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Yr 3 MSK > Foot problems > Flashcards

Foot problems Flashcards

1
Q

Name some forefoot problems

A
  • Hallux valgus
  • Hallux rigidus
  • Lesser toe deformities
  • Mortons neuroma
  • Metatarsalgia
  • Rheumatoid forefoot
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2
Q

What is hallux valgus?

A
  • Bunions

- Big toe tilts over smaller toes > bony lump appears on inside of foot

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3
Q

Aetiology of hallux valgus?

A
  • Genetic
  • Foot wear
  • Female > male
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4
Q

Symptoms of hallux valgus?

A
  • Pressure symptoms from show wear
  • Pain from toe crossing over
  • Metatarsalgia
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5
Q

Pathogenesis of hallux valgus?

A
  • 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
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6
Q

Diagnosis of hallux valgus?

A
  • Clinical

- X-ray

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7
Q

Non operative management of hallux valgus?

A
  • Shoe wear modification
  • Orthotics
  • Activity modification
  • Analgesia
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8
Q

Operative mangement of hallux valgus?

A
  • Release lateral soft tissues

- Osteotomy 1st metatarsal

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9
Q

What is hallux rigidus?

A
  • Latin for stiff big toe
  • Osteoarthritis of 1st MTP joint
  • Bimodal distribution of age
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10
Q

Symptoms of hallux rigidus?

A
  • Pain, often at extreme of dorsiflexion

- Limited ROM

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11
Q

Diagnosis of hallux rigidus?

A
  • Clinical

- X-ray

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12
Q

Non-operative management of hallux rigidus?

A
  • Shoe wear modification
  • Activity modification
  • Analgesia
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13
Q

Operative management of hallux rigidus?

A
  • Cheilectomy
  • Arthrodesis
  • Arthroplasty
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14
Q

What are some lesser toe deformities?

A
  • Claw toes
  • Hammer toes
  • Mallet toes
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15
Q

Aetiology of lesser toe deformities?

A
  • Imbalance between flexors/extensors
  • Show wear
  • Neurological
  • RA
  • Idiopathic
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16
Q

Symptoms of lesser toe deformities?

A
  • Deformity
  • Pain from dorsum
  • Pain from plantar side (metatarsalgia)
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17
Q

Non-operative management of lesser toe deformities?

A
  • Activity modification
  • Shoe wear modification
  • Orthotics
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18
Q

Operative management of lesser toe deformities?

A
  • Flexor to extensor transfer
  • Fusion of IP joint
  • Release MTP joint
  • Shortening osteotomy of metatarsal
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19
Q

What is mortons neuroma?

A

Thickening of nerve in foot causing pain and numbness

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20
Q

Aetiology of mortons neuroma?

A
  • Females 40-60y

- High heeled shoes

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21
Q

Symptoms of mortons neuroma?

A
  • Typically affects 3rd followed by 2nd webspace/toes
  • Intermittent neuralgic burning pain into toes
  • Altered sensation in webspace
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22
Q

Diagnosis of mortons neuroma?

A
  • Clinical
  • Mulders click
  • USS/MRI
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23
Q

Management of mortons neuroma?

A
  • Injections

- Surgical excision

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24
Q

What is metatarsalgia?

A
  • Symptom, not a diagnosis

- Synovitis, bursitis, arthitis, neuralgia, neuromata, freiburgs disease

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25
Q

What is the treatment of rheumatoid forefoot?

A
  • Shoe wear modification
  • Activity modification
  • Orthotics
  • 1st MTP arthrodesis
  • 2-5th toe excision arthroplasty
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26
Q

What are some midfoot problems?

A
  • Ganglia
  • OA
  • Plantar fibromatosis
27
Q

.Aetiology of dorsal foot ganglia?

A
  • Idiopathic
  • Underlying arthritis
  • Underlying tendon pathology
28
Q

Symptoms of dorsal foot ganglia?

A
  • Pain from wearing shoes

- General pain

29
Q

Treatment of dorsal foot ganglia?

A

Non-op:
-Aspiration
Op:
-Excision

30
Q

Different variations of arthritis affecting midfoot?

A
  • Post traumatic
  • OA
  • RA
31
Q

Treatment of midfoot arthritis?

A 
Non op:
-Activity/shoewear/orthotics
-Injections
Op:
-Fusion
32
Q

What is plantar fibromatosis?

A
  • Ledderhose disease
  • Progressive
  • ‘Dupytrens of foot’
  • Symptomatic on large/weightbearing areas
33
Q

Treatment of plantar fibromatosis?

A 
Non op:
-Shoewear/orthotics/activities etc
Op:
-Excision
-RT
34
Q

Name some hindfoot problems?

A
  • Achilles tendonitis/tendinosis
  • Plantar fasciitis
  • Ankle OA
  • Tibialis posterior dysfunction
  • Cavovarus foot
35
Q

What is achilles tendinosis?

A
  • Degenerative/overuse condition with little inflammation

- Tendinopathy describes symptoms

36
Q

What is achilles tendinopthy?

