Foot Problems Flashcards
what are the symptoms f hallux valgus?
> metatarsalgia
pain from crossing over of toes
pressure symptoms from shoes
describe the pathogenesis of hallux valgus
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
why would you carry out an xray in hallux valgus?
> determine the severity of the bone deformity
> exclude associated degenerative changes
what non-operative management is there for hallux valgus?
> wide, high toe box shoes
orthotics to off load pressure
analgesia
activity modification
what operative management is there for hallux valgus?
> osteotomy of 1st metatarsal (+/- proximal phalanx)
> release soft tissue
when is operative management of hallux valgus indicated?
> non-operative has failed
what are the symptoms of hallux rigidus?
> limitation of range of movement
asymptomatic
pain often in extreme dorsiflexion
what is osteoarthritis of the 1st metatarsal joint called?
hallux rigidus
how is hallux rigidus diagnosed?
> clinically
> xray: no joint space + osteophytes
what non-operative management is there for hallux rigidus?
> shoe and rigid sole
analgesia
activity modification
what operative management is there for hallux rigidus?
> arthroplasty
cheilectomy
arthroalests
what factors are associated with interdigital neuralgia (mortons neuroma)?
> high heels
females
40-60 yrs
what causes mortons neuralgia?
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
what are the symptoms of mortons neuroma?
> neuralgia pain (intermittent)
affects the 3rd (or 2nd) joint space
altered sensation in web space
how is mortons neuroma diagnosed?
> clinically
mulders click
US/MRI
how is mortons neuroma managed?
> injection for small lesions
> surgery to excise the lesion and nerve
what problems can occur after mortons neuroma surgery?
> recurrence
numbness
post op pain
what are some causes of lesser toe deformities?
> idiopathic > rheumatoid arthritis > neurological > shoe wear > unbalance in flexors and extensors
a small toe with a flexed end is called a what?
mallet toe
describe a hammer toe
the 1st metatarsal joint is hyperextended and the proximal flexed and the distal hyperextended
a hyperextended metatarsal joint would be called a what?
claw toe
what are some non-operative treatments for lesser toes deformities?
> shoe wear
orthotic insoles
activity modification
what are some operative treatments for lesser toe deformities?
> shortening osteomy of metatarsal
release of metatarsopharyngeal joint
flexor to extensor transfer
fusion of interpharayngeal joint
what can cause ganglia?
> underlying arthritis
> underlying tendon pathology
what might cause pain in a midfoot ganglia?
> shoes pressure
> underlying pathology
what treatment is there for ganglia?
> aspiration
> excision
name 3 different types of mid-foot arthritis
> osteoarthritis
post-traumatic arthritis
rheumatoid arthritis
What treatment options are there for midfoot arthritis?
> fusion > xray guided injection > activity modification > shoe wear > orthotics
what is planta fibromatosis?
dupuytrens of the foot
when does plantar fibromatosis become symptomatic?
> large
> weight bearing area
what is the management of plantar fibromatosis?
> avoid pressure with shoe wear
excise
radiotherapy
surgery +radiotherapy
what are the symptoms of ankle arthritis?
> pain
> stiffness
how is ankle arthritis diagnosed?
> clinically
x ray
exclusion of adjacent joint arthritis’s
what are the non-operative management options for ankle arthritis?
> weight loss > activity modification > analgesia > physiotherapy > steroid injection
what are the operative options for ankle arthritis?
> arthoscopic debriment (if exclusively anterior)
arthrodesis
joint replacement (questionable long term outcomes)
what are the symptoms of posterior tibial tendonitis?
> heels swinging from valgus to varus as heels rise
> pain medially and laterally
why is an MRI taken in posterior tibial tendonitis?
to assess the tendon
what is the management of posterior tibial tendonitis?
> orthotics (medial arch support)
reconstruction tendon
triple fusion (subtalar, calceocuboid and talonavicular)
what is the pathology of a fasciosis?
> disorganised and dysfunctional blood vessels and collagen > avascularity > absence of inflammatory cells > chronic degenerative change > fibroblast hypertrophy
what is the aetiology of plantar fasciitis?
> unknowen > athletes (high intensity) > obesity > prolonged standing > foot/lower limb rotational deformities > tight gastrocnemius complex
what symptoms can plantar fasciitis have?
> 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
what are the 1st and 2nd line treatments for plantar fasciitis?
> NSAIDS > stretching > physiotherapy > corticosteroid injection > weight loss > rest > ICE > night splinting
what are 3rd line treatments for plantar fasciitis?
> topaz plasma coblation > platelet rich plasma > surgery > nitric oxide > extracaorpeal shockwave therapy
what is a differential diagnosis for plantar fasciitis?
> calconeal pathology
arthritis
nerve entrapment syndrome
what is a paratendinopathy?
true inflammatory problem showing paratendonitis histologically
what is insertional tendinopathy?
within 2 cm of the insertion
what is mid substance tendinopathy?
within 2-7cm of insertion
what is Achilles tendinosis?
degenerative/overuse condition with little inflammation
what are the differences in aetiologies between tendinopathies and paratendinopathies?
tendinopathy: > obesity > over 40yrs > steroids > diabetes
paratendinopathy
> age 30-40yrs
> athletic populations
what symptoms present in Achilles tendinopathy?
Pain
> following or during exercise
> recurrent episodes
difficulty putting on shoes
how is achilles tendinopathy diagnosed?
clinically
>tenderness
> rupture test
what is the non-operative treatment of Achilles tendinopathy?
> weight loss > activity modification > shoe wear modification > physiotherapy > immobilisation > extracorporeal shockwave treatment
what causes diabetic foot ulcers?
> lack of patient education
neuropathy
autonomic neuropathy (lack of sweating skin sensitive to microtrauma)
poor vascular supply
how can diabetic foot ulcers be prevented?
> nutrition > treat infection > diabetic control > good vascular supply > manage external pressure > smoking cessation
what surgical treatment is available for diabetic foot ulcers?
> improve vascular supply
debride ulcers and gather deep samples for microbiology
correct any deformity
amputation
what is the 5yr patient mortality for diabetic foot ulcers?
50%
how many diabetic foot ulcers lead to amputation?
25%
what cause charcots neuroarthropathy?
> syphilis
diabetes
any neuropathy
what are the 3 stages of rapid bone destruction?
- fragmentation
- coalescence
- remodelling
how is charcots foot diagnosed?
> MRI
xray
greater than a 3 degree difference with limb
a diabetic patient presents with an acutely swollen erythematous foot. what do you think it is?
charcots foot
how is charcots foot managed?
> correct the deformity
immobilisation until acute fragmentation has resolved
prevention
