Foot problems Flashcards by Pete McEwan

What are non-operative methods of management for foot problems?

Analgesia
Shoe wear modification
Activity modification
Weight loss
Physiotherapy
Orthotics ie insoles

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When should we operate for foot problems?

If non-operative fails

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What is hallux valgus also known as?

Bunion

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What is the aetiology of hallux valgus?

Genetic
Foot wear
Much more common in females

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What are symptoms of hallux valgus?

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

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What is the pathogenesis of hallux valgus?

Lateral anglulation of great toe
Tendons pull realigned to lateral of centre of rotation of toe, worsening deformity
Leads to a cycle of increasing pull from tendons worsening deformity

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How is hallux valgus diagnosed?

Clinical examination

Xray

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How is hallux valgus operated on?

Release lateral soft tissues and osteotomy of 1st metatarsal

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What is hallux rigidus?

Stiff big toe

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What causes hallux rigidus?

Osteoarthritis of 1st metatarsal-phalangeal joint

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What are symptoms of hallux rigidus?

Many asymptomatic
Pain at extreme of dorsiflexion
Limitation of range of movement

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What is the gold standard treatment for hallux rigidus?

1st metatarsal-phalangeal joint fusion

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What are the lesser toe deformities?

Hammer toe
Claw toe
Mallet toe

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What is hammer toe?

Deformity of the toe caused by forced flexion of the proximal interphalangeal joint

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What is claw toe?

Deformity of the toe caused by forced flexion of the proximal and distal interphalangeal joints

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What is mallet toe?

Deformity of the toe caused by forced flexion of the distal interphalangeal joint

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What is the aetiology of the lesser toe deformities?

Imbalance between flexors/extensors
Shoe wear
Neurological
Rheumatoid arthritis
Idiopathic

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What are symptoms of lesser toe deformities?

Deformity
Pain from dorsum
Pain from plantar side

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What are non-operative treatment options for lesser toe deformities?

Activity modification
Shoe wear - flat shoes with high toe box
Orthotic insoles - metatarsal support

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What are operative treatment options for lesser toe deformities?

Flexor to extensor transfer
Fusion of interphalangeal joint
Release metatarsophalangeal joint
Shortening osteotomy of metatarsal

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What is a neuroma?

Thickening of neural tissue

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What is Morton’s neuroma?

Neuroma on plantar side commonly between third and fourth toes

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What is the aetiology of Morton’s neuroma?

Mechanically induced degenerative neuropathy associated with high heeled shoes

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What are symptoms of Morton’s neuroma?

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

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How is Morton's neuroma diagnosed?

Clinical examination/history Mulder's click Ultrasound = best investigation

How is Morton's neruoma managed?

Injection for small lesions | Surgery if numbness or recurrence

What is metatarsalgia?

Pain of the ball of the foot

What are potential causes of metatarsalgia?

``` Synovitis Bursitis Arthritis Neuralgia Neuroma Freiberg's disease ```

How is rheumatoid forefoot treated?

Non-operative - Shoewear/orthotics/activity Operative - 1st metatarsalphalangeal joint arthrodesis 2-5th toe excision arthroplasty

What is a dorsal foot ganglia?

A cystic lesion arising from a tendon or joint capsule

What is the possible aetiology of dorsal foot ganglia?

Idiopathic Underlying arthritis Underlying tendon pathology

What are symptoms of dorsal foot ganglia?

Pain from pressure from shoe wear | Pain from underlying problem

What are treatment options for dorsal foot ganglia?

Aspiration 'Family bible' - compression I guess, idk how to word this shit Surgical excision

Is dorsal foot ganglia likely to be recurrent?

Yes - 50%

What is plantar fibromatosis?

'Dupuytren's of the foot' - asymptomatic unless very large or on weightbearing area

What is achilles tendinosis?

The achilles tendon becomes inflamed

What is insertional tendinopathy?

Tendinosis within 2cm of tendon insertion

What is non-insertional tendinopathy?

Tendinosis within 2-7cm

What is the calcaneus?

The heel bone

What is achilles paratendinopathy?

The surrounding sheathe of the achilles tendon becomes inflamed

What are risk factors for paratendonopathy?

Athletic population Age 30-40 Male:female = 2:1

What are risk factors for tendonopathy?

40+y Obesity Steroids Diabetes

What are symptoms of achilles tendinopathy?

``` Pain during exercise Pain following exercise Recurrent episodes Difficulty fitting shoes if inserstional tendinosis Rupture ```

What investigations are done for achilles tendinopathy?

Ultrasound | MRI

How do you test for achilles tendon rupture?

Simmonds test | Matles test

What are non-operative treatment options for achilles tendinopathy?

``` Activity modification Weight loss Shoe wear modification Physiotherapy Extra-corporeal shockwave treatment Immobilisation ```

What is done to modify shoe wear in achilles tendinopathy?

Add a slight heel

What are operative treatment options for achilles tendinopathy?

Gastrocnemius recession | Release and debridement of tendon

What is fasciosis?

Chronic degenerative change, fibroblast hypertrophy, absence of inflammatory cells, disorganised and dysfunctional blood vessels and collagen, avascularity

What are potential risk factors for plantar fasciitis?

``` Athletes with high intensity training Running with poorly padded shoes Obesity Prolonged standing Lower limb rotational deformities Tight gastro-soleus complex ```

What are symptoms of plantar fasciitis?

Pain first thing in the morning Pain on weight bearing after rest Pain located at origin of plantar fascia Frequently long lasting - 2+ years

What are differentials for plantar fasciitis?

Nerve entrapment syndrome Arthritis Calcaneal pathology

How is plantar fasciitis treated?

``` Rest/change training? Stretching Ice NSAIDs Orthoses Physiotherapy Weight loss Corticosteroid injections Night splinting ```

What is the aetiology of ankle arthritis?

Idiopathic

What is the mean age of presentation of ankle arthritis?

What are symptoms of ankle arthritis?

Pain | Stiffness

What are non-operative treatment options for ankle arthritis?

``` Weight loss Activity modification Analgesia Physiotherapy Steroid injections ```

What are clinical features of tibialis posterior tendon dysfunction?

Adult flat foot planovalgus | Medial or lateral pain

How is tibialis posterior tendon dysfunction diagnosed?

Double and single heel raise

How is tibialis posterior tendon dysfunction managed?

Orthotics - medial arch support

What is the aetiology of diabetic foot ulcer?

Diabetic neuropathy - patient is unaware of trauma Autonomic neuropathy - lack of sweating/sebum production leads to dry cracked skin Poor vascular supply

How is diabetic foot ulcer managed?

Prevention - diabetic foot clinic Modify main detriments to healing - diabetic control, smoking, vascular supply, external pressure (shoes), infection, nutrition

What is aetiology of charcot's neuroarthropathy?

Any cause of neuropathy Diabetes Syphillis

What are the 3 stages of bone destruction in charcot neuroarthropathy?

Fragmentation Coalescence Remodelling

How is charchot neuroarthropathy diagnosed?

Suspicion in any diabetic with acutely swollen erythematous foot Greater than 3 degree difference between limbs Frequently not painful MRI scan

How is charcot neuroarthropathy managed?

Prevention Immobilisation/non-weight bearing until acute fragmentation resolved Correct deformity