Foot Problems Flashcards
What are some of the general non operative treatment options for foot problems?
Analgesia Physiotherapy Weight loss Shoe wear modification Activity modification Orthotics
What are some common forefoot problems?
Hallux valgus Hallux rigidus Lesser toe deformities Morton’s neuroma Metatarsalgia Rheumatoid Forefoot
What are the symptoms of hallux valgus?
Pressure symtoms from shoe wear
Pain form crossing over of toes
Metatarsalgia
What is the pathogenesis of hallux valgus?
Lateral angulation of great toe
Tendons pull realigned to lateral of centre of rotation of toe worsening deformity
Sesamoid bones sublux
As deformity progresses abnormalities of lesser toes occur
How is a diagnosis of hallux valgus made?
Clinical examination
Xray
What are the management options for hallux valgus?
Shoe wear modification Orthotics Activity modification Analgesia Release lateral soft tissues Osteotomy 1st metatarsal +/- proximal phalanx
What is hallux rigidus?
Osteoarthritis of 1st MCP
What are the symptoms of hallux rigidus?
Pain often at extreme of dorsiflexion
Limitation of range of movement
What are the management options for hallux rigidus?
Activity modification Shoe wear with rigid sole Analgesia Cheilectomy Arthrodesis Arthroplasty
What is the aetiology of lesser toe deformity?
Imbalance of flexors/extensors Shoe wear Neurological Rheumatoid arthritis Idiopathic
What are the general symptoms of lesser toe deformities?
Pain from dorsum
Pain from plantar side
What are the treatment options for lesser toe deformities?
Activity modification Shoe wear (flat shoes with high toe box) Orthotic insoles Flexor to extensor transfer Fusion of interphalangeal joint Release metatarsophalangeal joint Shortening osteotomy of metatarsal
What is the aetiology of Morton’s neuroma?
High healed shoes
What are the symptoms of Morton’s neuroma?
Typically affects 3rd flowed by 2nd webspace/toes
Neuralgic burning pain into toes
Intermittent
Altered sensation in webspace
How is a diagnosis of Morton’s neuroma made?
USS/MRI
Mulder’s click
What is the management for Morton’s neuroma?
Injection for small lesions
Excision of lesion including a action of normal nerve
What is the treatment for rheumatoid forefoot?
Shoe/orthotics/activity modification
1st MTPJ arthrodesis
2-5th oe excision arthroplasty
What are the symptoms of dorsal foot ganglia?
Pain from pressure of shoewear
Pain from underlying problem
What is the treatment for dorsal foot ganglia?
Aspiration
Excision
What are the treatment options for mid foot arthritis?
Activity/shoewear/orthotics
Xray guided injections
Fusion operation
What are the treatment options for plantar fibromatosis?
Avoid pressure
Shoe wear/orthotics
Excision
Radiotherapy
What is an insertional tedinopathy?
With 2cm of insertion
What is a non-insertional/id-substance tendinopathy?
2-7cm of insertion
What is achilles tendinopathy associated with?
Non-athletic population >40 Obesity Steroids Diabetes
What are the symptoms of an achilles tendinopathy?
Pain during exercise Pain following exercise Recurrent episodes Difficulty fitting shoes Rupture
How is a diagnosis of an achilles tendinopathy made?
Tenderness
Tests for rupture (Simmonds, Matles)
USS
MRI
What are the treatment options for achilles tendinopathy?
Activity modification Weight loss Shoe wear modification Physio Extra-corporeal shockwave treatment Immobilisation Gastrocnemius recession Release and debridement of tendon
What is fasciosis?
Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen, asvascularity
What is the aetiology of plantar fasciitis?
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
What are the symptoms of plantar fasciitis?
Pain first thing in morning Pain on weight bearing after rest Post-static dyskinesia Pain located at origin of plantar fascia Frequently long lasting – 2 years or more
What is the differential diagnosis of plantar fasciitis?
Nerve entrapment syndrome
Arthritis
Calcaneal pathology
How is the diagnosis of plantar fasciitis made?
Mainly clinical
Occasionally x-rays, ultrasound and MRI
What are the treatment options 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
What are the symptoms of ankle arthritis?
Pain
Stiffness
How is a diagnosis of ankle arthritis made?
Clinical
Xrays
CT
What are the management options for ankle arthritis?
Weight loss, activity modification, analgesia, physiotherapy, steroid injections
Arthroscopic anterior debridement
Arthrodesis
Joint replacement
What are the management options for tibialis posterior tendon dysfunction?
Orthotics
Reconstruction of tendon
Triple fusion
What is the treatment for diabetic foot ulcer?
Prevention Improve diabetic control Smoking Vascular supply External pressure (splints/shoes/weight bearing) Internal pressure (deformity) Infection Nutrition Debride ulcers and get deep samples for microbiology Correct any deformity to offload area Amputation
What is the pathophysiology of Charcot’s neuroarthropathy?
Lack of proprioception and protective pain sensation
Abnormal autonomic nervous system results in increased vascular supply and bone resorption
What are the 3 stages of Charcot’s neuroarthropathy?
Fragmentation
Coalescence
Remodelling
What are the management options for Charcot’s neuroarthropathy?
Prevention
Immobilisation
Correct deformity
