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Musculo-skeletal > Foot Problems > Flashcards

Foot Problems Flashcards

1
Q

What is the aetiology of hallux valgus (bunions)?

A
  • Genetic
  • Foot wear
  • Female > Male
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2
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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3
Q

Describe the pathogenesis of hallux valgus

A
  • Lateral angulation of the great toe
  • Tendon pull realigned to lateral of centre of rotation of toe
  • Increased pull worsens the deformity
  • Sesamoid bones sublux - less weight foes through the big toe
  • Abnormalities of the lesser toes begin to occur
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4
Q

How can hallux valgus be diagnosed?

A
  • Clinical

- XR

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5
Q

How can hallux valgus be managed?

A
  • Shoe wear modification
  • Orthotics
  • Activity modification
  • Analgesia
  • Operative: release lateral soft tissues and osteotomy
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6
Q

What is hallux rigidus?

A

Osteoarthritis of the 1st MTP joint (pain and limitation of movement

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7
Q

How is hallux rigidus diagnosed?

A
  • Clinical

- Radiographs

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8
Q

How can hallux rigidus?

A
  • Activity modification
  • Shoe wear with rigid sole
  • Analgesia
  • Surgery: cheilectomy, arthrodesis and arthroplasty
  • 1st MTPJ fusion is gold standard
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9
Q

Name three lesser toe deformities

A
  • Hammer toe
  • Claw toe
  • Mallet toe
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10
Q

What is the aetiology of lesser toe deformities?

A
  • Imbalance between flexors and extensors
  • Shoe wear
  • Neurological
  • RA
  • Idiopathic
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11
Q

What is the presentation of lesser toe deformities?

A
  • Deformity
  • Pain from dorsum
  • Pain from plantar side
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12
Q

What are the management options for lesser toe deformities?

A
  • Activity modification
  • Shoe wear modifications
  • Orthotic insoles
  • Operative: flexor to extensor transfer, fusion of IPJ, release of MPJ and shortening osteotomy of metatarsal
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13
Q

What is the aetiology of Morton’s neuroma?

A
  • Mechanical degenerative neuropathy
  • Females aged 40-60
  • Associated with wearing high heeled shoes
  • Common digital nerve relatively tethered to one metatarsal and movement in the adjacent metatarsal causing mechanical shear
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14
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 the webspace
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15
Q

How is Morton’s neruoma diagnosed?

A
  • Clinical
  • Mulder’s click
  • USS/MRI
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16
Q

How can Moton’s neuroma be managed?

A
  • Injection for small lesions

- Excision of the lesion including a section of normal nerve

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17
Q

What are the management options for rheumatoid forefoot?

A
  • Shoewear/orthotics/activity etc.
  • 1st MTPJ arthrodesis
  • 2-5th toe excision arthroplasty
18
Q

What are the causes of dorsal foot ganglia and how is it treated?

A
  • Cause: idiopathic, underlying arthritis and underlying tendon pathology
  • Pain from pressure from foot wear or pain from underlying problem
19
Q

How can dorsal foot ganglia be treated?

A
  • Aspiration
  • Excision
  • Hit it with something heavy
20
Q

What are the treatment options for midfoot arthritis?

A
  • Activity/shoewear/orthotics etc.
  • Injections
  • Fusion
21
Q

What is plantar fibromatosis and how does it present?

A
  • Dupuytren’s of the foot

- Usually asymptomatic unless very large or on weight bearing area

22
Q

How can plantar fibromatosis be treated?

A
  • Avoid pressure: footwear and orthotics
  • Excision
  • Rafiotherapy
  • Combination of radiotherapy and surgery
23
Q

How does Achilles tendinopathy present?

A
  • Insertion or non insertional/ mid substance tendinopathy
  • Bursitis (retrocalcaneal or superficial calcaneal)
  • Paratendinopathy
24
Q

What is the aetiology of achilles tendinopathy?

A
  • Para is commonest in athletic populations aged 30-40

- Tendinopathy: over 40, obesity, steroids and diabetes

25
Q

What are the symptoms of achilles tendinopathy?

A
  • Pain during or following exercise
  • Recurrent episodes
  • Difficulty fitting shoes
  • Rupture
26
Q

How can achilles tendinopathy be diagnosed?

A
  • Clinical
  • USS
  • MRI
27
Q

How can achilles tendinopathy be treated?

A
  • Activity modification
  • Weight loss
  • Shoe wear modification
  • Physio
  • Shockwave treatment
  • Immobilisation
  • Gastrocnemius recession
  • Release and debridement of the tendon
28
Q

What is plantar fasciosis/fasciitis?

A

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

29
Q

What is the aetiology of plantar fasciitis?

A
  • Athletes with high intensity or rapid increase in training
  • Running with poorly padded shoes or on hard surfaces
  • Obesity
  • Occupations involving prolonged standing
  • Lower limb rotational deformities
  • Tight gastro-soleus complex
30
Q

What are the symptoms of plantar fasciitis?

A
  • Pain first thing in the morning
  • Pain on weight bearing after rest
  • Pain at the origin of plantar fascia
  • Frequently lasts 2 yrs or more
31
Q

What investigations can be used to diagnose plantar fasciitis?

A
  • XR
  • USS
  • MRI
32
Q

What are the management options for plantar fasciitis?

A
  • Rest, chainge training
  • Stretching
  • ICE
  • NSAIDs
  • Orthoses
  • Physio
  • Weight loss
  • Injections (steroid)
  • Night splinting
33
Q

What are the management options for ankle arthritis?

A
  • Weight loss/activity modification/physio/steroid injections
  • Arthroscopic anterior debridement
  • Arthrodesis
  • Joint replacement
34
Q

What are the features of tibialis posterior tendon dysfunction?

A
  • Acquired adult flat foot planovalgus
  • Diagnosed by double and single heel raise and MRI
  • Medial or lateral pain
35
Q

How can tibialis posterior tendon dysfunction be treated?

A
  • Orthoses

- Surgery: reconstruction or triple fusion (subtalar, talonavicular and calcaneocuboid)

36
Q

How can a diabetic foot ulcer be treated?

A
  • Prevention
  • Modify causative factors:
    • diabetic control, smoking etc.
    • Vascular supply, external/ internal pressure, infection and nutrition
  • Surgical: improve vascular supply, debride ulcers, correct any deformity and amputation
37
Q

What are the causes of charcot neuroarthropathy?

A
  • Any neuropathy (diabetic most common)

- Historically associated with syphilis

38
Q

Describe the pathophysiology of charcot neuroarthropathy

A
  • Neurotraumatic: lack of proprioception and protective pain sensation
  • Neurovascular: abnormal autonomic nervous system results in increased vascular supply and bone resorption
  • 3 Stages: fragmentation, coalaescence and remodelling
39
Q

Which investigations can help diagnose charcot neuroarthropathy?

A
  • XR

- MRI

40
Q

How can Charcot neuroarthropathy be managed?

A
  • Prevention
  • Immobilisation/non weight bearing
  • Correct deformity

Musculo-skeletal (27 decks)

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