Foot Problems - Hindfoot Flashcards

1
Q

Includes

A

Achilles Tendinopathy
Plantar Fasciitis
Ankle Osteoarthritis

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2
Q

Define Achilles tendinopathy

A

A degenerative/overuse condition with little inflammation, hence the term tendinitis should be avoided

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3
Q

What are the types of Achilles Tendinopathy?

A
  • Insertional Tendinopathy (Within 2cm of insertion)
  • Mid-substance Tendinopathy
  • Bursitis either retrocalcaneal or superficial calcaneal
  • Paratendinopathy (true inflammation)
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4
Q

Who gets Achilles paratendinopathy?

A

Athletic people in their 30s-40s, more often men

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5
Q

Who gets an Achilles tendinopathy?

A

Non-athletics populations >40.

Associated with obesity, steroids and diabetes

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6
Q

How does Achilles Tendinopathy present?

A

Pain during or following exercise.
Insertional tendinopathy can cause difficulties putting shoes on.
Visible rupture in some cases

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7
Q

How do we diagnose someone with Achilles Tendinopathy?

A

Clinically:

  • Tenderness
  • Rupture tests

Tests:

  • US
  • MRI
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8
Q

How do we test for Achilles rupture as part of tendinopathy?

A

Simmond’s Test - Squeeze soleus to see if the calf still moves

Matles’ Test

“Angle of the dangle”

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9
Q

How do we treat an achilles tendinopathy?

A

Non-operative:

  • Acitvity modification
  • Weight loss
  • Shoe wear modification
  • Physiotherapy
  • Extra-corporeal Shockwave
  • Immobilisation

Operatively:

  • Gastrocnemius Recession
  • Release & debridement of tendon
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10
Q

Define Plantar Fasciitis?

A

More of a fasciosis.
Its a chronic degenerative change involving:
- Fibroblast hypertrophy
- Absent inflammatory cells
- Dysfunctional blood vessels & collagen
- Avascularity

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11
Q

What causes Plantar Fasciitis?

A

Unknown but its associated with:

  • High intensity training
  • Running with poor padding
  • Obesity
  • Occupations with prolonged standing
  • Foot deformities
  • Tight Gastro-soleus complex
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12
Q

How does plantar fasciitis present?

A

Pain in the morning or on weight bearing after rest (post-static dyskinesia)
Pain is at the origin of plantar fascia

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13
Q

DDX for plantar fasciitis?

A

Nerve entrapment
Arthritis
Calcaneal Pathology

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14
Q

How do we diagnose Plantar Fasciitis?

A

Clinically

Can use X-rays, US or MRI

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15
Q

Treatments for Plantar Fasciitis?

A
Rest
Stretching
Ice
NSAIDs
Orthotics
Physiotherapy
Weight loss
CCS injection
Night splinting
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16
Q

Any 2nd/3rd line treatments for Plantar fasciitis?

A
Extracorporeal Shockwave therapy
Topaz Plasma Coblation
Nitric Oxide
Platelet rich plasma
Endoscopic or open surgery
17
Q

What causes arthritis in the ankle and how does it present?

A

Just pain and stiffness

Tends to present in the 40s either idiopathic or post-traumatic

18
Q

How do we diagnose ankle arthritis?

A

Clinically along with radiographs and a CT

19
Q

How do we manage ankle arthritis without surgery?

A
Weight Loss
Activity Modification
Analgesia
Physiotherapy
Steroid Injections
20
Q

How do we surgically manage Ankle Arthritis?

A

Anterior only symptoms? - Arthroscopic Ant. Debridement

Gold Standard is Arthrodesis

Joint Replacement can maintain ROM