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Musculoskeletal + Rheumatology > Foot Pathology > Flashcards

Foot Pathology Flashcards

1
Q

What is hallux valgus?

A

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

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2
Q

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

A

F>M

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3
Q

What causes hallux valgus?

A

Genetic

Foot wear

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4
Q

How does hallux valgus present?

A

Pressure symptoms from show wear

Pain from crossing over of toes

Metatarsalgia

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5
Q

What is the management of hallux valgus?

A

Shoe wear modification

Orthotics to offload pressure and correct deformity

Activity modification

Analgesia

Osteotomy of 1st metatarsal +/- proximal phalanx

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6
Q

What is hallux rigidus?

A

Disorder of the joints located at the big toe

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7
Q

What causes hallux rigidus?

A

Idiopathic

Genetic

Multiple microtrauma

Bimodal distribution of age

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8
Q

How does hallux rigidus present?

A

Mainly asymptomatic

Pain, often at extreme dorsiflexion

Limitation of range of movement

Osteoarthritis of 1st MTP joint

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9
Q

What is the management of hallux rigidus?

A

Activity modification

Shoe wear with rigid sole

Analgesia

Arthrodesis/1st MTPJ fusion

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10
Q

What are the types of lesser toe deformities?

A

Hammer

Claw

Mallet

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11
Q

What can cause lesser toe deformities?

A

Imbalance between flexors/extensors

Shoe wear

Neurological

Rheumatoid arthritis

Idiopathic

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12
Q

What is morton’s neuroma?

A

Thickening of the tissue around the nerves leading to the toes

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13
Q

What sex is more commonly affected by Mortons neuroma?

A

F>M

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14
Q

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

A

40-60s

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15
Q

What causes Morton’s neuroma?

A

Mechanically induced degenerative neuropathy

Frequently associated with wearing high healed shoes

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16
Q

How does Morton’s neuroma present?

A

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

17
Q

How is Morton’s neuroma managed?

A

US for diagnosis

Avoid high heels

Metatarsal pad

Referall if symptoms persist over 3 months with modifications

Corticosteroid injection or neurectomy

18
Q

What is plantar fibromatosis?

A

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

19
Q

How does plantar fibromatosis present?

A

Progressive thickening

Usually asymptomatic unless very large or on weightbearing area

20
Q

How is plantar fibromatosis managed?

A

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

21
Q

What is achilles tendonitis?

A

Degenerative/overuse condition of the achilles tendon with little inflammation

22
Q

What causes tendinopathy achilles tendonitis?

A

Most common in non-athletic populations

Age 40+

Obesity

Steroids

Diabetes

Ciprofloxacin

23
Q

What causes paratendinopathy achilles tendonitis?

A

Athletes

24
Q

How does achilles tendonitis present?

A

Pain during and following exercise

Recurrent episodes

Difficulty fitting shoes

Tenderness

Rupture

25
Q

What tests can assess for rupture of achilles tendon?

A

Simmonds

Angle of the Dangle

Maltes

26
Q

What is the management of achilles tendonitis?

A

Activity modification

Weight loss

Shoe wear modification

Physiotherapy

Extra-corporeal shockwave treatment

Immobilisation with below knee cast

Gastrocnemius recession

Release and debridement of tendon

27
Q

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

A

US

28
Q

What causes plantar fascitis?

A

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

29
Q

How does plantar fascitis present?

A

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

30
Q

How is plantar fascitis managed?

A

Weight loss if high BMI

Rest feet where possible

Supportive shoes and insoles

NSAIDs

Corticosteroid injections

Orthopaedic referral

31
Q

How does Posterior Tibial Tendon Dysfunction present?

A

Double and single heel raise: Heel should swing from valgus to varus as heel rises

Medial or lateral pain

Acquired adult flat foot planovalgus

32
Q

How is posterior tibial tendon dysfunction managed?

A

Orthotics: Medial arch support

Reconstruction of tendon/tendon transfer

Triple fusion: Subtalar, talonavicular and calcaneocuboid

33
Q

Give features of stress fractures

A

Repetitive activity and loading of normal bone resulting in small hairline fractures

Severe pain

Callus formation

Antalgic gait

34
Q

What bone is the most common for stress fractures?

A

2nd metatarsal, occuring in otherwise healthy individuals

35
Q

What is the most common fracture of the foot?

A

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

36
Q

Give features of club foot

A

Inverted and plantar flexed foot

Usually diagnosed on the newborn exam

37
Q

What is associated with club foot?

A

Spina bifida

Cerebral palsy

Edward’s syndrome

Oligohydramnios

Arthrogryposis

38
Q

How is clubfoot managed?

A

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

Musculoskeletal + Rheumatology (16 decks)

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