Foot Problems Flashcards
What is the aetiology of hallux valgus (bunions)?
- Genetic
- Foot wear
- Female > Male
What are the symptoms of hallux valgus?
- Pressure symptoms from shoe wear
- Pain from crossing over of toes
- Metatarsalgia
Describe the pathogenesis of hallux valgus
- 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
How can hallux valgus be diagnosed?
- Clinical
- XR
How can hallux valgus be managed?
- Shoe wear modification
- Orthotics
- Activity modification
- Analgesia
- Operative: release lateral soft tissues and osteotomy
What is hallux rigidus?
Osteoarthritis of the 1st MTP joint (pain and limitation of movement
How is hallux rigidus diagnosed?
- Clinical
- Radiographs
How can hallux rigidus?
- Activity modification
- Shoe wear with rigid sole
- Analgesia
- Surgery: cheilectomy, arthrodesis and arthroplasty
- 1st MTPJ fusion is gold standard
Name three lesser toe deformities
- Hammer toe
- Claw toe
- Mallet toe
What is the aetiology of lesser toe deformities?
- Imbalance between flexors and extensors
- Shoe wear
- Neurological
- RA
- Idiopathic
What is the presentation of lesser toe deformities?
- Deformity
- Pain from dorsum
- Pain from plantar side
What are the management options for lesser toe deformities?
- Activity modification
- Shoe wear modifications
- Orthotic insoles
- Operative: flexor to extensor transfer, fusion of IPJ, release of MPJ and shortening osteotomy of metatarsal
What is the aetiology of Morton’s neuroma?
- 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
What are the symptoms of Morton’s neuroma?
- Typically affects 3rd followed by 2nd webspace/toes
- Neuralgic burning pain into toes
- Intermittent
- Altered sensation in the webspace
How is Morton’s neruoma diagnosed?
- Clinical
- Mulder’s click
- USS/MRI
How can Moton’s neuroma be managed?
- Injection for small lesions
- Excision of the lesion including a section of normal nerve
What are the management options for rheumatoid forefoot?
- Shoewear/orthotics/activity etc.
- 1st MTPJ arthrodesis
- 2-5th toe excision arthroplasty
What are the causes of dorsal foot ganglia and how is it treated?
- Cause: idiopathic, underlying arthritis and underlying tendon pathology
- Pain from pressure from foot wear or pain from underlying problem
How can dorsal foot ganglia be treated?
- Aspiration
- Excision
- Hit it with something heavy
What are the treatment options for midfoot arthritis?
- Activity/shoewear/orthotics etc.
- Injections
- Fusion
What is plantar fibromatosis and how does it present?
- Dupuytren’s of the foot
- Usually asymptomatic unless very large or on weight bearing area
How can plantar fibromatosis be treated?
- Avoid pressure: footwear and orthotics
- Excision
- Rafiotherapy
- Combination of radiotherapy and surgery
How does Achilles tendinopathy present?
- Insertion or non insertional/ mid substance tendinopathy
- Bursitis (retrocalcaneal or superficial calcaneal)
- Paratendinopathy
What is the aetiology of achilles tendinopathy?
- Para is commonest in athletic populations aged 30-40
- Tendinopathy: over 40, obesity, steroids and diabetes
What are the symptoms of achilles tendinopathy?
- Pain during or following exercise
- Recurrent episodes
- Difficulty fitting shoes
- Rupture
How can achilles tendinopathy be diagnosed?
- Clinical
- USS
- MRI
How can achilles tendinopathy be treated?
- Activity modification
- Weight loss
- Shoe wear modification
- Physio
- Shockwave treatment
- Immobilisation
- Gastrocnemius recession
- Release and debridement of the tendon
What is plantar fasciosis/fasciitis?
Chronic degenerative change, fibroblast hypertrophy, absence of inflammatory cells, disorganised and dysfunctional blood vessels and collagen
What is the aetiology of plantar fasciitis?
- 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
What are the symptoms of plantar fasciitis?
- 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
What investigations can be used to diagnose plantar fasciitis?
- XR
- USS
- MRI
What are the management options for plantar fasciitis?
- Rest, chainge training
- Stretching
- ICE
- NSAIDs
- Orthoses
- Physio
- Weight loss
- Injections (steroid)
- Night splinting
What are the management options for ankle arthritis?
- Weight loss/activity modification/physio/steroid injections
- Arthroscopic anterior debridement
- Arthrodesis
- Joint replacement
What are the features of tibialis posterior tendon dysfunction?
- Acquired adult flat foot planovalgus
- Diagnosed by double and single heel raise and MRI
- Medial or lateral pain
How can tibialis posterior tendon dysfunction be treated?
- Orthoses
- Surgery: reconstruction or triple fusion (subtalar, talonavicular and calcaneocuboid)
How can a diabetic foot ulcer be treated?
- 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
What are the causes of charcot neuroarthropathy?
- Any neuropathy (diabetic most common)
- Historically associated with syphilis
Describe the pathophysiology of charcot neuroarthropathy
- 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
Which investigations can help diagnose charcot neuroarthropathy?
- XR
- MRI
How can Charcot neuroarthropathy be managed?
- Prevention
- Immobilisation/non weight bearing
- Correct deformity
