Foot Pathology Flashcards
What is hallux valgus?
Deformity of the big toe, also known as a ‘bunion’
What sex is most likely to be affected by hallux valgus?
F>M
What causes hallux valgus?
Genetic
Foot wear
How does hallux valgus present?
Pressure symptoms from show wear
Pain from crossing over of toes
Metatarsalgia
What is the management of hallux valgus?
Shoe wear modification
Orthotics to offload pressure and correct deformity
Activity modification
Analgesia
Osteotomy of 1st metatarsal +/- proximal phalanx
What is hallux rigidus?
Disorder of the joints located at the big toe
What causes hallux rigidus?
Idiopathic
Genetic
Multiple microtrauma
Bimodal distribution of age
How does hallux rigidus present?
Mainly asymptomatic
Pain, often at extreme dorsiflexion
Limitation of range of movement
Osteoarthritis of 1st MTP joint
What is the management of hallux rigidus?
Activity modification
Shoe wear with rigid sole
Analgesia
Arthrodesis/1st MTPJ fusion
What are the types of lesser toe deformities?
Hammer
Claw
Mallet
What can cause lesser toe deformities?
Imbalance between flexors/extensors
Shoe wear
Neurological
Rheumatoid arthritis
Idiopathic
What is morton’s neuroma?
Thickening of the tissue around the nerves leading to the toes
What sex is more commonly affected by Mortons neuroma?
F>M
Which age group is most commonly affected by Morton’s neuroma?
40-60s
What causes Morton’s neuroma?
Mechanically induced degenerative neuropathy
Frequently associated with wearing high healed shoes
How does Morton’s neuroma present?
Forefoot pain, typically affecting 3rd inter-metatarsophalangeal web space
Worse on walking, described as burning or shooting pain
Altered sensation in web space
Mulder’s Click
How is Morton’s neuroma managed?
US for diagnosis
Avoid high heels
Metatarsal pad
Referall if symptoms persist over 3 months with modifications
Corticosteroid injection or neurectomy
What is plantar fibromatosis?
Non-malignant thickening of the deep connective tissue or fascia of the feet
How does plantar fibromatosis present?
Progressive thickening
Usually asymptomatic unless very large or on weightbearing area
How is plantar fibromatosis managed?
Avoid pressure by shoe wear modification and orthotics
Excision, up to 80% risk of recurrence
Radiotherapy, similar recurrence as excision
Combination of radiotherapy/surgery, low risk recurrence but high risk of complications
What is achilles tendonitis?
Degenerative/overuse condition of the achilles tendon with little inflammation
What causes tendinopathy achilles tendonitis?
Most common in non-athletic populations
Age 40+
Obesity
Steroids
Diabetes
Ciprofloxacin
What causes paratendinopathy achilles tendonitis?
Athletes
How does achilles tendonitis present?
Pain during and following exercise
Recurrent episodes
Difficulty fitting shoes
Tenderness
Rupture
What tests can assess for rupture of achilles tendon?
Simmonds
Angle of the Dangle
Maltes
What is the management of achilles tendonitis?
Activity modification
Weight loss
Shoe wear modification
Physiotherapy
Extra-corporeal shockwave treatment
Immobilisation with below knee cast
Gastrocnemius recession
Release and debridement of tendon
What is the initial imaging modality of choice for suspected achilles tendon rupture?
US
What causes plantar fascitis?
Idiopathic
In athletes is associated with high intensity or rapid increase in training
Running with poorly padded shoes or hard surfaces
Obesity, also a predictor of functional loss
Occupations involving prolonged standing
Foot/lower limb rotational deformities
Tight gastro-soleus complex
How does plantar fascitis present?
Stabbing heel pain
- First thing in the morning
- Weight bearing after rest
- Relieved by rest
- Worsened walking barefoot
- Exacerbated walking on tip toes
Frequently long lasting, 2 years or more
Antalgic gait on affected side
How is plantar fascitis managed?
Weight loss if high BMI
Rest feet where possible
Supportive shoes and insoles
NSAIDs
Corticosteroid injections
Orthopaedic referral
How does Posterior Tibial Tendon Dysfunction present?
Double and single heel raise: Heel should swing from valgus to varus as heel rises
Medial or lateral pain
Acquired adult flat foot planovalgus
How is posterior tibial tendon dysfunction managed?
Orthotics: Medial arch support
Reconstruction of tendon/tendon transfer
Triple fusion: Subtalar, talonavicular and calcaneocuboid
Give features of stress fractures
Repetitive activity and loading of normal bone resulting in small hairline fractures
Severe pain
Callus formation
Antalgic gait
What bone is the most common for stress fractures?
2nd metatarsal, occuring in otherwise healthy individuals
What is the most common fracture of the foot?
5th metatarsal, often following inversion injuries of the ankle (1st is least common)
Give features of club foot
Inverted and plantar flexed foot
Usually diagnosed on the newborn exam
What is associated with club foot?
Spina bifida
Cerebral palsy
Edward’s syndrome
Oligohydramnios
Arthrogryposis
How is clubfoot managed?
Ponseti method consists of manipulation and progressive casting which starts soon after birth, deformity is usually corrected after 6-10 weeks
Night-time braces should be applied until the child is aged 4 years
