Foot Problems - Other

Question 1

What is Posterior Tibial Tendon Dysfunction?

Answer 1

A relatively common inflammation of the post tibial tendon

Question 2

How do we diagnose Posterior Tibial Tendon Dysfunction?

Answer 2

Clinically with double & single heel raise, along with medial or lateral pain.
+ an MRI to assess the tendon

Question 3

How do we manage Post. Tibial Tendon Dysfunction

Answer 3

• Orthotics
• Reconstruction of tendon
• Triple fusion of subtalar, talonavicular and calcaneocuboid joints

Question 4

What causes a diabetic foot ulcer?

Answer 4

• Diabetic Neuropathy - patient unaware of trauma
• Autonomic neuropathy - lack of sweating/normal sebum production -> Dry cracked skin and sensitivity to trauma
• Poor vascular supply -> poor healing

Question 5

How do we prevent Diabetic Foot Ulcers?

Answer 5

• Diabetic Control
• Smoking
• Vascular Supply
• External Pressure from shoes/splints
• Internal pressure (Deformity)
• Infection
• Nutrition

Question 6

How do we treat a diabetic foot ulcer?

Answer 6

Surgically:

• Improve vascular supply
• Debride ulcers
• Correct deformity to reduce load on an area
• Amputation

Question 7

Prognosis for Diabetic Foot Ulcer?

Answer 7

15% of diabetics -> ulceration
25% of ulcer patients -> Amputation
5yr patient mortality is 50%

Question 8

Define Charcot Neuroarthropathy?

Answer 8

Progressive degeneration of a weight bearing joint.
Any neuropathy, mostly diabetes leads to rapid bone destruction occuring in 3 stages:
- Fragmentation
- Coalescence
- Remodelling

Question 9

How do we diagnose Charcot Neuroarthropathy?

Answer 9

consider in any Diabetic patient with acutely swollen erythematous foot, especially with neuropathy.

Look for a >3* difference between limbs, pain

Do X-ray and MRI

Question 10

How do we manage a charcot neuroarthropathy?

Answer 10

• Prevention
• Immobilise + no-weight bearing until acute fragmentation resolved
• Correct Deformity