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Musculoskeletal > Foot Problems > Flashcards

Foot Problems Flashcards

1
Q

What is the medical term for bunions?

A

Hallux Vargus

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2
Q

What are the risk factors for hallux valgus?

A

Genetics
Shoe type and wearing
Female

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3
Q

What are the symptoms of hallux valgus?

A

Pressure symptoms from shoe wear
Pain from crossing over of toes
Metatarsalgia

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4
Q

What is the pathogenesis of hallux valgus?

A

Lateral angulation of great toe.
Tendons pull realigned to lateral of centre of rotation of toe worsening deformity
Vicious cycle of increased pull creating increased deformity
Sesamoid bones sublux – less weight goes through great toe
As deformity progresses abnormalities of lesser toes occur

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5
Q

What is the management of hallux valgus?

A

Shoe wear modification (wide +/- high toe box)
Orthotics to offload pressure/correct deformity
Activity modification
Analgesia
Release lateral soft tissues
Osteotomy 1st metatarsal +/- proximal phalanx
Generally good outcome but recurrence inevitable

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6
Q

What is Hallux Rigidus?

A

Osteoarthritis of first MTP joint

Typical shape of metatarsal head is slightly pointed rather than rounded

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7
Q

What are the symptoms of hallux rigidus?

A

Many asymptomatic
Pain – often at extreme of dorsiflexion
Limitation of range of movement-dorsiflexion

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8
Q

What is the management of hallux rigidus?

A 
Activity modification
Shoe wear with rigid sole
Analgesia
Cheilectomy-remove dorsal impingement
Arthrodesis
Arthroplasty
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9
Q

What are the risk factors for lesser toe deformities?

A 
Imbalance between flexors/extensors
Shoe wear 
Neurological
Rheumatoid arthritis
Idiopathic
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10
Q

What are the symptoms of lesser toe deformities?

A

Deformity
Pain from dorsum
Pain from plantar side (metatarsalgia)

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11
Q

What is the management of lesser toe deformities?

A 
Activity modification
Shoe wear – flat shoes with high toe box to accommodate deformity 
Orthotic insoles – metatarsal bar/dome support
Operative
Flexor to extensor transfer
Fusion of interphalangeal joint
Release metatarsophalangeal joint
Shortening osteotomy of metatarsal
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12
Q

What are the risk factors for interdigital neuralgia/Morton’s neuroma?

A

Mechanically induced degenerative neuropathy
Tends to affect females aged 40-60
Frequently associated with wearing high healed shoes
Common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear

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13
Q

What are the symptoms of Morton’s neuroma?

A

Typically affects 3rd followed by 2nd webspace/toes
Neuralgic burning pain into toes
Intermittent
Altered sensation in webspace

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14
Q

How is Morton’s neuroma diagnosed?

A

MRI
US
Clinical diagnosis
Mulder’s click

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15
Q

What is the management of Morton’s neuroma?

A

Injection for small lesions

Surgery – excision of lesion including a section of normal nerve

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16
Q

What is plantar fibromatosis?

A

Ledderhose disease
“Dupuytren’s of the foot”
Progressive
Usually asymptomatic unless very large or on weightbearing area
Treatment
Non-operative – avoid pressure – shoe wear/orthotics
Operative – excision (up to 80% risk of recurrence)
Radiotherapy (similar recurrence as operative)
Combination radiotherapy/surgery (low risk recurrence/high risk complications)

17
Q

What is Achilles tendinosis?

A

Degenerative / overuse condition with little inflammation

18
Q

What are types of Achilles tendinopathy?

A 
Insertional tendinopathy 
within 2cm of insertion
Non-insertional / mid-substance tendinopathy
2-7cm of insertion
Bursitis
Retrocalcaneal 
Superficial calcaneal
Para tendinopathy is a true inflammatory problem showing Para tendonitis histologically
19
Q

What are the risk factors for both tendinopathy and tendinopathy of the Achilles tendon?

A 
Paratendonopathy
Commonest in athletic populations
Age group 30-40
Male:Female = 2:1
Tendonopathy
Commonest in non-athletic populations
Aged over 40
Obesity
Steroids
Diabetes
20
Q

What are the symptoms for Achilles tendinopathy?

A 
Pain during exercise 
Pain following exercise
Recurrent episodes
Difficulty fitting shoes (insertional)
RUPTURE
21
Q

What imaging should be done for Achilles tendinopathy?

A

US

MRI

22
Q

What clinical tests can be done to check for an Achilles tendon rupture?

A

Calf squeeze-the soleus muscle is gently squeezed and this should move the foot, if it doesn’t then the Achilles tendon is fully ruptured between the soleus muscle and the heel
“Angle of the dangle”
Matles

23
Q

What is the management of Achilles tendinopathy?

A 
Activity modification
Weight loss
Shoe wear modification – slight heel
Physiotherapy – Eccentric stretching
Extra-corporeal shockwave treatment
Immobilisation (in below knee cast)
Gastrocnemius recession
Release and debridement of tendon
24
Q

What is plantar fasciitis?

A

Actually fasciosis- Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen, avascularity of the plantar fascia

25
Q

What are the risk factors for plantar fasciitis?

A

In athletes associated with high intensity or rapid increase in training
Running with poorly padded shoes or hard surfaces
Obesity
Occupations involving prolonged standing
Foot/lower limb rotational deformities
Tight gastro-soleus complex
Aged 40-60 years old

26
Q

What are the symptoms of plantar fasciitis?

A

Heel pain relieved with rest
Worse pain in first few steps after a period of sitting/lying down-post static dyskinesia
Unilateral pain more likely
Pain worse barefoot
Pain made better with NSAID use
Positive Windlass test- pain with metatarsophalangeal joint extension

27
Q

What is the management of plantar fasciitis?

A 
Rest, change training
Stretching – Achilles +/- direct stretching
Ice
NSAIDs
Orthoses – Heel pads
Physiotherapy
Weight loss
Injections – corticosteroid (good in short term but may make condition worse long term)
Night Splinting
Extracorporeal Shockwave therapy
Topaz Plasma Coblation
Nitric Oxide
Platelet Rich Plasma
Endoscopic / Open Surgery
28
Q

What is Tibialis posterior tendon dysfunction?

A

Acquired adult flat foot planovalgus

29
Q

How is Tibialis posterior tendon dysfunction diagnosed?

A

Use single and double heel raises-heels should switch from valgus to varus
MRI

30
Q

What is the management of Tibialis posterior tendon dysfunction?

A 
Orthotics – medial arch support
Reconstruction of tendon (tendon transfer)
Triple fusion (subtalar, talonavicular and calcaneocuboid)

Musculoskeletal (20 decks)

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