Foot Problems - Forefoot Flashcards
Contains:
Hallux Valgus Hallux Rigidus Lesser Toe deformities Morton's Neuroma Metatarsalgia Rheumatoid forefoot
What is hallux valg\us?
A bunion
Lateral angulation of the big toe, the tendons then pull lateral to the toes center of rotation leading to worsening angulation
What cause Hallux Valgus?
Genetics and Foot Wear
It has a significant female proponderance
Symptoms of Hallux Valgus?
Pressure symptoms from the shoe
Pain of the toes crossing over
Metatarsalgia
How do we diagnose Hallux Valgus?
Clinical diagnosis
Can use X-rays to determine severity of deformity
How do we manage Hallux Valgus?
Non-operative:
- Shoe wear modification
- Orthotics
- Activity Modification
- Analgesia
Operative:
- Release lateral soft tissue
- Osteotomy of 1st metatarsal
What is Hallux Rigidus?
Literally “Stiff Big Toe”
Its osteoarthritis of the 1st MTP join
What causes Hallux Rigidus?
Possibly genetic or due to multiple microtrauma
How does hallux rigidus present?
Many are asymptomatic.
Others have a limited range of motion and pain (often at extreme of dorsiflexion)
How do we diagnose hallux rigidus?
Clinically and with radiographs to spot the Osteoarthritis
How do we manage Hallux Rigidus?
Non-operative:
- Activity modification
- Shoe wear modification
- Analgesia
Operative
- Cheilectomy (removing the dorsal impingement)
- Arthrodesis (1st MTPJ fusion is gold standard but permanent)
- Arthroplasty (1st MTPJ hemiarthroplasty is good for maintaining ROM but fails alot)
What are the types of lesser toe deformities?
Claw Toe - both IP joints deformed
Hammer Toe - 1st IP joint deformed
Mallet Toe - 2nd IP joint deformed
What causes a lesser toe deformity?
Flexor/extensor imbalance Shoe Wear Neurological conditions Rheumatoid arthritis Idiopathic
How does a lesser toe deformity present?
Visible deformity +/- dorsal pain +/- plantar pain (metatarsalgia)
How do we treat a deformed lesser toe?
Non-operative:
- Activity Modification
- Shoe wear modification
- Orthotic insoles
Operative:
- Flexor to extensor transfer
- IP joint fusion
- MTP joint release
- Shortening osteotomy of metatarsal
What is Morton’s Neuroma aka Interdigital Neuroma?
a mechanically induced degenerative neuropathy of a common digital nerve, typically in the 3rd then 2nd web spaces.
Associated with women in their 40s/50s who frequently wear high heels
How does Morton’s Neuroma present?
Intermittent Neuralgic burning pain into toes along with altered sensation in the webspaces.
Typically affects the 3rd then 2nd webspaces
How do we diagnose Morton’s Neuroma?
Clinical presentation
Mulder’s Click
US or MRI
How do we manage Morton’s Neuroma?
Injection
Surgical excision of lesion (associated with numbess & recurrence)
How do we treat Rheumatoid Forefoot?
Non-operative:
- Shoewear
- Orthotics
- Activity
- Analgesia
Operative:
- 1st MTPJ arthrodesis
- 2-5th toe excision arthroplasty
