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Musculoskeletal > Foot Pathology > Flashcards

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
Q

Small lesion Rx for Nortons Neuroma

A

Steroid injection

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26
Q

Surgery Rx for Mortons Neuroma

A

Surgical excision

Inc. section of normal n.

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27
Q

Surgical complications of Mortons Neuroma

A

Numbness
Recurrence
Chronic pain

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28
Q

What is a dorsal foot ganglion

A

A ganglion cyst that arises on the dorsal aspect of the foot

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29
Q

What does a dorsal foot ganglion arise from

A

Joint or tendon sheath

30
Q

Aetiology of dorsal foot ganglion

A

Idiopathic
Underlying arthritis
Underlying tendon pathology

31
Q

Clinical features of dorsal foot ganglion

A

Soft cyst - non mobile
Pain from pressure from footwear
Pain from underlying problem

32
Q

Ix for dorsal foot ganglion

A

Aspiration

USS

33
Q

Rx for dorsal foot ganglion

A

Watchful waiting if not causing any issues
Aspiration
Excision

34
Q

Prognosis for dorsal foot ganglion

A

High rate recurrence

35
Q

What is ledderhouse disease also known as

A

Plantar fibromatosis

36
Q

What is plantar fibromatosis

A

Non-malignant thickening of deep fascia within the foot

37
Q

clinical features of plants fibromatosis

A

Usually asymptomatic unless very large or on weight bearing

38
Q

Risk factors for planta fibromatosis

A

FH disease
Increased in males
DM
Epilepsy

39
Q

Rx for plantar fibromatosis

A

Avoid pressure
Shower modification
Orthotics

Excision
Radiotherapy

40
Q

Complication of surgical Rx of plantar fibromatosis

A

Recurrence

41
Q

Causes of Achilles tendon rupture

A

Jumping
Running
Falling

42
Q

Clinical features of Achilles Tendon rupture

A

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
Q

Clinical examination tests for Achilles Tendon Rupture

A

Simmonds
Thompson’s
angle of the dangle sign

44
Q

Ix for Achilles tendon rupture

A

O/E
USS
MRI

45
Q

Conservative Rx Achilles Tendon Rupture

A

Casting
Immobilisation
Analgesia

46
Q

Surgical Rx Achilles Tendon Rupture

A

Tendon repair

47
Q

What is planta fasciitis a common cause

A

Plantar heel pain

48
Q

Aetiology of plantar fasciitis

A

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
Q

Pathology of Plantar Fasciitis

A

Not inflammatory

Arises from degenerative changes caused by micro traumas

50
Q

Clinical features of Plantar Fasciitis

A

Pain in bottom of the heel
Worst first thing in the morning
Pain on weight bearing after rest
(post-static dyskinesia)

51
Q

When is the pain worst in Plantar Fasciitis

A

1st thing in the morning

52
Q

Ix for Plantar Fasciitis

A 
Mainly clinical Dx 
Occasionally:
USS 
X-rays 
MRI
53
Q

Newer/3rd line therapies for Plantar Fasciitis

A 
Extra-corpeal Shockwave 
Therapy 
Topaz Plasma Coblation 
Nitric oxide 
Platelet rich plasma

Surgery

54
Q

Conservative Rx for plantar fasciitis

A 
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
Q

Ddx for plantar fasciitis

A

Nerve entrapment syndrome
Arthritis
Calcaneal pathology q

56
Q

What does Tibialis Posterior Tendon Dysfunction cause

A

Acquired flatfoot planovalgus

57
Q

Clinical examination tests to assess for Tibialis Posterior Tendon Dysfunction

A

Double and Single Limb Heel Raise

58
Q

Clinical features Tibialis Posterior Tendon Dysfunction

A

Collapsed arch
Foot tilted medially
Look at foot from posterior angle

59
Q

Rx for Tibialis Posterior Tendon Dysfunction

A 
Orthotics – medial arch support
Reconstruction of tendon (tendon transfer)
Triple fusion (subtalar, talonavicular and calcaneocuboid)
60
Q

What is metararsalgia

A

Symptoms not a dx

61
Q

Causes of metatarsalgia

A 
Increased BMI 
High heel wearing 
Toe deformities 
Foot deformities 
High impact sports 
Inflammatory arthritis 
Morton's neuroma
62
Q

Describe metatarsalgia

A

Pain on the ball of the foot

63
Q

Rx for metatarsalgia

A 
Weight loss 
Rest 
Shoe wear modification 
Physio. 
Analgesia

Other treatments depend on underlying cause

64
Q

Describe claw toe

A

Flexion contracture of DIP and PIP joints

Hyperextension of MTP joint

65
Q

Describe hammer toe

A

Flexion contracture in PIP joint

66
Q

Describe mallet tow

A

Flexion contracture of DIP which can become fixed

67
Q

Aetiology of lesser toe deformities

A 
Imbalance between flexors and extensors 
Shoe wear 
Neurological 
RA 
Idiopathic 
Typically >60yr
68
Q

Symptoms of lesser toe deformities

A

Deformity
Pain from dorsum
Pain from plantar side (metatarsalgia)

69
Q

Non-Operative Rx lesser toe deformities

A

Activity modification
Shoe wear
Orthotic insoles

70
Q

Operative Rx lesser toe deformities

A

Flexor to extensor transfer
Fusion of interphalangeal joint
Release of metararsophalangeal joint
Shortening osteotomy of metatarsal

71
Q

When is and isn’t surgery indicated for lesser toe deformities

A

Is considered for painful reasons

Is not considered for cosmetic reasons

Musculoskeletal (13 decks)

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