Forefoot problems Flashcards
What is hallux valgus?
Bunions
Lateral angulation of great toe
What are the causes hallux valgus?
Genetic
Footwear
Who is hallux valgus seen in?
Women
What are the signs and symptoms of hallux valgus?
Pressure symptoms from footwear
Pain from crossing ver toes
Metatarsalgia
How is hallux valgus diagnosed?
Clinical
Xrays- determine severity of underlying bone deformity, exclude associated degenerative disease
What is the non operative treatment of hallux valgus?
Shoe modification
Orthotics to offload pressure or correct deformity
What is the indication for operative management of hallux valgus?
If non operative fails or is unacceptable to the patient
What are the types of operative treatment of hallux valgus?
Release lateral soft tissues
Osteotomy 1st metatarsal +/- proximal phalanx
What is hallux rigidus?
Stiff big toe
Osteoarthritis of 1st MTP joint
What is the aetiology of hallux rigidus?
Not known- possible genetic or due to multiple microtrauma
What are the symptoms of hallux rigidus?
Mainly asymptomatic
Pain- often at extreme of dorsiflexion
Limitation of range of movement
How is hallux rigidus diagnosed?
Clinical
Xray
What is the non operative treatment of hallux rigidus?
Activity modification
Shoes with rigid sole
Analgesia
What are the operative treatments of hallux rigidus?
Cheilectomy- removing dorsal impingement
Arthrodesis- gold standard, 1st MTPJ fusion
Arthroplasty- 1st MTPJ hemiarthroplasty
What are the lesser toe deformities?
Claw toes
Hammer toes
Mallet does
What causes abnormalities of the lesser toes?
Imbalance between flexors and extensors Show wear Neurological Rheumatoid arthritis Idiopathic
What are the symptoms of lesser toe abnormalities?
Deformity
Pain from dorsal
Metatarsalgia
What is the non operative treatment of lesser toe abnormalities?
Activity modification
Shoes with flat soles and high toe box
Orthotic soles
What are the operative treatments of lesser toe abnormalities?
Flexor to extensor transfer
Fusion of interphalangeal joint
Release metatarsophalangeal joint
Shortening of osteotomy of metatarsal
What is Morton’s neuroma?
Interdigit neuroma
What is associated with Morton’s neuroma?
Associated with high heeled shoes
Where is affected by Morton’s neuroma?
3rd webspace followed by 2nd webspace
What are the signs and symptoms of Morton’s neuroma?
Neurlgic burning pain into toes- intermittent
Altered sensation in webscape
How is Morton’s neuroma diagnosed?
Clinical- Mulder’s click
US- gold standard
MRI
