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MSK > Foot Problems > Flashcards

Foot Problems Flashcards

1
Q

what are the symptoms f hallux valgus?

A

> metatarsalgia
pain from crossing over of toes
pressure symptoms from shoes

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2
Q

describe the pathogenesis of hallux valgus

A

tendons pull realigned to lateral centre rotation of toe worsening deformity creating alter al angulation of the big toe. the lesser toes then deform ad the sesamoid bones sublux so less weight goes through the big toes

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3
Q

why would you carry out an xray in hallux valgus?

A

> determine the severity of the bone deformity

> exclude associated degenerative changes

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4
Q

what non-operative management is there for hallux valgus?

A

> wide, high toe box shoes
orthotics to off load pressure
analgesia
activity modification

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5
Q

what operative management is there for hallux valgus?

A

> osteotomy of 1st metatarsal (+/- proximal phalanx)

> release soft tissue

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6
Q

when is operative management of hallux valgus indicated?

A

> non-operative has failed

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7
Q

what are the symptoms of hallux rigidus?

A

> limitation of range of movement
asymptomatic
pain often in extreme dorsiflexion

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8
Q

what is osteoarthritis of the 1st metatarsal joint called?

A

hallux rigidus

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9
Q

how is hallux rigidus diagnosed?

A

> clinically

> xray: no joint space + osteophytes

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10
Q

what non-operative management is there for hallux rigidus?

A

> shoe and rigid sole
analgesia
activity modification

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11
Q

what operative management is there for hallux rigidus?

A

> arthroplasty
cheilectomy
arthroalests

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12
Q

what factors are associated with interdigital neuralgia (mortons neuroma)?

A

> high heels
females
40-60 yrs

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13
Q

what causes mortons neuralgia?

A

it is a mechanically induced degenerative neuropathy. the common digital nerve is relatively tethered to the 7th metatarsal and movement in the adjacent metatarsal creates a mechanical tear

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14
Q

what are the symptoms of mortons neuroma?

A

> neuralgia pain (intermittent)
affects the 3rd (or 2nd) joint space
altered sensation in web space

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15
Q

how is mortons neuroma diagnosed?

A

> clinically
mulders click
US/MRI

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16
Q

how is mortons neuroma managed?

A

> injection for small lesions

> surgery to excise the lesion and nerve

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17
Q

what problems can occur after mortons neuroma surgery?

A

> recurrence
numbness
post op pain

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18
Q

what are some causes of lesser toe deformities?

A 
> idiopathic
> rheumatoid arthritis
> neurological
> shoe wear
> unbalance in flexors and extensors
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19
Q

a small toe with a flexed end is called a what?

A

mallet toe

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20
Q

describe a hammer toe

A

the 1st metatarsal joint is hyperextended and the proximal flexed and the distal hyperextended

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21
Q

a hyperextended metatarsal joint would be called a what?

A

claw toe

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22
Q

what are some non-operative treatments for lesser toes deformities?

A

> shoe wear
orthotic insoles
activity modification

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23
Q

what are some operative treatments for lesser toe deformities?

A

> shortening osteomy of metatarsal
release of metatarsopharyngeal joint
flexor to extensor transfer
fusion of interpharayngeal joint

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24
Q

what can cause ganglia?

A

> underlying arthritis

> underlying tendon pathology

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25
Q

what might cause pain in a midfoot ganglia?

A

> shoes pressure

> underlying pathology

26
Q

what treatment is there for ganglia?

A

> aspiration

> excision

27
Q

name 3 different types of mid-foot arthritis

A

> osteoarthritis
post-traumatic arthritis
rheumatoid arthritis

28
Q

What treatment options are there for midfoot arthritis?

A 
> fusion 
> xray guided injection
> activity modification
> shoe wear
> orthotics
29
Q

what is planta fibromatosis?

A

dupuytrens of the foot

30
Q

when does plantar fibromatosis become symptomatic?

A

> large

> weight bearing area

31
Q

what is the management of plantar fibromatosis?

A

> avoid pressure with shoe wear
excise
radiotherapy
surgery +radiotherapy

32
Q

what are the symptoms of ankle arthritis?

A

> pain

> stiffness

33
Q

how is ankle arthritis diagnosed?

