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MSK > Foot problems > Flashcards

Foot problems Flashcards

1
Q

What are some possible causes of hallux valgus (bunions)?

A

Genetic
Foot wear
Significant female preponderance

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2
Q

What are some symptoms of hallux valgus?

A

Pressure symptoms from shoe wear
Pain from crossing over of toes
Metatarsalgia

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3
Q

What causes hallux valgus?

A

Lateral angulation of toe
Tendons pull realigned to lateral of centre
Increased pull creates increased deformity

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4
Q

How is hallux valgus diagnosed?

A

Clinical

X-ray

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5
Q

What is x-ray used for in hallux valgus?

A

Assess severity of bone deformity

Exclude associated degenerative change

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6
Q

What are some non-operative treatment options for hallux valgus?

A

Shoe wear modification
Orthotics to offload pressure/correct deformity
Activity modification
Analgesia

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7
Q

What are some operative treatment options for hallux valgus?

A

Release lateral soft tissues
Osteotomy 1st metatarsal +/- proximal phalanx
Generally good outcome but recurrence inevitable

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8
Q

What is hallux rigidus?

A

Stiff big toe

Osteoarthritis of 1st MTP joint

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9
Q

How does hallux rigidus present?

A

Limited range of movement
Pain mostly on dorsiflexion
Many asymptomatic

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10
Q

What are some non-operative treatment options for hallux rigidus?

A

Activity modification
Shoe wear with rigid sole
Analgesia

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11
Q

What are the operative treatment options for hallux rigidus?

A

Cheilectomy
Arthrodesis
Arthroplasty
1st MTPJ fusion (gold standard)

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12
Q

What is cheilectomy?

A

Remove dorsal impingement

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13
Q

What are some lesser toe deformities?

A

Claw toes
Hammer toes
Mallet toes

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14
Q

What are some causes of lesser toe deformities?

A 
Imbalance between flexors/extensors
Shoe wear 
Neurological
Rheumatoid arthritis
Idiopathic
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15
Q

What are some symptoms of lesser toe deformities?

A

Deformity
Pain on dorsum of foot
Pain from plantar side

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16
Q

What are some operative treatment options for lesser toe deformities?

A

Flexor to extensor transfer
Fusion of interphalangeal joint
Release metatarsophalangeal joint
Shortening osteotomy of metatarsal

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17
Q

What are some non-operative treatment options for lesser toe deformities?

A

Activity modification
Shoe wear – flat shoes with high toe box to accommodate deformity
Orthotic insoles to support metatarsal bar/dome

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18
Q

What is interdigital neuroma?

A

Morton’s neuroma

Common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear

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19
Q

What are some possible causes of Morton’s neuroma?

A

Mechanically induced degenerative neuropathy
Tends to affect females aged 40-60
Frequently associated with wearing high healed shoes

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20
Q

How does Morton’s neuroma present?

A

Typically affects 3rd followed by 2nd webspace/toes
Neuralgic burning pain into toes
Intermittent
Altered sensation in webspace

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21
Q

How is Morton’s neuroma diagnosed?

A

Clinical
Mulder’s click
USS best test
MRI

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22
Q

How are Morton’s neuromas managed?

A

Injection for small lesions

Excision of lesion including section of normal nerve

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23
Q

What are some possible causes of metatarsalgia?

A 
Synovitis
Bursitis
Arthritis
Neuralgia
Neuromata
Freiberg's disease
Tight gastrocnemius
24
Q

What are some non-operative treatment options for rheumatoid forefoot?

A

Shoewear
Orthotics
Activity modification

25
Q

What are some operative treatment options for rheumatoid forefoot?

A

1st MTJP arthrodesis

2-5th tow excision arthroplasty

26
Q

Where do dorsal foot ganglia come from?

A

Joint or tendon sheath

27
Q

What causes dorsal foot ganglia?

A

Idiopathic
Underlying arthritis
Underlying tendon pathology

28
Q

What are some symptoms of dorsal foot ganglia?

