Foot Problems Flashcards
Non-operative management of foot problmes?
Analgesia, Shoe wear modification, Activity modification, Weight loss, Physiotherapy,
Forefoot problems?
Hallux valgus, Hallux rigidus, Lesser toe deformities, Morton’s neuroma, Metatarsalgia, Rheumatoid forefoot
What is hallux valgus?
Bunions
Aetiology of hallux valgus?
Genetic,
Foot wear,
Female
Symptoms of hallux valgus
Pressure symptoms from shoe wear,
Pain from crossing over of toes,
Metatarsalgia
Pathology of hallux valgus
There is lateral angulation of the great toe caused by tendons pull realigning to the lateral of centre of rotation.
In hallux valgus less weight goes through the toe because of….
Sesame is bone subluxation
Non-operative management of hallux valgus?
Shoe wear modification,
Orthotics,
Activity modification,
Analgesia
Operative treatment of hallux valgus?
Release lateral soft tissues,
Osteotomy 1st metatarsal
What is hallux rigidus?
Stiff big toe cause by osteoarthritis of 1st MTP joint
Hallux rigidus symptoms?
Asymptomatic,
Pain at extreme of dorsi flexion,
Limited ROM
Non-operative management of hallux rigidus?
Activity modification, shoe wear with rigid sole, analgesia
Operative management of hallux rigidus
Cheilectomy,
Arthodesis,
Arthroplasty
What is a cheilectomy?
Removal of dorsal impingement
What is arthrodesis?
surgical immobilization of a joint by fusion of the bones
What are claw toes/
Hyperextension in MTP,
Flexion in PIP
What is hammer toe?
Hyperextension in MTP
What is mallet toe?
Flexion in PIP
Lesser toe deformities aetiology?
Imbalance between flexors/extensors, Shoe wear, Neurological, Rheumatoid arthritis, Idiopathic
Lesser toe deformities symptoms?
Deformity,
Pain from dorsum,
Pain from plantar side
Lesser toe deformities non-operative treatment?
Activity modification,
Change shoe wear,
Orthotic insoles
Lesser toe deformities operative treatment?
Flexor to extensor transfer,
Fusion of interphalangeal joint,
Release metatarsophalangeal joint,
Shortening osteotomy of metatarsal
What is Morton’s neuroma?
Mechanically induced degenerative neuropathy
Risk factors of Morton’s neuroma?
Female,
40-60,
High heels
Symptoms of Morton’s neuroma?
Normally 3rd/2nd webspaces affected,
Neuralgic burning pain into toes,
Intermittent,
Altered sensation in webspace
Investigations of Mortons neuroma?
Clinical,
Mulders click,
US/MRI
Management of Morton’s neuroma?
Steroid injection,
Excision of lesion including section of normal nerve
Causes of metatarsalgia?
Synovitis, bursitis, arthritis, neuralgia, neuromata, Freiberg’s disease
Treatment of rheumatoid forefoot?
Shoe wear, Orthotics, Activity, Arthrodesis (1st MTPJ), Arthroplasty (2-5th toe excision)
Risk factors for dorsal foot ganglia?
Arthritis,
Tendon pathology
Symptoms of dorsal foot ganglia?
Pain from pressure from shoe wear,
Pain from underlying problem
Treatment of dorsal foot ganglia
Aspiration,
Excision
Midfoot arthritis causes
Post-traumatic or
Idiopathic
Treatment of midfoot arthritis?
Activity, Shoewear, Orthotics, Steroid injections, Arthrodesis
Plantar fibromatosis define
Also called Ledderhose disease,
Dupuytrens of the foot
Treatment of plantar fibromatosis?
Shoewear,
Orthotics,
Excision,
Radiotherapy
What is Achilles tendinosis?
Degenerative/ overuse condition with little inflammation
Name the clinical conditions of the Achilles tendinopathies?
Insertional tendinopathy (within 2cm of insertion),
Non-insertional (2-7cm of insertion),
Bursitis,
Paratendinopathy
What is the difference between tendinopathy and paratendenopathy?
Paratendenopathy is true inflammatorym showing paratendonitis histologically,
Is common in the athletic population
Whereas tendinopathy is common in non-athletic propulsion
Risk factors of tendonopathy?
> 40,
Obesity,
Steroids,
Diabetes
Symptoms of Achilles tendinopathy
Pain during exercise, Pain following exercise, Recurrent episodes, Difficulty fitting shoes, Rupture
Diagnosis of Achilles tendinopathy?
Clinical (tenderness, Simmonds and angle of the dangle tests)
US,
MRI
What are the Achilles Rupture tests?
Simmonds,
Matles
Non-operative treatment of Achilles Tendinopathy?
Activity modification, Weight loss, Shoe wear modification, Physiotherapy, Extra-corporeal shockwave treatment, Immobilisation
Operative treatment of Achilles tendinopathy?
Gastrocnemius recession,
Release and debridement of tendon
What is fasciosis?
Chronic degenerative change, Fibroblast hypertrophy, Absence inflammatory cells, Disorganised and dysfunctional blood vessels and collagen, Asvascularity
What is plantar fasciitis?
Fasciosis and the body cant make extra cellular matrix required for repair and remodelling
Risk factors of plantar fasciitis?
Athletes 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
Plantar fasciitis symptoms?
Pain first thing in the morning,
Pain on weight bearing after rest,
Pain located at origin of plantar fascia
DD of plantar fasciitis
Nerve entrapment syndrome,
Arthritis,
Calcaneal pathology
Treatment for plantar fasciiitis?
Rest, Change training, Stretching, Ice, NSAIDs, Orthoses, Physiotherapy, Weight loss, Corticosteroids injection, Night splinting
New treatment for plantar fasciitis?
Extracorporeal shockwave therapy, Topaz plasma coblation, Nitric Oxide, Platlet rick plasma, Endoscopic/open surgery
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
Clinical diagnosis of tibialis posterior tendon dysfunction
Double and single heel raise
Symptoms of tibialis posterior tendon dysfunction
Medial or lateral pain
Treatment of tibialis posterior tendon dysfunction
Orthoses (medial arch support),
Reconstruction of tendon,
Triple fusion
What are the 3 stages of Charcot neuroarthropathy bone destruction
Fragmentation,
Coalescence,
Remodelling