A

> clinically
x ray
exclusion of adjacent joint arthritis’s

34
Q

what are the non-operative management options for ankle arthritis?

A 
> weight loss
> activity modification
> analgesia
> physiotherapy
> steroid injection
35
Q

what are the operative options for ankle arthritis?

A

> arthoscopic debriment (if exclusively anterior)
arthrodesis
joint replacement (questionable long term outcomes)

36
Q

what are the symptoms of posterior tibial tendonitis?

A

> heels swinging from valgus to varus as heels rise

> pain medially and laterally

37
Q

why is an MRI taken in posterior tibial tendonitis?

A

to assess the tendon

38
Q

what is the management of posterior tibial tendonitis?

A

> orthotics (medial arch support)
reconstruction tendon
triple fusion (subtalar, calceocuboid and talonavicular)

39
Q

what is the pathology of a fasciosis?

A 
> disorganised and dysfunctional blood vessels and collagen
> avascularity
> absence of inflammatory cells
> chronic degenerative change
> fibroblast hypertrophy
40
Q

what is the aetiology of plantar fasciitis?

A 
> unknowen
> athletes (high intensity)
> obesity
> prolonged standing
> foot/lower limb rotational deformities
> tight gastrocnemius complex
41
Q

what symptoms can plantar fasciitis have?

A

> pain in the morning
pain on weight bearing after rest
pain located at the origin of the plantar fascia
symptoms lasting more than 2 years

42
Q

what are the 1st and 2nd line treatments for plantar fasciitis?

A 
> NSAIDS
> stretching
> physiotherapy
> corticosteroid injection
> weight loss
> rest
> ICE
> night splinting
43
Q

what are 3rd line treatments for plantar fasciitis?

A 
> topaz plasma coblation
> platelet rich plasma
> surgery
> nitric oxide
> extracaorpeal shockwave therapy
44
Q

what is a differential diagnosis for plantar fasciitis?

A

> calconeal pathology
arthritis
nerve entrapment syndrome

45
Q

what is a paratendinopathy?

A

true inflammatory problem showing paratendonitis histologically

46
Q

what is insertional tendinopathy?

A

within 2 cm of the insertion

47
Q

what is mid substance tendinopathy?

A

within 2-7cm of insertion

48
Q

what is Achilles tendinosis?

A

degenerative/overuse condition with little inflammation

49
Q

what are the differences in aetiologies between tendinopathies and paratendinopathies?

A 
tendinopathy:
> obesity
> over 40yrs
> steroids 
> diabetes

paratendinopathy
> age 30-40yrs
> athletic populations

50
Q

what symptoms present in Achilles tendinopathy?

A

Pain
> following or during exercise
> recurrent episodes

difficulty putting on shoes

51
Q

how is achilles tendinopathy diagnosed?

A

clinically
>tenderness
> rupture test

52
Q

what is the non-operative treatment of Achilles tendinopathy?

A 
> weight loss
> activity modification
> shoe wear modification
> physiotherapy
> immobilisation
> extracorporeal shockwave treatment
53
Q

what causes diabetic foot ulcers?

A

> lack of patient education
neuropathy
autonomic neuropathy (lack of sweating skin sensitive to microtrauma)
poor vascular supply

54
Q

how can diabetic foot ulcers be prevented?

A 
> nutrition
> treat infection
> diabetic control
> good vascular supply
> manage external pressure
> smoking cessation
55
Q

what surgical treatment is available for diabetic foot ulcers?

A

> improve vascular supply
debride ulcers and gather deep samples for microbiology
correct any deformity
amputation

56
Q

what is the 5yr patient mortality for diabetic foot ulcers?

A

50%

57
Q

how many diabetic foot ulcers lead to amputation?

A

25%

58
Q

what cause charcots neuroarthropathy?

A

> syphilis
diabetes
any neuropathy

59
Q

what are the 3 stages of rapid bone destruction?

A
  1. fragmentation
  2. coalescence
  3. remodelling
60
Q

how is charcots foot diagnosed?

A

> MRI
xray
greater than a 3 degree difference with limb

61
Q

a diabetic patient presents with an acutely swollen erythematous foot. what do you think it is?

A

charcots foot

62
Q

how is charcots foot managed?

A

> correct the deformity
immobilisation until acute fragmentation has resolved
prevention

MSK (19 decks)

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