Foot Problems Flashcards
What are the treatment options for common foot and ankle problems?
Non operative assessment - analgesia Shoe modification Activity modification Weight loss Physio Orthotics including insoles/bracing
Operative management if failure of non-operative.
What are some common forefoot problems?
Hallux valgus Hallus rigidus Lesser toe deformities Morton's neuroma Metatarsalgia Rheumatoid forefoot
What is Hallux Valgus?
Bunions
Bony lump appears on side of big toe that is now turning towards other toes.
Increased pull of tendons increases deformity, eventually progresses to abnormalities of lesser toes.
Symptoms - pressure sores from footwear, pain from crossing over of toes, metatarsalgia (ball of foot becomes painful and inflamed).
What is Hallux rigidus?
Disorder of joint located at base of big toe, causing it to become stiff and painful.
OA of 1st MTP joint.
What are some examples of lesser toe deformities?
Claw toes
Hammer toes
Mallet toes
What is Morton’s Neuroma?
Interdigital neuralgia usually between 3rd and 4th toes.
Inflammation, severe pain and numbness.
tends to affect females aged 40-60yrs. Associated with wearing high heels.
Nerve tethered to 1 metatarsal and movement in others causes shear.
How is Morton’s neuroma diagnosed?
Clinically
Mulder’s click
Ultrasound (best)
MRI
What is the management for Morton’s neuroma?
Injection for small lesions
Surgery - excision of lesion including small section of normal nerve.
What are some common mid foot problems?
Ganglia
Osteoarthritis
Plantar fibromatosis
What are dorsal foot ganglia?
Benign cystic lesion arising from joint or tendon sheath.
Symptoms include pain from pressure of shoe wear, pain from underlying problem.
Aspiration, or excision can be used to treat.
What is plantar fibromatosis?
Non-malignant thickening of the feet’s deep connective tissue, or fascia.
Dupuytren’s of the foot.
Also known as Ledderhose disease.
Usually asymptomatic unless very large or on weight bearing area.
Avoid pressure, excision, radiotherapy and combination therapy are all treatment options.
What are some common hindfoot problems?
Achilles tendonitis/tendinosis Plantar fasciitis Ankle osteoarthritis Tibialis posterior dysfunction Cavovarus foot
What is achilles tendonitis/tendonosis?
Degenerative/overuse condition of the achilles tendon. Little inflammation. Pain, tenderness, nodules, swelling. Pain during/after exercise Recurrent episodes Difficulty fitting shoes. MRI/ultrasound to investigate. Simmonds rupture test (squeeze calf). Angle of the dangle test.
What is the treatment for achilles tendinopathy?
Activity modification Weight loss Slight heel in shoe Eccentric stretching Extra-corporeal shockwave treatment Immobilsation Gastrocnemius recession Release and debridement of tendon.
What is plantar fasciitis?
Strong band on bottom of foot becomes irritated.
Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessel and collagen, avascularity.
Can’t make extracellular matrix required to fix it.
What are the symptoms of plantar fasciitis?
Pain first thing in morning
Pain on weight bearing after rest - post static dyskinesia
Pain located at origin of plantar fascia.
Frequently long lasting - 2years or more.
What is the treatment for plantar fasciitis?
Rest and change in training Stretching - achilles Ice NSAIDs Orthoses - heel pads Physio Weight loss Injections - corticosteroid Night splinting. 3rd line treatments - extracorporeal shockwave therapy, topaz plasma coblation, nitric oxide, platelet rich plasma, endoscopic/open surgery.
What is tibialis posterior tendon dysfunction?
Changes within the tendon causing inability to support the arch. Results in flattening of the foot.
4 stages
largely clinical diagnosis with double and single heel raise.
Medial or lateral pain
What is the management of tibias posterior tendon dysfunction?
Orthotics - medial arch support. Reconstruction of tendon triple fusion (subtalar, talonavicular and calcaneocuboid)
What is diabetic foot ulcer?
Open sore or wound on foot due to diabetic neuropathy.
Usually lack of sweating/ normal sebum production creating dry cracked skin that is more sensitive to minor trauma.
Poor vascular supply.
What is the treatment for diabetic foot ulcers?
Prevention diabetic control Smoking cessation Improve vascular supply Ease external pressure through splints, shoes, weight bearing. Improve risk of infection and nutrition. Debride ulcers Surgical correction of deformity. Amputation
What is Charcot neuroarthropathy?
Condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage.
With continued walking foot changes shape.
Characterised by rapid bone destruction occurring in 3 stages: fragmentation, coalescence and remodelling.
How is Charcot’s neuroarthropathy diagnosed?
Consider in any diabetic with acute swollen erythematous foot.
Greater than 3 degree difference between limbs.
Frequently not painful.
Radiographs
MRI
What is the management for Charcot’s neuroarthropathy?
Prevention
Immobilsation until acute fragmentation resolved.
Correct deformity to avoid ulceration and amputation.
What are tarsal coalitions?
Abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage or fibrous tissue, may lead to limited motion and pain in one or both feet.
What are some features of ankle arthritis?
Commonly post traumatic
Consider haemochromatosis if non known trauma and under 50yrs.
Mean onset age 46yrs compared to 51 yrs in hip arthritis.
What 2 tendons form the achilles tendon?
Gastrocnemius and Soleus
What is a cavovarus foot?
Foot deformity characterised by an abnormally high arch and an inverted heel.
Excessive weight is placed on the ball and heel of the foot when standing or walking.
Weakness of intrinsic muscles also results in clawing of toes.
Overpull of tibialis posterior resulting in adduction of forefoot.
What are the clinical manifestations of cavovarus foot?
Plantar callosities due to plantarflexion of metatarsals and clawing of toes.
Ankle instability due to hind foot varus.
Altered gait due to equinus (weakness of tibias anterior)
Stress fractures of lateral metatarsals due to overpull of tibialis posterior.
What 5 questions would you ask someone with suspected cavovarus foot?
Progressive? Family history? Muscle pain or weakness? Elevated creatinine kinase? Altered sensation?
What investigative test is used in Cavovarus foot?
Coleman Block test.
Differentiates between forefoot driven hindfoot varus and hindfoot driven varus.
Patient stands with 1st ray hanging over the edge of the block
If hindfoot varus corrects, then it is compensating for a rigidly plantarflexed 1st ray.
