Foot problems

Question 1

Halux Valgus/ Bunions aetiology and symptoms

Answer 1

aeitology - footwear, genetic, females. Symptoms - pressure from show wear, pain from crossing of toes, metatarsalgia.

Question 2

pathogenesis

Answer 2

lateral angulation of the great toe. Tendons pull realigned to lateral of centre of rotation of toe worsening deformity. Vicious cycle of increased pull creating increased deformity.

Question 3

diagnosis and Mx

Answer 3

xray. Shoe wear modification, orthotics, analgesia, activity alteration, Osteotomy of 1st metatarsal (scarf, basal)

Question 4

Hallux rigidus/ stiff toe overveiw…

Answer 4

osteoarthritis of 1st MTP joint, pain, limitation of range of movement, xray, Mx- analgesia, activity modification, Surgery - 1st MTPJ Fusion, Cheilectomy, Arthodesis, Arthroplasty

Question 5

Lesser toe deformities…

Answer 5

claw, hammer and mallet. Aetiology - flexor/extensor imbalance, shoe wear, neurological, RA. Symptoms - deformity, pain from the dorsum and plantar sides. Tx - shhoe waear and activity modification, orthotic insoles. Surgery - flexor to extensor transfer, fusion of Interphalangeal joint, shortening osteotomy of the metatarsal.

Question 6

Mortons neuroma aetiology

Answer 6

mechanically induced, females 40-60, high heels, common digital nerve tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear.

Question 7

symptoms…

Answer 7

3rd/2nd webspace effected, neuralgic burning pain into toes, intermittent, altered sensation in the webspace.

Question 8

diagnosis…

Answer 8

Mulders click, US and MRI

Question 9

Mx

Answer 9

injection for small lesions, surgery - excision of lesion

Question 10

Metatarsalgia

Answer 10

sympton not cause. Caused by synovitis, bursitis, arthritis, neuralgia, freibergs disease, consider a tight gastrocnemius

Question 11

Rheumatoid foot Tx

Answer 11

shoewear/orthotics/activity, surgery - 1st MTPJ arthodesis.

Question 12

Dorsal foot ganglia aetiology and symptoms and Tx

Answer 12

underlying arthritis or tendon pathology. Sx- pain. Tx - aspiration, excision.

Question 13

Midfoot Arthritis

Answer 13

post trauma, osteoarthritis, RA, Tx - acti/shoes/orthotics, injections, operative fusion.

Question 14

Plantar Fibromatosis

Answer 14

ledderhose disease, dupuytrens of the foot, progressive, asymptomatic, Tx - ac/sh/orth, radiotherapy, excision.

Question 15

Types of Achilles tendonitis

Answer 15

degenerative overuse condition with little inflammation types: insertional, non-insertional, bursitis (retro/superficial calcaneal), paratendinopathy.

Question 16

Aetiology of achillies tendonitis

Answer 16

paratendinopathy - athletes, 30-40, males 2:1. Tendonopathy - nonathletic, over 40, obesity, steroids, DM.

Question 17

Symptoms…achillies tendonitis

Answer 17

pain during and following exercise, recurrent episodes, wearing shoes, Beware of rupture.

Question 18

Dx of achilles tendonitis

Answer 18

clinical - tenderness, rupture tests (Simmonds test - squeeze calf muscle and if the foot moves then the tendon isnt fully ruptured), angle of the dangle and matles, Ix - US, MRI.

Question 19

Tx - achillies tendonitis

Answer 19

act/sh/orth, physio, weight loss, extra-corporeal shockwave tx, immobilisation. Surgery - gastrocnemius recession, release and debridement of the tendon.

Question 20

Plantar Fasciitis…

Answer 20

Fasciosis - Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen, asvascularity Cant make Extra Cellular Matrix required for repair and re-modelling

Question 21

Aetiology - Plantar Fasciitis..

Answer 21

high intensity training, running with poorly padded shoes on hard surfaces, obesity, occupations involving prolonged standing, rotational deformities, tight gastro-soleus complex.

Question 22

symptoms… Plantar Fasciitis..

Answer 22

pain in the morning, on weight bearing after rest, pain in the origin of plantar fascia, long lasting - 2 or more yrs.

Question 23

ddx and Ix - Plantar Fasciitis..

Answer 23

nerve entrapment syndrome, arthritis, calcaneal pathyology, Ix - clinical, MRI ans US.

Question 24

Tx Plantar Fasciitis..

Answer 24

rest, training, stretching, ice, NSAID’s, othroses, physio, weight loss, corticosteroid injections, night splinting.

Question 25

3rd line tx - Plantar Fasciitis..

Answer 25

Extracorporeal Shockwave therapy, Topaz Plasma Coblation, Nitric Oxide, Platelet Rich Plasma, Endoscopic / Open Surgery

Question 26

Ankle Arthritis

Answer 26

40’s, post-traumatic, pain and stiffness, CT, mx - weight loss, analgesia, act/shoes/orthotics, physio, steroid injections. Arthodesis, joint replacement, ankle fusion.

Question 27

Posterior tibial tendon dysfunction

Answer 27

acquired adult flat foot planovalgus, common, clincal diagnosis - double or single heel raise, medial or lateral pain, Mx - orthoses or surgery - triple fusion, reconstruction.

Question 28

Diabetic foot ulcer

Answer 28

neuropathy, poor vascular supply and lack of patient eduction, tx - prevention, diabetic control, smoking, vascular supply, external pressure, infection, nutrition. Surgical - debride, amputation, improve vascular supply

Question 29

Charcot Neuropathy

Answer 29

aetiology - dm, neuropathies, syphilis. Pathophysiology - Neurotraumatic (Lack of proprioception and protective pain sensation), Neurovascular (Abnormal autonomic nervous system results in increased vascular supply and bone resorption). Fragmentation, coalescence, remodelling, Mx - immobilisation, amputation.