Orthotic insoles
Operative Rx lesser toe deformities
Flexor to extensor transfer
Fusion of interphalangeal joint
Release of metararsophalangeal joint
Shortening osteotomy of metatarsal
When is and isn’t surgery indicated for lesser toe deformities
Is considered for painful reasons
Is not considered for cosmetic reasons
