Forefoot problems

Question 1

What is hallux valgus?

Answer 1

Bunions

Lateral angulation of great toe

Question 2

What are the causes hallux valgus?

Answer 2

Genetic

Footwear

Question 3

Who is hallux valgus seen in?

Answer 3

Women

Question 4

What are the signs and symptoms of hallux valgus?

Answer 4

Pressure symptoms from footwear
Pain from crossing ver toes
Metatarsalgia

Question 5

How is hallux valgus diagnosed?

Answer 5

Clinical

Xrays- determine severity of underlying bone deformity, exclude associated degenerative disease

Question 6

What is the non operative treatment of hallux valgus?

Answer 6

Shoe modification

Orthotics to offload pressure or correct deformity

Question 7

What is the indication for operative management of hallux valgus?

Answer 7

If non operative fails or is unacceptable to the patient

Question 8

What are the types of operative treatment of hallux valgus?

Answer 8

Release lateral soft tissues

Osteotomy 1st metatarsal +/- proximal phalanx

Question 9

What is hallux rigidus?

Answer 9

Stiff big toe

Osteoarthritis of 1st MTP joint

Question 10

What is the aetiology of hallux rigidus?

Answer 10

Not known- possible genetic or due to multiple microtrauma

Question 11

What are the symptoms of hallux rigidus?

Answer 11

Mainly asymptomatic
Pain- often at extreme of dorsiflexion
Limitation of range of movement

Question 12

How is hallux rigidus diagnosed?

Answer 12

Clinical

Xray

Question 13

What is the non operative treatment of hallux rigidus?

Answer 13

Activity modification
Shoes with rigid sole
Analgesia

Question 14

What are the operative treatments of hallux rigidus?

Answer 14

Cheilectomy- removing dorsal impingement
Arthrodesis- gold standard, 1st MTPJ fusion
Arthroplasty- 1st MTPJ hemiarthroplasty

Question 15

What are the lesser toe deformities?

Answer 15

Claw toes
Hammer toes
Mallet does

Question 16

What causes abnormalities of the lesser toes?

Answer 16

Imbalance between flexors and extensors
Show wear
Neurological
Rheumatoid arthritis
Idiopathic

Question 17

What are the symptoms of lesser toe abnormalities?

Answer 17

Deformity
Pain from dorsal
Metatarsalgia

Question 18

What is the non operative treatment of lesser toe abnormalities?

Answer 18

Activity modification
Shoes with flat soles and high toe box
Orthotic soles

Question 19

What are the operative treatments of lesser toe abnormalities?

Answer 19

Flexor to extensor transfer
Fusion of interphalangeal joint
Release metatarsophalangeal joint
Shortening of osteotomy of metatarsal

Question 20

What is Morton’s neuroma?

Answer 20

Interdigit neuroma

Question 21

What is associated with Morton’s neuroma?

Answer 21

Associated with high heeled shoes

Question 22

Where is affected by Morton’s neuroma?

Answer 22

3rd webspace followed by 2nd webspace

Question 23

What are the signs and symptoms of Morton’s neuroma?

Answer 23

Neurlgic burning pain into toes- intermittent

Altered sensation in webscape

Question 24

How is Morton’s neuroma diagnosed?

Answer 24

Clinical- Mulder’s click
US- gold standard
MRI

Question 25

What is the management of Morten’s neuroma?

Answer 25

Injection for small lesions

Surgery- excision of lesion including section of normal nerve

Question 26

What is the treatment of rheumatoid forefoot?

Answer 26

Non op- shoe wear, orthotics, activity modification
Operative- 1st MTPJ arthrodesis
2-5th toe excision arthroplasty