Foot problems Flashcards
name some forefoot problems
- hallux valgus
- hallux rigid
- morton’s neuroma
- metatarsalgia
what is hallux valgus
bunions
what are the risk factors of hallux valgus
- genetics
- footwear
- gender (female)
what are the symptoms of hallux valgus
- pain from footwear
- pain from toes crossing over
- metatarsalgia
why would you x-ray someone with hallux valgus
- to show the severity of the deformity
- to rule out degenerative changes
how I hallux valgus managed
operative = release of the lateral soft tissues, osteotomy of the 1st metatarsal non-operative = analgesia, activity modification, shoe wear modification, orthotics
what is meant by hallux rigidus
a stiff big toe
how is hallux rigidus managed
operative:
- cheilectomy (removal of some bone at the head of the 1st metatarsal bone)
- arthrodesis (immobilising the joint via the fusion of the bones)
- arthroplasty (surgical reconstruction of a joint)
non-operative:
- activity modification
- analgesia
- modified footwear
what is the gold standard treatment for hallux rigidus
arthrodesis
name some lesser toe deformities
- claw toes
- hammer toes
- mallet toes
what joint is affected in claw toes
both the proximal and the distal interphalangeal joints of the foot
what joint is affected in hammer toes
the proximal interphalangeal joints
what joint is affected in mallet toes
the distal interphalangeal joitns
what are the causes of lesser toe deformities
shoe wear, neurological problems, rheumatoid arthritis, imbalance between the flexors and the extensors
what are the treatment options for lesser toe deformities
non-operative = activity modification, shoe wear modification (flat shoes with high toe box) and orthotic insoles
operative = flexor to extensor transfer, fusion of the interphalangeal joints, shortening of the metatarsal bone
what is Morton’s neuroma
compression of the plantar digital nerve in the foot (usually between the 3rd and 4th toe) - due to the thickening of the transverse inter metatarsal ligament
who is most affected by Morton’s neuroma
women between 40-60 and more in those who wear high heeled shoes
what are the symptoms of Morton’s neuroma
burning and altered sensation in the affected webspace - the symptoms are intermittent
what is the best tool for the diagnosis of Morton’s neuroma
USS
what is meant by Mulder’s click
this is a clinical test that can be used to help the diagnosis of Morton’s neuroma - this is when pain is provoked by squeezing the metatarsal bones together
what is the management of Morton’s neuroma
- injections for small lesions or excision of the lesion
what is meant by metatarslgia
this is a symptom associated with pain and inflammation in the ball of the foot
what is rheumatoid forefoot
this is an autoimmune (type 3 hypersensitivity) disease of the foot - there may be signs of hallux values, metatarsalgia and toe deformities
what is the treatment of rheumatoid forefoot
- activity modification
- shoe wear modification
- orthotics
- 1st metatarsalphalangeal arthrodesis
- arthroplasty
name some mid foot problems
ganglia, osteoarthritis, plantar fibromatosis
where do dorsal foot ganglia arise from
from joints or tendon sheaths - usually from underlying pathology
what is the treatment of dorsal foot ganglia
aspiration or excision
what is plantar fibromatosis
this is known as dupuytrens of the foot - there is thickening of the fascia of the foot and nodular development
what is the treatment of plantar fibromatosis
radiotherapy, excision, shoe wear modification and orthotics
name some hind foot problems
- achilles tendonitis
- plantar fasciitis
- ankle osteoarthritis
- cavernous foot
- posterior tibilais tendon dysfunction
in which people is achilles tendonopathy most common
non-athletic, obese people, those with diabetes, those on steroids and generally >40 years old
in which people is para-tendonopaty most common
athletic populations
what is achilles tendonitis not the correct name
there is very little inflammation
what are the symptoms of achilles tendonopathy
pain during and following exercise, difficulty putting on shoes
what are the risk factors for achilles tendonopathy
obesity, diabetes, steroid use, age (>40)
what clinical test is used to assess achilles tendon rupture
Simmond’s test
what is the treatment of achilles tendonopathy
non-operative = weight loss, activity modification, shoe wear modification, physiotherapy, shock wave treatment, immobilisation
operative = gastrocnemius resection, release of the tendon
what is plantar fasciitis and what are the symptoms
chronic degenerative changes of the plantar fascia in the foot - proliferation of fibroblasts
Symptoms = pain on weight bearing, pain first thing in the morning, pain located at the origin of the plantar fascia
what are the causes of plantar fasciitis
- prolonged standing
- running I poorly padded shoes
- obesity
what is the differential diagnosis of plantar fasciitis
nerve entrapment or arthritis
what is the treatment of plantar fasciitis
rest, ice, NSAIDs, physiotherapy, weight loss, heel pads, corticosteoid injections, platelet rich plasma, nitric oxide, shockwave therapy
what are the symptoms of ankle arthritis
pain and stiffness of the ankle
what are the management options of ankle arthritis
- activity modification
- weight loss
- anlagesia
- physiotherapy
- joint replacement surgery
- steroid injections
- arthrodesis
what is the result of dysfunction of the posterior tibial tendon
flattening of the arch of the foot
what are the most common symptoms of posterior tibial tendon dysfunction
- flattening of the foot (progressive)
- inward rolling of the foot
- pain and swelling of the foot
what is the treatment of posterior tibial tendon dysfunction
orthotics or surgery
in which direction should the heels swing as they rise
from valgus to varus
what are the management options of diabetic foot ulcers
- stop smoking
- external pressure
- surgery to correct deformity and to debris the ulcer
- surgery to improve vascular supply
- amputation
- nutrition referral
what is Charcots neuropathy
this is rapid bone deconstruction of the foot causing inflammation and swelling
how is Charcots neuropathy diagnosed
radiographs, MRI and clinically
what are the treatment options of Charcots neuropathy
surgery to correct the deformity and immobilisation