A

->1 clinical condition

> Insertional tendinopathy: <2cm of insertion
Non insertional tendinopathy: 2-7cm of insertion
Bursitis: retrocalcaneal/superficial calcaneal
Paratendinopathy

37
Q

What is the aetiology of

  • Paratendonopathy
  • Tendonopathy?
A

Paratendonopathy

  • Athletic populations
  • 30-40y
  • 2:1 male

Tendonopathy

  • Non-athletic populations
  • 40+y
  • Obesity
  • Steroids
  • DM
38
Q

Symptoms of achilles tendinopathy?

A
  • Pain during/after exercise
  • Recurrent
  • Difficulty fitting shoes
  • RUPTURE
39
Q

Diadnosis of mono?

A
  • Clinical (simmonds, matles, angle of dangle)
  • USS
  • MRI
40
Q

Treatment of achilles tendinopathy?

A 
Non op:
-Activity/shoewear etc
-Weight loss
-Physiotherapy
-Extra corporeal shockwave treatment
-Immobilisation
Op:
-Gastrocnemius recession
-Release and debridement of tendon
41
Q

What is plantar fasciitis?

A

Chronic degenerative change, fibroblast hypertrophy, absent inflammatory cells, avascularity

42
Q

Aetiology of plantar fasciitis?

A
  • High intensity training/rapid inc in training intensity
  • Poorly padded shoes when running
  • Obesity
  • Prolonged standing
43
Q

Symptoms of plantar fasciitis?

A
  • Pain in morning/weight bearing

- Located at origin of plantar fascia

44
Q

Differential diagnosis of plantar fasciitis?

A
  • Nerve entrapment syndrome
  • Arthritis
  • Calcaneal pathology
45
Q

Diagnosis of plantar fasciitis?

A
  • Clinical

- Xrays/USS/MRI

46
Q

Initial treatment of plantar fasciitis?

A
  • Rest
  • Stretching
  • Ice
  • NSAIDS
  • Orthotics (heel pads)
  • Physio
  • Weight loss
  • Corticosteroid injection
  • Night splinting
47
Q

Newer/third line treatments of plantar fasciitis?

A
  • Extracorporeal shockwave therapy
  • Topaz plasma coblation
  • Nitric oxide
  • Platelet rich plasma
  • Endoscopic/open surgery
48
Q

Aetiology of ankle arthritis?

A
  • 46y on average
  • Commonly post traumatic
  • Idiopathic
49
Q

Symptoms of ankle arthritis?

A
  • Pain

- Stiffness

50
Q

Diagnosis of ankle arthritis?

A
  • Clinical
  • Xray
  • CT
51
Q

Non operative management of ankle arthritis?

A
  • Weight loss
  • Activity modification
  • Analgesia
  • Physiotherapy
  • Steroid injections
52
Q

Operative management of ankle arthritis?

A
  • Arthrodesis

- Joint replacement

53
Q

What is tibialis posterior tendon dysfunction?

A
  • Acquired adult flat foot planovalgus
  • Relatively common
  • Clinical diagnosis mainly (MRI can assess tendon)
  • Medial/lateral pain
54
Q

Management of tibialis posterior tendon dysfunction?

A
  • Orthotics (medial arch support)
  • Reconstruction of tendon
  • Triple fusion (subtalar, talonavicular and calcaneocuboid)
55
Q

What is the aetiology of diabetic foot ulcer?

A
  • Diabetic neuropathy
  • Diabetic autonomic neuropathy
  • Poor vasc supply
  • Lack of patient education
56
Q

Non op treatment of diabetic foot ulcer?

A

-Prevention
-Modify detriments to healing
>Diabetic control
>Smoking
>Vasc supply
>External pressure
>Internal pressure (deformity)
>Infection
>Nutrition

57
Q

Op treatment of diabetic foot ulcer?

A
  • Improve vasc supply
  • Debride ulcers
  • Correct deformity
  • Amputate
58
Q

Prognosis of diabetic foot ulcer?

  • Ulceration
  • Amputations preceded by ulcers
  • Ulcers leading to amputation
  • Mortality
A
  • 15% diabetics get ulcers
  • 85% amputations preceded by ulcers
  • 25% ulcers lead to amputation
  • 50% mortality
59
Q

Aetiology of charcots foot(neuroarthropathy)?

A

-Any neuropathy cause (DM commonest)

60
Q

Pathophysiology theories of charcots foot?

A
  • Neurotraumatic (lack of propioception and protective pain sensation)
  • Neurovascular (abnormal ANS = inc vasc supply and bone resorption)
61
Q

What is charcots foot?

A

Characterised by rapid bone destruction occuring in 3 stages:

  • Fragmentation
  • Coalescence
  • Remodelling
62
Q

Diagnosis of charcots foot?

A
  • Clinical
  • Consider in neuropathy
  • Frequently not painful
  • Xray
  • MRI
63
Q

Management of charcots foot?

A
  • Prevention
  • Immobilisation unti acute fragmentation resolved
  • Correct deformity (can lead to ulceration)

Yr 3 MSK (12 decks)

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