Foot problems Flashcards
Halux Valgus/ Bunions aetiology and symptoms
aeitology - footwear, genetic, females. Symptoms - pressure from show wear, pain from crossing of toes, metatarsalgia.
pathogenesis
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.
diagnosis and Mx
xray. Shoe wear modification, orthotics, analgesia, activity alteration, Osteotomy of 1st metatarsal (scarf, basal)
Hallux rigidus/ stiff toe overveiw…
osteoarthritis of 1st MTP joint, pain, limitation of range of movement, xray, Mx- analgesia, activity modification, Surgery - 1st MTPJ Fusion, Cheilectomy, Arthodesis, Arthroplasty
Lesser toe deformities…
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.
Mortons neuroma aetiology
mechanically induced, females 40-60, high heels, common digital nerve tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear.
symptoms…
3rd/2nd webspace effected, neuralgic burning pain into toes, intermittent, altered sensation in the webspace.
diagnosis…
Mulders click, US and MRI
Mx
injection for small lesions, surgery - excision of lesion
Metatarsalgia
sympton not cause. Caused by synovitis, bursitis, arthritis, neuralgia, freibergs disease, consider a tight gastrocnemius
Rheumatoid foot Tx
shoewear/orthotics/activity, surgery - 1st MTPJ arthodesis.
Dorsal foot ganglia aetiology and symptoms and Tx
underlying arthritis or tendon pathology. Sx- pain. Tx - aspiration, excision.
Midfoot Arthritis
post trauma, osteoarthritis, RA, Tx - acti/shoes/orthotics, injections, operative fusion.
Plantar Fibromatosis
ledderhose disease, dupuytrens of the foot, progressive, asymptomatic, Tx - ac/sh/orth, radiotherapy, excision.
Types of Achilles tendonitis
degenerative overuse condition with little inflammation types: insertional, non-insertional, bursitis (retro/superficial calcaneal), paratendinopathy.
Aetiology of achillies tendonitis
paratendinopathy - athletes, 30-40, males 2:1. Tendonopathy - nonathletic, over 40, obesity, steroids, DM.
Symptoms…achillies tendonitis
pain during and following exercise, recurrent episodes, wearing shoes, Beware of rupture.
Dx of achilles tendonitis
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.
Tx - achillies tendonitis
act/sh/orth, physio, weight loss, extra-corporeal shockwave tx, immobilisation. Surgery - gastrocnemius recession, release and debridement of the tendon.
Plantar Fasciitis…
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
Aetiology - Plantar Fasciitis..
high intensity training, running with poorly padded shoes on hard surfaces, obesity, occupations involving prolonged standing, rotational deformities, tight gastro-soleus complex.
symptoms… Plantar Fasciitis..
pain in the morning, on weight bearing after rest, pain in the origin of plantar fascia, long lasting - 2 or more yrs.
ddx and Ix - Plantar Fasciitis..
nerve entrapment syndrome, arthritis, calcaneal pathyology, Ix - clinical, MRI ans US.
Tx Plantar Fasciitis..
rest, training, stretching, ice, NSAID’s, othroses, physio, weight loss, corticosteroid injections, night splinting.
3rd line tx - Plantar Fasciitis..
Extracorporeal Shockwave therapy, Topaz Plasma Coblation, Nitric Oxide, Platelet Rich Plasma, Endoscopic / Open Surgery
Ankle Arthritis
40’s, post-traumatic, pain and stiffness, CT, mx - weight loss, analgesia, act/shoes/orthotics, physio, steroid injections. Arthodesis, joint replacement, ankle fusion.
Posterior tibial tendon dysfunction
acquired adult flat foot planovalgus, common, clincal diagnosis - double or single heel raise, medial or lateral pain, Mx - orthoses or surgery - triple fusion, reconstruction.
Diabetic foot ulcer
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
Charcot Neuropathy
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.
