Foot Pathology

Question 1

What is hallux valgus?

Answer 1

Deformity of the big toe, also known as a ‘bunion’

Question 2

What sex is most likely to be affected by hallux valgus?

Answer 2

F>M

Question 3

What causes hallux valgus?

Answer 3

Genetic

Foot wear

Question 4

How does hallux valgus present?

Answer 4

Pressure symptoms from show wear

Pain from crossing over of toes

Metatarsalgia

Question 5

What is the management of hallux valgus?

Answer 5

Shoe wear modification

Orthotics to offload pressure and correct deformity

Activity modification

Analgesia

Osteotomy of 1st metatarsal +/- proximal phalanx

Question 6

What is hallux rigidus?

Answer 6

Disorder of the joints located at the big toe

Question 7

What causes hallux rigidus?

Answer 7

Idiopathic

Genetic

Multiple microtrauma

Bimodal distribution of age

Question 8

How does hallux rigidus present?

Answer 8

Mainly asymptomatic

Pain, often at extreme dorsiflexion

Limitation of range of movement

Osteoarthritis of 1st MTP joint

Question 9

What is the management of hallux rigidus?

Answer 9

Activity modification

Shoe wear with rigid sole

Analgesia

Arthrodesis/1st MTPJ fusion

Question 10

What are the types of lesser toe deformities?

Answer 10

Hammer

Claw

Mallet

Question 11

What can cause lesser toe deformities?

Answer 11

Imbalance between flexors/extensors

Shoe wear

Neurological

Rheumatoid arthritis

Idiopathic

Question 12

What is morton’s neuroma?

Answer 12

Thickening of the tissue around the nerves leading to the toes

Question 13

What sex is more commonly affected by Mortons neuroma?

Answer 13

F>M

Question 14

Which age group is most commonly affected by Morton’s neuroma?

Answer 14

40-60s

Question 15

What causes Morton’s neuroma?

Answer 15

Mechanically induced degenerative neuropathy

Frequently associated with wearing high healed shoes

Question 16

How does Morton’s neuroma present?

Answer 16

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

Question 17

How is Morton’s neuroma managed?

Answer 17

US for diagnosis

Avoid high heels

Metatarsal pad

Referall if symptoms persist over 3 months with modifications

Corticosteroid injection or neurectomy

Question 18

What is plantar fibromatosis?

Answer 18

Non-malignant thickening of the deep connective tissue or fascia of the feet

Question 19

How does plantar fibromatosis present?

Answer 19

Progressive thickening

Usually asymptomatic unless very large or on weightbearing area

Question 20

How is plantar fibromatosis managed?

Answer 20

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

Question 21

What is achilles tendonitis?

Answer 21

Degenerative/overuse condition of the achilles tendon with little inflammation

Question 22

What causes tendinopathy achilles tendonitis?

Answer 22

Most common in non-athletic populations

Age 40+

Obesity

Steroids

Diabetes

Ciprofloxacin

Question 23

What causes paratendinopathy achilles tendonitis?

Answer 23

Athletes

Question 24

How does achilles tendonitis present?

Answer 24

Pain during and following exercise

Recurrent episodes

Difficulty fitting shoes

Tenderness

Rupture

Question 25

What tests can assess for rupture of achilles tendon?

Answer 25

Simmonds Angle of the Dangle Maltes

Question 26

What is the management of achilles tendonitis?

Answer 26

Activity modification Weight loss Shoe wear modification Physiotherapy Extra-corporeal shockwave treatment Immobilisation with below knee cast Gastrocnemius recession Release and debridement of tendon

Question 27

What is the initial imaging modality of choice for suspected achilles tendon rupture?

Answer 27

US

Question 28

What causes plantar fascitis?

Answer 28

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

Question 29

How does plantar fascitis present?

Answer 29

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

Question 30

How is plantar fascitis managed?

Answer 30

Weight loss if high BMI Rest feet where possible Supportive shoes and insoles NSAIDs Corticosteroid injections Orthopaedic referral

Question 31

How does Posterior Tibial Tendon Dysfunction present?

Answer 31

Double and single heel raise: Heel should swing from valgus to varus as heel rises Medial or lateral pain Acquired adult flat foot planovalgus

Question 32

How is posterior tibial tendon dysfunction managed?

Answer 32

Orthotics: Medial arch support Reconstruction of tendon/tendon transfer Triple fusion: Subtalar, talonavicular and calcaneocuboid

Question 33

Give features of stress fractures

Answer 33

Repetitive activity and loading of normal bone resulting in small hairline fractures Severe pain Callus formation Antalgic gait

Question 34

What bone is the most common for stress fractures?

Answer 34

2nd metatarsal, occuring in otherwise healthy individuals

Question 35

What is the most common fracture of the foot?

Answer 35

5th metatarsal, often following inversion injuries of the ankle (1st is least common)

Question 36

Give features of club foot

Answer 36

Inverted and plantar flexed foot Usually diagnosed on the newborn exam

Question 37

What is associated with club foot?

Answer 37

Spina bifida Cerebral palsy Edward's syndrome Oligohydramnios Arthrogryposis

Question 38

How is clubfoot managed?

Answer 38

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