Foot Problems - Hindfoot Flashcards
Includes
Achilles Tendinopathy
Plantar Fasciitis
Ankle Osteoarthritis
Define Achilles tendinopathy
A degenerative/overuse condition with little inflammation, hence the term tendinitis should be avoided
What are the types of Achilles Tendinopathy?
- Insertional Tendinopathy (Within 2cm of insertion)
- Mid-substance Tendinopathy
- Bursitis either retrocalcaneal or superficial calcaneal
- Paratendinopathy (true inflammation)
Who gets Achilles paratendinopathy?
Athletic people in their 30s-40s, more often men
Who gets an Achilles tendinopathy?
Non-athletics populations >40.
Associated with obesity, steroids and diabetes
How does Achilles Tendinopathy present?
Pain during or following exercise.
Insertional tendinopathy can cause difficulties putting shoes on.
Visible rupture in some cases
How do we diagnose someone with Achilles Tendinopathy?
Clinically:
- Tenderness
- Rupture tests
Tests:
- US
- MRI
How do we test for Achilles rupture as part of tendinopathy?
Simmond’s Test - Squeeze soleus to see if the calf still moves
Matles’ Test
“Angle of the dangle”
How do we treat an achilles tendinopathy?
Non-operative:
- Acitvity modification
- Weight loss
- Shoe wear modification
- Physiotherapy
- Extra-corporeal Shockwave
- Immobilisation
Operatively:
- Gastrocnemius Recession
- Release & debridement of tendon
Define Plantar Fasciitis?
More of a fasciosis.
Its a chronic degenerative change involving:
- Fibroblast hypertrophy
- Absent inflammatory cells
- Dysfunctional blood vessels & collagen
- Avascularity
What causes Plantar Fasciitis?
Unknown but its associated with:
- High intensity training
- Running with poor padding
- Obesity
- Occupations with prolonged standing
- Foot deformities
- Tight Gastro-soleus complex
How does plantar fasciitis present?
Pain in the morning or on weight bearing after rest (post-static dyskinesia)
Pain is at the origin of plantar fascia
DDX for plantar fasciitis?
Nerve entrapment
Arthritis
Calcaneal Pathology
How do we diagnose Plantar Fasciitis?
Clinically
Can use X-rays, US or MRI
Treatments for Plantar Fasciitis?
Rest Stretching Ice NSAIDs Orthotics Physiotherapy Weight loss CCS injection Night splinting
Any 2nd/3rd line treatments for Plantar fasciitis?
Extracorporeal Shockwave therapy Topaz Plasma Coblation Nitric Oxide Platelet rich plasma Endoscopic or open surgery
What causes arthritis in the ankle and how does it present?
Just pain and stiffness
Tends to present in the 40s either idiopathic or post-traumatic
How do we diagnose ankle arthritis?
Clinically along with radiographs and a CT
How do we manage ankle arthritis without surgery?
Weight Loss Activity Modification Analgesia Physiotherapy Steroid Injections
How do we surgically manage Ankle Arthritis?
Anterior only symptoms? - Arthroscopic Ant. Debridement
Gold Standard is Arthrodesis
Joint Replacement can maintain ROM
