Foot problems Flashcards
Name some forefoot problems
- Hallux valgus
- Hallux rigidus
- Lesser toe deformities
- Mortons neuroma
- Metatarsalgia
- Rheumatoid forefoot
What is hallux valgus?
- Bunions
- Big toe tilts over smaller toes > bony lump appears on inside of foot
Aetiology of hallux valgus?
- Genetic
- Foot wear
- Female > male
Symptoms of hallux valgus?
- Pressure symptoms from show wear
- Pain from toe crossing over
- Metatarsalgia
Pathogenesis of hallux valgus?
- Lateral angulation of great toe
- Tendons pull realigned to lateral to central of rotation of toe, worsening deformity
- Vicious cycle of inc. pull = inc. deformity
- Sesamoid bones sublux =less weight through big toe
- As deformity progresses deformity of lesser toes occur
Diagnosis of hallux valgus?
- Clinical
- X-ray
Non operative management of hallux valgus?
- Shoe wear modification
- Orthotics
- Activity modification
- Analgesia
Operative mangement of hallux valgus?
- Release lateral soft tissues
- Osteotomy 1st metatarsal
What is hallux rigidus?
- Latin for stiff big toe
- Osteoarthritis of 1st MTP joint
- Bimodal distribution of age
Symptoms of hallux rigidus?
- Pain, often at extreme of dorsiflexion
- Limited ROM
Diagnosis of hallux rigidus?
- Clinical
- X-ray
Non-operative management of hallux rigidus?
- Shoe wear modification
- Activity modification
- Analgesia
Operative management of hallux rigidus?
- Cheilectomy
- Arthrodesis
- Arthroplasty
What are some lesser toe deformities?
- Claw toes
- Hammer toes
- Mallet toes
Aetiology of lesser toe deformities?
- Imbalance between flexors/extensors
- Show wear
- Neurological
- RA
- Idiopathic
Symptoms of lesser toe deformities?
- Deformity
- Pain from dorsum
- Pain from plantar side (metatarsalgia)
Non-operative management of lesser toe deformities?
- Activity modification
- Shoe wear modification
- Orthotics
Operative management of lesser toe deformities?
- Flexor to extensor transfer
- Fusion of IP joint
- Release MTP joint
- Shortening osteotomy of metatarsal
What is mortons neuroma?
Thickening of nerve in foot causing pain and numbness
Aetiology of mortons neuroma?
- Females 40-60y
- High heeled shoes
Symptoms of mortons neuroma?
- Typically affects 3rd followed by 2nd webspace/toes
- Intermittent neuralgic burning pain into toes
- Altered sensation in webspace
Diagnosis of mortons neuroma?
- Clinical
- Mulders click
- USS/MRI
Management of mortons neuroma?
- Injections
- Surgical excision
What is metatarsalgia?
- Symptom, not a diagnosis
- Synovitis, bursitis, arthitis, neuralgia, neuromata, freiburgs disease
What is the treatment of rheumatoid forefoot?
- Shoe wear modification
- Activity modification
- Orthotics
- 1st MTP arthrodesis
- 2-5th toe excision arthroplasty
What are some midfoot problems?
- Ganglia
- OA
- Plantar fibromatosis
.Aetiology of dorsal foot ganglia?
- Idiopathic
- Underlying arthritis
- Underlying tendon pathology
Symptoms of dorsal foot ganglia?
- Pain from wearing shoes
- General pain
Treatment of dorsal foot ganglia?
Non-op:
-Aspiration
Op:
-Excision
Different variations of arthritis affecting midfoot?
- Post traumatic
- OA
- RA
Treatment of midfoot arthritis?
Non op: -Activity/shoewear/orthotics -Injections Op: -Fusion
What is plantar fibromatosis?
- Ledderhose disease
- Progressive
- ‘Dupytrens of foot’
- Symptomatic on large/weightbearing areas
Treatment of plantar fibromatosis?
Non op: -Shoewear/orthotics/activities etc Op: -Excision -RT
Name some hindfoot problems?
- Achilles tendonitis/tendinosis
- Plantar fasciitis
- Ankle OA
- Tibialis posterior dysfunction
- Cavovarus foot
What is achilles tendinosis?
- Degenerative/overuse condition with little inflammation
- Tendinopathy describes symptoms
What is achilles tendinopthy?
