Foot Problems - Forefoot

Question 1

Contains:

Answer 1

Hallux Valgus
Hallux Rigidus
Lesser Toe deformities 
Morton's Neuroma
Metatarsalgia
Rheumatoid forefoot

Question 2

What is hallux valg\us?

Answer 2

A bunion
Lateral angulation of the big toe, the tendons then pull lateral to the toes center of rotation leading to worsening angulation

Question 3

What are the risk factors Hallux Valgus?

Answer 3

• Genetics
• Foot Wear
• female
• FH
• Neuromuscular disease
• Hypermobility

Question 4

Symptoms of Hallux Valgus?

Answer 4

• Pressure symptoms from the shoe
• Pain of the toes crossing over
• Metatarsalgia
• some report massive pain with small deformities
• others report little pain with large bunions

Question 5

How do we diagnose Hallux Valgus?

Answer 5

Clinical diagnosis

Can use X-rays to determine severity of deformity

Question 6

How do we manage Hallux Valgus?

Answer 6

Non-operative:

• Shoe wear modification
• Orthotics
• Activity Modification
• Analgesia

Operative:
- Release lateral soft tissue
- Osteotomy of 1st metatarsal
+/- proximal phalanx

Question 7

What is Hallux Rigidus?

Answer 7

Literally “Stiff Big Toe”

Its osteoarthritis of the 1st MTP join

Question 8

What causes Hallux Rigidus?

Answer 8

Possibly genetic or due to multiple microtrauma

Question 9

How does hallux rigidus present?

Answer 9

• Many are asymptomatic.
• limited range of motion
• pain (often at extreme of dorsiflexion)

Question 10

How do we diagnose hallux rigidus?

Answer 10

Clinically and with radiographs to spot the Osteoarthritis

Question 11

How do we manage Hallux Rigidus?

Answer 11

Non-operative:

• Activity modification
• Shoe wear modification
• Analgesia

Operative

• Cheilectomy (removing the dorsal impingement a.k.a lump)
• Arthrodesis (1st MTPJ fusion is gold standard but permanent)
• Arthroplasty (1st MTPJ hemiarthroplasty is good for maintaining ROM but fails alot)

Question 12

What are the types of lesser toe deformities?

Answer 12

Claw Toe - both IP joints deformed
Hammer Toe - 1st IP joint deformed
Mallet Toe - 2nd IP joint deformed

Question 13

What causes a lesser toe deformity?

Answer 13

• Flexor/extensor imbalance
• Shoe Wear
• Neurological conditions
• Rheumatoid arthritis
• Idiopathic

Question 14

How does a lesser toe deformity present?

Answer 14

-Visible deformity
+/- dorsal pain
+/- plantar pain (metatarsalgia)

Question 15

How do we treat a deformed lesser toe?

Answer 15

Non-operative:

• Activity Modification
• Shoe wear modification
• Orthotic insoles

Operative:

• Flexor to extensor transfer
• IP joint fusion
• MTP joint release
• Shortening osteotomy of metatarsal

Question 16

What is Morton’s Neuroma aka Interdigital Neuroma?

Answer 16

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

Question 17

How does Morton’s Neuroma present?

Answer 17

• Intermittent Neuralgic burning pain into toes
• Altered sensation in the webspaces.
• Typically affects the 3rd then 2nd webspaces
• Swelling over the nerve

Question 18

How do we diagnose Morton’s Neuroma?

Answer 18

Clinical presentation
Mulder’s Click
US or MRI

Question 19

How do we manage Morton’s Neuroma?

Answer 19

Injection
Nitrogen freezing
Insoles
Surgical excision of lesion (associated with numbess & recurrence)

Question 20

How do we treat Rheumatoid Forefoot?

Answer 20

Non-operative:

• Shoewear
• Orthotics
• Activity
• Analgesia

Operative:

• 1st MTPJ arthrodesis
• 2-5th toe excision arthroplasty

Question 21

What is metartalsalgia?

Answer 21

Adult forefoot pain