Foot Problems - Hindfoot

Question 1

Includes

Answer 1

Achilles Tendinopathy
Plantar Fasciitis
Ankle Osteoarthritis

Question 2

Define Achilles tendinopathy [1]

Why is achilles tendonitis a misnomer? [1]

Answer 2

A degenerative/overuse condition [1] with little inflammation, hence the term tendinitis should be avoided

Question 3

What are the types of Achilles Tendinopathy? [4]

Answer 3

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

Question 4

Who gets Achilles paratendinopathy? [3]

Answer 4

Athletic people [1] in their 30s-40s [1], more often men [1]

Question 5

Who gets an Achilles tendinopathy? [2]

Give 3 risk factors

Answer 5

Non-athletics populations [1] >40 [1]

Associated with obesity, steroids and diabetes [3]

Question 6

How does Achilles Tendinopathy present? [3]

Answer 6

Pain during or following exercise [1]
Insertional tendinopathy can cause difficulties putting shoes on [1]
Visible rupture in some cases [1]

Question 7

How do we diagnose someone with Achilles Tendinopathy? [4]

Answer 7

Clinically:

• Tenderness
• Rupture tests

Tests:

• US
• MRI

Question 8

How do we test for Achilles rupture as part of tendinopathy? [2]

Answer 8

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

Matles’ Test
“Angle of the dangle”

Question 9

How do we treat an achilles tendinopathy?
Non-operative [6]
Operative [2]

Answer 9

Non-operative:

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

Operatively:

• Gastrocnemius Recession
• Release & debridement of tendon

Question 10

Pathophysiology of plantar fasciitis [4]

Answer 10

Its a chronic degenerative [1] change involving:

• Fibroblast hypertrophy
• Absent inflammatory cells
• Dysfunctional blood vessels & collagen
• Avascularity

Question 11

What are the risk factor associated with Plantar Fasciitis? [6]

Answer 11

Unknown cause but its associated with:

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

Question 12

How does plantar fasciitis present? [3]

Answer 12

Pain in the morning [1] or on weight bearing after rest (post-static dyskinesia) [1]
Pain is at the origin of plantar fascia [1]

Question 13

DDX for plantar fasciitis? [3]

Answer 13

Nerve entrapment
Arthritis
Calcaneal Pathology

Question 14

How do we diagnose Plantar Fasciitis? [2]

Answer 14

Clinically

Can use X-rays, US or MRI

Question 15

Non-invasive management for Plantar Fasciitis?
Self-help [4]
Prescribed [3]

Answer 15

Rest, Stretching, Ice
Weight loss
Physio

NSAIDs
Orthotics, Night splinting (keeps foot at 90)
CCS injection

Question 16

What are the 2nd/3rd line treatments for Plantar fasciitis? [5]

Answer 16

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

Question 17

What causes arthritis in the ankle and how does it present? [2]

Answer 17

Just pain and stiffness

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

Question 18

How do we diagnose ankle arthritis? [3]

Answer 18

Clinically along with radiographs and a CT

Question 19

How do we manage ankle arthritis without surgery? [5]

Answer 19

Weight Loss
Activity Modification
Analgesia
Physiotherapy
Steroid Injections

Question 20

How do we surgically manage Ankle Arthritis? [3]

Answer 20

Anterior only symptoms? - Arthroscopic Ant. Debridement
Gold Standard is Arthrodesis
Joint Replacement can maintain ROM