Foot problems Flashcards
What are non-operative methods of management for foot problems?
Analgesia Shoe wear modification Activity modification Weight loss Physiotherapy Orthotics ie insoles
When should we operate for foot problems?
If non-operative fails
What is hallux valgus also known as?
Bunion
What is the aetiology of hallux valgus?
Genetic
Foot wear
Much more common in females
What are symptoms of hallux valgus?
Pressure symptoms from shoe wear
Pain from crossing over of toes
Metatarsalgia
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
How is hallux valgus diagnosed?
Clinical examination
Xray
How is hallux valgus operated on?
Release lateral soft tissues and osteotomy of 1st metatarsal
What is hallux rigidus?
Stiff big toe
What causes hallux rigidus?
Osteoarthritis of 1st metatarsal-phalangeal joint
What are symptoms of hallux rigidus?
Many asymptomatic
Pain at extreme of dorsiflexion
Limitation of range of movement
What is the gold standard treatment for hallux rigidus?
1st metatarsal-phalangeal joint fusion
What are the lesser toe deformities?
Hammer toe
Claw toe
Mallet toe
What is hammer toe?
Deformity of the toe caused by forced flexion of the proximal interphalangeal joint
What is claw toe?
Deformity of the toe caused by forced flexion of the proximal and distal interphalangeal joints
What is mallet toe?
Deformity of the toe caused by forced flexion of the distal interphalangeal joint
What is the aetiology of the lesser toe deformities?
Imbalance between flexors/extensors Shoe wear Neurological Rheumatoid arthritis Idiopathic
What are symptoms of lesser toe deformities?
Deformity
Pain from dorsum
Pain from plantar side
What are non-operative treatment options for lesser toe deformities?
Activity modification
Shoe wear - flat shoes with high toe box
Orthotic insoles - metatarsal support
What are operative treatment options for lesser toe deformities?
Flexor to extensor transfer
Fusion of interphalangeal joint
Release metatarsophalangeal joint
Shortening osteotomy of metatarsal
What is a neuroma?
Thickening of neural tissue
What is Morton’s neuroma?
Neuroma on plantar side commonly between third and fourth toes
What is the aetiology of Morton’s neuroma?
Mechanically induced degenerative neuropathy associated with high heeled shoes
What are symptoms of Morton’s neuroma?
Typically affects 3rd followed by 2nd webspace
Neuralgic burning pain in toes
Intermittent
Altered sensation in webspace
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?
46
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
