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MSK > Foot problems > Flashcards

Foot problems Flashcards

1
Q

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

A 
Analgesia
Shoe wear modification
Activity modification
Weight loss
Physiotherapy
Orthotics ie insoles
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2
Q

When should we operate for foot problems?

A

If non-operative fails

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3
Q

What is hallux valgus also known as?

A

Bunion

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4
Q

What is the aetiology of hallux valgus?

A

Genetic
Foot wear
Much more common in females

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5
Q

What are symptoms of hallux valgus?

A

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

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6
Q

What is the pathogenesis of hallux valgus?

A

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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7
Q

How is hallux valgus diagnosed?

A

Clinical examination

Xray

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8
Q

How is hallux valgus operated on?

A

Release lateral soft tissues and osteotomy of 1st metatarsal

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9
Q

What is hallux rigidus?

A

Stiff big toe

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10
Q

What causes hallux rigidus?

A

Osteoarthritis of 1st metatarsal-phalangeal joint

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11
Q

What are symptoms of hallux rigidus?

A

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

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12
Q

What is the gold standard treatment for hallux rigidus?

A

1st metatarsal-phalangeal joint fusion

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13
Q

What are the lesser toe deformities?

A

Hammer toe
Claw toe
Mallet toe

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14
Q

What is hammer toe?

A

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

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15
Q

What is claw toe?

A

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

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16
Q

What is mallet toe?

A

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

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17
Q

What is the aetiology of the lesser toe deformities?

A 
Imbalance between flexors/extensors
Shoe wear
Neurological
Rheumatoid arthritis
Idiopathic
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18
Q

What are symptoms of lesser toe deformities?

A

Deformity
Pain from dorsum
Pain from plantar side

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19
Q

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

A

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

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20
Q

What are operative treatment options for lesser toe deformities?

A

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

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21
Q

What is a neuroma?

A

Thickening of neural tissue

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22
Q

What is Morton’s neuroma?

A

Neuroma on plantar side commonly between third and fourth toes

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23
Q

What is the aetiology of Morton’s neuroma?

A

Mechanically induced degenerative neuropathy associated with high heeled shoes

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24
Q

What are symptoms of Morton’s neuroma?

A

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

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25
Q

How is Morton’s neuroma diagnosed?

A

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

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26
Q

How is Morton’s neruoma managed?

A

Injection for small lesions

Surgery if numbness or recurrence

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27
Q

What is metatarsalgia?

A

Pain of the ball of the foot

28
Q

What are potential causes of metatarsalgia?

A 
Synovitis
Bursitis
Arthritis
Neuralgia
Neuroma
Freiberg's disease
29
Q

How is rheumatoid forefoot treated?

A

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

30
Q

What is a dorsal foot ganglia?

A

A cystic lesion arising from a tendon or joint capsule

31
Q

What is the possible aetiology of dorsal foot ganglia?

A

Idiopathic
Underlying arthritis
Underlying tendon pathology

32
Q

What are symptoms of dorsal foot ganglia?

A

Pain from pressure from shoe wear

Pain from underlying problem

33
Q

What are treatment options for dorsal foot ganglia?

A

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

34
Q

Is dorsal foot ganglia likely to be recurrent?

A

Yes - 50%

35
Q

What is plantar fibromatosis?

A

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

36
Q

What is achilles tendinosis?

A

The achilles tendon becomes inflamed

37
Q

What is insertional tendinopathy?

A

Tendinosis within 2cm of tendon insertion

38
Q

What is non-insertional tendinopathy?

A

Tendinosis within 2-7cm

39
Q

What is the calcaneus?

A

The heel bone

40
Q

What is achilles paratendinopathy?

A

The surrounding sheathe of the achilles tendon becomes inflamed

41
Q

What are risk factors for paratendonopathy?

A

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

42
Q

What are risk factors for tendonopathy?

A

40+y
Obesity
Steroids
Diabetes

43
Q

What are symptoms of achilles tendinopathy?

A 
Pain during exercise
Pain following exercise
Recurrent episodes
Difficulty fitting shoes if inserstional tendinosis
Rupture
44
Q

What investigations are done for achilles tendinopathy?

A

Ultrasound

MRI

45
Q

How do you test for achilles tendon rupture?

A

Simmonds test

Matles test

46
Q

What are non-operative treatment options for achilles tendinopathy?

A 
Activity modification
Weight loss
Shoe wear modification
Physiotherapy
Extra-corporeal shockwave treatment
Immobilisation
47
Q

What is done to modify shoe wear in achilles tendinopathy?

A

Add a slight heel

48
Q

What are operative treatment options for achilles tendinopathy?

A

Gastrocnemius recession

Release and debridement of tendon

49
Q

What is fasciosis?

A

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

50
Q

What are potential risk factors for plantar fasciitis?

A 
Athletes with high intensity training
Running with poorly padded shoes
Obesity
Prolonged standing
Lower limb rotational deformities
Tight gastro-soleus complex
51
Q

What are symptoms of plantar fasciitis?

A

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

52
Q

What are differentials for plantar fasciitis?

A

Nerve entrapment syndrome
Arthritis
Calcaneal pathology

53
Q

How is plantar fasciitis treated?

A 
Rest/change training?
Stretching
Ice
NSAIDs
Orthoses
Physiotherapy
Weight loss
Corticosteroid injections
Night splinting
54
Q

What is the aetiology of ankle arthritis?

A

Idiopathic

55
Q

What is the mean age of presentation of ankle arthritis?

A

46

56
Q

What are symptoms of ankle arthritis?

A

Pain

Stiffness

57
Q

What are non-operative treatment options for ankle arthritis?

A 
Weight loss
Activity modification
Analgesia
Physiotherapy
Steroid injections
58
Q

What are clinical features of tibialis posterior tendon dysfunction?

A

Adult flat foot planovalgus

Medial or lateral pain

59
Q

How is tibialis posterior tendon dysfunction diagnosed?

A

Double and single heel raise

60
Q

How is tibialis posterior tendon dysfunction managed?

A

Orthotics - medial arch support

61
Q

What is the aetiology of diabetic foot ulcer?

A

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

62
Q

How is diabetic foot ulcer managed?

A

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

63
Q

What is aetiology of charcot’s neuroarthropathy?

A

Any cause of neuropathy
Diabetes
Syphillis

64
Q

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

A

Fragmentation
Coalescence
Remodelling

65
Q

How is charchot neuroarthropathy diagnosed?

A

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

66
Q

How is charcot neuroarthropathy managed?

A

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

MSK (30 decks)

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