Foot Problems - Hindfoot

Question 1

Includes

Answer 1

Achilles Tendinopathy
Plantar Fasciitis
Ankle Osteoarthritis
Tibialis posterior dysfunction 
Cavovarus foot

Question 2

Define Achilles tendinopathy

Answer 2

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

Question 3

What are the types of Achilles Tendinopathy?

Answer 3

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

Question 4

Who gets Achilles paratendinopathy?

Answer 4

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

Question 5

Who gets an Achilles tendinopathy?

Answer 5

Non-athletics populations >40.

Associated with obesity, steroids and diabetes

Question 6

How does Achilles Tendinopathy present?

Answer 6

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

Question 7

How do we diagnose someone with Achilles Tendinopathy?

Answer 7

Clinically:

• Tenderness
• Rupture tests

Tests:

• US
• MRI

Question 8

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

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?

Answer 9

Non-operative:

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

Operatively:

• Gastrocnemius Recession
• Release & debridement of tendon

Question 10

Define Plantar Fasciitis?

Answer 10

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

Question 11

What causes Plantar Fasciitis?

Answer 11

Unknown 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?

Answer 12

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

Question 13

DDX for plantar fasciitis?

Answer 13

Nerve entrapment
Arthritis
Calcaneal Pathology

Question 14

How do we diagnose Plantar Fasciitis?

Answer 14

Clinically

Can use X-rays, US or MRI

Question 15

Treatments for Plantar Fasciitis?

Answer 15

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

Question 16

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

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?

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?

Answer 18

Clinically along with radiographs and a CT

Question 19

How do we manage ankle arthritis without surgery?

Answer 19

Weight Loss
Activity Modification
Analgesia
Physiotherapy
Steroid Injections

Question 20

How do we surgically manage Ankle Arthritis?

Answer 20

Anterior only symptoms? - Arthroscopic Ant. Debridement

Gold Standard is Arthrodesis

Joint Replacement can maintain ROM