->1 clinical condition
> Insertional tendinopathy: <2cm of insertion
Non insertional tendinopathy: 2-7cm of insertion
Bursitis: retrocalcaneal/superficial calcaneal
Paratendinopathy
What is the aetiology of
- Paratendonopathy
- Tendonopathy?
Paratendonopathy
- Athletic populations
- 30-40y
- 2:1 male
Tendonopathy
- Non-athletic populations
- 40+y
- Obesity
- Steroids
- DM
Symptoms of achilles tendinopathy?
- Pain during/after exercise
- Recurrent
- Difficulty fitting shoes
- RUPTURE
Diadnosis of mono?
- Clinical (simmonds, matles, angle of dangle)
- USS
- MRI
Treatment of achilles tendinopathy?
Non op: -Activity/shoewear etc -Weight loss -Physiotherapy -Extra corporeal shockwave treatment -Immobilisation Op: -Gastrocnemius recession -Release and debridement of tendon
What is plantar fasciitis?
Chronic degenerative change, fibroblast hypertrophy, absent inflammatory cells, avascularity
Aetiology of plantar fasciitis?
- High intensity training/rapid inc in training intensity
- Poorly padded shoes when running
- Obesity
- Prolonged standing
Symptoms of plantar fasciitis?
- Pain in morning/weight bearing
- Located at origin of plantar fascia
Differential diagnosis of plantar fasciitis?
- Nerve entrapment syndrome
- Arthritis
- Calcaneal pathology
Diagnosis of plantar fasciitis?
- Clinical
- Xrays/USS/MRI
Initial treatment of plantar fasciitis?
- Rest
- Stretching
- Ice
- NSAIDS
- Orthotics (heel pads)
- Physio
- Weight loss
- Corticosteroid injection
- Night splinting
Newer/third line treatments of plantar fasciitis?
- Extracorporeal shockwave therapy
- Topaz plasma coblation
- Nitric oxide
- Platelet rich plasma
- Endoscopic/open surgery
Aetiology of ankle arthritis?
- 46y on average
- Commonly post traumatic
- Idiopathic
Symptoms of ankle arthritis?
- Pain
- Stiffness
Diagnosis of ankle arthritis?
- Clinical
- Xray
- CT
Non operative management of ankle arthritis?
- Weight loss
- Activity modification
- Analgesia
- Physiotherapy
- Steroid injections
Operative management of ankle arthritis?
- Arthrodesis
- Joint replacement
What is tibialis posterior tendon dysfunction?
- Acquired adult flat foot planovalgus
- Relatively common
- Clinical diagnosis mainly (MRI can assess tendon)
- Medial/lateral pain
Management of tibialis posterior tendon dysfunction?
- Orthotics (medial arch support)
- Reconstruction of tendon
- Triple fusion (subtalar, talonavicular and calcaneocuboid)
What is the aetiology of diabetic foot ulcer?
- Diabetic neuropathy
- Diabetic autonomic neuropathy
- Poor vasc supply
- Lack of patient education
Non op treatment of diabetic foot ulcer?
-Prevention
-Modify detriments to healing
>Diabetic control
>Smoking
>Vasc supply
>External pressure
>Internal pressure (deformity)
>Infection
>Nutrition
Op treatment of diabetic foot ulcer?
- Improve vasc supply
- Debride ulcers
- Correct deformity
- Amputate
Prognosis of diabetic foot ulcer?
- Ulceration
- Amputations preceded by ulcers
- Ulcers leading to amputation
- Mortality
- 15% diabetics get ulcers
- 85% amputations preceded by ulcers
- 25% ulcers lead to amputation
- 50% mortality
Aetiology of charcots foot(neuroarthropathy)?
-Any neuropathy cause (DM commonest)
Pathophysiology theories of charcots foot?
- Neurotraumatic (lack of propioception and protective pain sensation)
- Neurovascular (abnormal ANS = inc vasc supply and bone resorption)
What is charcots foot?
Characterised by rapid bone destruction occuring in 3 stages:
- Fragmentation
- Coalescence
- Remodelling
Diagnosis of charcots foot?
- Clinical
- Consider in neuropathy
- Frequently not painful
- Xray
- MRI
Management of charcots foot?
- Prevention
- Immobilisation unti acute fragmentation resolved
- Correct deformity (can lead to ulceration)
