Forefoot Conditions Flashcards
From the list select the possiblae Forefoot Pathologies
a) Heel Spur
b) Superfiocial Calcaneal Bursitus
c) Mortons Neuroma
d) Plantaris Tedinopathy
e) Fat Pad Atrophy
f) Hallux Valgus
g) Hallux Limitus/Rigidus
h) Plantar Plate Injury
c) Mortons Neuroma
e) Fat Pad Atrophy
f) Hallux Valgus
g) Hallux Limitus/Rigidus
h) Plantar Plate Injury
Describe Mortons Neuroma/Nerve Entrapment 5
What it is
Where it occurs
Mechanical factors predisopsing pathology 3
Compression and irritaation of an Interdigital nerve causing degenertive allteration to one of the intermetatarsal nerves
Most commonly occurs between in th 3rd 4th interdigital space
Mechanical factors predisposing Mortons neroma:
* Forefoot Hypermobility
* Neural Ischemia
* Conjoined Nerve
What are the signs and symptomns associated with Mortons Neuroma 4
Charecteristic
Cause and aggravater
Charecteristic
Visible sign
- Sharp Burning pain in the plantar aspect of the Forefoot (Met heads + MTPJ)
- Compression of the interdigital nerves. Pain that is aggravated by walking and wearing tight shoes or high heels and alleviated by rest and removing the shoe
- Numbness and the feeling of a pebble in the shoe
- Churchill’s Sign (Splay of digits)
What Test would you conduct to aid diagnoses of Mortons Neuroma 2
Mulders Click
* Patient foot of the end of the couch
* Place your hand cupping the sides of the foot and squeeze the 1st and 5th Metatarsal heads together
* Apply direct pressure in a proximal direction with the thumb at the affected web space
* A posotive sign is when a palpable click is felt of heard
Finger Thumb Squeeze Test
* The symptomatic intermetatarsal space is squeezed between the tips of the index finger (dorsal) and thumb (plantar)
* Splaying of the involved toes is used as a guide for correct positioning and pressure of the thumb and index finger
* Test is Posotive if pain is produced
Ultrasound +MRI
What are the differential diagnosis for Mortons Neuroma 6
Tarsal Tunnel syndrome
Intermetatarsal Bursitis
Rupture Plantar Plate
Friebergs Osteochondrosis
Arthiirtis
MTPJ Synovitis
What is the managemnet of Mortons Neuroma 8
Primary aim of alleviating pressure and irritation of the nerve
Patient education
Wide toe box footwear
Orthotics = Met Dome
Corticosteroid injection
Shockwave Therapy
Accupunture
Surgical excision
Detail Hallux Limitus 2
plus subdivisions
Hallux Limitus referes to the preliminary restriction of Sagital Plane motion at the 1st MTPJ
Charecterised by moderate ostoearthritic changes at first MTPJ
Further divided into Structural Hallux Limitus and Functional Hallux Limitus
Structural Hallux Limitus = Limited Dorsiflexion in weight bearing and non-weight bearing
Functional Hallux Limitus = Dorsiflexion at first MTPJ limited in weight bearing but functions normally in the unloaded foot
Detail Hallux Rigidus
Complete structural restriction in Sagital Plane Motion at 1st MTPJ
Describe the Effects on GAIT Seen in a patient with Hallux Limitus
Sagital plane Explination 5 sentences
Visual effects 5
- MTPJ is one of the 3 Rockers (Ankle, Heel, MTPJ)
- Failure of one of the rockers to permit Sagital Plane motion leads to Sagital Plane Blockade
- Dorsiflexion of the MTPJ during propulsion enables the transfer of body mass fom the loaded to unloaded foot.
- Limitation of Dorsiflexion will inhibt forward progression and efficient propulsion via preventing MLA from rising via the Windlass Mechanism
- Lack of windlass activation will lead to proximal compensations:
1. Delayed Heel lift due to compensatory pronation at the midtarsal joint (late in stance)
2. Vertical toe off where the foot is lifted avoiding propulsive phase
3. Increased Lateral Weight bearing (avoid loading 1st Ray adopting inevrted position)
4. Abducted or Adducted Toe Off (to follow the path of least resistance)
5. Flexion (knee, hip, lumbar flexion)
What are the management options for Functional Hallux Limitus 5 total
3 orthortic
Improve MTPJ range of motion or windlass function.
Orthotics – e.g.1st Ray Cut-Out, 1st MTPJ Cut-out, Cluffy Wedge
Exercise – e.g. Peroneus Longus Strengthening, Tibialis Posterior Strengthening
Injection Therapy
Footwear – Flexible forefoot, forefoot rocker.
What are the management options for Structural Hallux Limitus 5
Treatment aims to immobilise MTPJ range of motion or reduce inflammatory response.
Orthotics = Mortons extension
Exercise therapy
Injection Therapy
Firm Soled Footwear or Rocker Sole
Describe Hallux Valgus
What is the common cause of HAV 2
Lateral devation of of the Hallux and Medial deviation of the 1st Metatarsal
Common HAV cause is 1st ray instability and often considered a hypermobility deformity
What would you expect to observe in the 1st MTPJ of a foot with HAV 6
Hallux Limitus/Rigidus (Reduced Dorsiflexion AND Plantarflexion)
Overlying
Erythema to 1st MTPJ
Dorsal Osteophytic Lipping
Callosity and or Medial Callus to interphalangeal joint
Possible abductory flick
From a radiographic perspective,
hallux valgus is considered present
when the angle formed between the
longitudinal bisections of the first
metatarsal and proximal phalanx is what?
a) gretaer than 10 %
b) lower than 15%
c) greater than 15%
d) greater than 25%
c) greater than 15%
Stage 3 of the Manchester Scale for grading Hallux Valgus is what?
a) Hallux continues to deviate and presses onto the neighboring digit even more so. Subluxation occurs (partial dislocation). An apropulsive gait (limp), possible pain and width increasing of the forefoot
b) Unstable 1st ray effects the 1st MTPJ, uneven Hallucis traction from the adductor and abductor. Pronation causes instability during propulsion
c) Complete dislocation of the 1st MTPJ and, further increased width of the forefoot. 2nd toe flexion deformity resultant from increased weightbearing over 2nd MTPJ.
d) Lateral shifting of the hallux, adductor and long lever arm of the extensor tendons now pull on a deviated hallux. This stage is the first one where the hallux touches the 2nd toe.
a) Hallux continues to deviate and presses onto the neighboring digit even more so. Subluxation occurs (partial dislocation). An apropulsive gait (limp), possible pain and width increasing of the forefoot