A

Pain from pressure from shoe wear

Pain from underlying problem

29
Q

How are dorsal foot ganglia treated?

A

Immobilisation to stop growth
Aspiration
Excision

30
Q

What is ledderhose disease?

A

Plantar fibromatosis

“Dupuytrens of the foot”

31
Q

How does plantar fibromatosis present?

A

Usually asymptomatic unless very large or over weightbearing area
Progressive

32
Q

How is plantar fibromatosis treated?

A

Orthotics
Excision
Radiotherapy

33
Q

What is the difference between paratendonopathy and tendonopathy?

A

Tendonopathy more common in non-athletic populations rather than athletic
Tendonopathy also often associated with obesity, steroids, diabetes

34
Q

How does achilles tendonopathy present?

A

Pain during exercise
Pain following exercise
Recurrent episodes
Difficulty fitting shoes

35
Q

Can achilles tendonopathy cause rupture?

A

Yes

36
Q

How is achilles tednonopathy diagnosed?

A

Tenderness
Test for rupture
USS
MRI

37
Q

What are some tests used to check for achilles rupture?

A

Simmonds test

Matles (“angle of the dangle”)

38
Q

What are some non-operative treatment options for achilles tendonopathy?

A 
Activity modification
Weight loss
Shoe wear modification – slight heel
Physiotherapy – Eccentric stretching
Extra-corporeal shockwave treatment
Immobilisation
39
Q

What are the operative treatment options for achilles tendonopathy?

A

Gastrocnemius recession

Release and debridement of tendon

40
Q

What is plantar fasciitis?

A

Chronic degenerative change
Fibroblast hypertrophy
Disorganised and dysfunctional blood vessels and collagen

41
Q

What are some possible causes of plantar fasciitis?

A

High intensity or rapid increase in training
Running with poorly padded shoes or hard surfaces
Obesity
Job with prolonged standing
Foot/lower limb rotational deformities
Tight gastro-soleus complex

42
Q

How does plantar fasciitis present?

A

Pain first thing in the morning

Pain on weight bearing after rest

43
Q

What are some possible differential diagnoses with plantar fasciitis?

A

Nerve entrapment syndrome
Arthritis
Calcaneal pathology

44
Q

How is plantar fasciitis diagnosed?

A

Mainly clinical

Sometimes x-rays, USS, MRI

45
Q

How can plantar fasciitis be treated?

A 
Rest
Stretching
Ice
NSAIDs
Orthoses
Physio
Weight loss
Corticosteroid injections
Night splinting
46
Q

What is tibialis posterior tendon dysfunction?

A

Acquired adult flat foot planovalgus

47
Q

Where does pain occur in tibialis posterior tendon dysfunction?

A

Medial or lateral

48
Q

How is tibialis posterior tendon dysfunction managed?

A

Orthoses or surgery

49
Q

How is tibialis posterior tendon dysfunction diagnosed?

A

Largely clinical diagnoses

Single and double heel raise (heels should normally swing from varus to valgus)

50
Q

How does surgery resolve diabetic foot ulcers?

A

Improve Vascular Supply
Debride ulcers and get deep samples for microbiology
Correct any deformity to offload area
Amputation

51
Q

What is neurovascular charcot neuropathy?

A

Abnormal autonomic nervous system results in increased vascular supply and bone resorption

52
Q

What is neurotraumatic charcot neuropathy?

A

Lack of proprioception and protective pain sensation

53
Q

When should charcot neuropathy be considered?

A

High index of suspicion
Consider in any diabetic with acutely swollen erythematous foot especially with neuropathy
Greater than 3 degree difference between limbs
Frequently not painful

54
Q

Which tests are used for charcot neuropathy?

A

Radiographs

MRI

55
Q

How is charcot neuropathy managed?

A

Prevention
Immobilisation
Correct deformity causing neuropathy

MSK (26 decks)

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