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MSK > Hindfoot pathology > Flashcards

Hindfoot pathology Flashcards

1
Q

What are some common hindfoot problems?

A
  • Achilles tendonitis/tendinosis
  • Plantar fasciitis
  • Ankle osteoarthritis
  • Tibialis posterior dysfunction
  • Cavovarus foot
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2
Q

What is achilles tendonopathy?

A
  • Degenerative/overuse condition with little inflammation
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3
Q

What is insertional tendonopathy?

A
  • Effects the tendon within 2cm of the point of insertion on the bone
  • [Effects the lower segment of the tendon]
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4
Q

What is non-insertional/mid substance tendonopathy?

A

Effects the tendon 2-7cm from the site of insertion

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5
Q

What is achilles bursitis?

What are the two types of achilles bursitis?

A

Inflammation of the fluid-filled sac (bursa) located either between the skin of the back of the heel and the Achilles tendon

  • Retrocalcaneal
  • Superficial calcaneal
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6
Q

What is paratendonopathy?

A

True inflammatory problem showing paratendonitis histologically

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7
Q

What is the aetiology of paratendonopathy?

A
  • Most common in athletic populations
  • Age group 30-40
  • Male:Female, 2:1
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8
Q

What is the aetiology of tendonopathy?

A
  • Most common in non-athletic populations
  • >40 yrs old
  • Obesity/steroids/DM risk factors
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9
Q

SSx of achilles tendonopathy?

A
  • Pain during exercise
  • Pain following exercise
  • Recurrant episodes
  • Difficulty fitting shoes
  • Rupture can occur too
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10
Q

How do we diagnose achilles tendonopathy?

A
  • Test for rupture
  • Tenderness
  • USS
  • MRI
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11
Q

What is the test for ruptured achilles?

A

Simmonds test

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12
Q

What is the treatment for achilles tendonopathy?

A

Non-operative

  • Activity mods
  • Weight loss
  • Footwear mods
  • Physiotherapy
  • Immobilsation

Operative

  • Gastrocnemius recession
  • Release and debridement of tendon
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13
Q

What is plantar fasciitis[fasciosis]?

A

Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen, asvascularity

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14
Q

What is the aetiology of plantar fasciitis?

A
  • Not known
  • [In athletes] associated with high intensity or rapid increase in training
  • Running with poorly padded trainers or hard surface
  • Obesity
  • Occupations with lengthy standing
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15
Q

SSx of plantar fasciitis?

A
  • Pain first thing in the morning
  • Pain on weight bearing after rest [post-static dyskinesia]
  • Pain located at origin of plantar fascia
  • Frequently long lasting
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16
Q

Differential for plantar fasciitis?

A
  • Nerve entrapment syndrome
  • Arthritis
  • Calcaneal pathology
17
Q

How is the diagnosis made for plantar fasciitis?

A
  • Mainly clinical
  • Xrays, USS, MRI are occasionally used!
18
Q

Treatment for plantar fasciitis?

A
  • Rest, change training
  • Stretching
  • ice
  • NSAIDS
  • Orthoses
  • Physiotherapy
  • Weight loss
19
Q

What is the aetiology of ankle arthritis?

A
  • Mean age of presentation is 46
  • Commonly post-traumatic
  • Idiopathic
20
Q

SSx of ankle arthritis?

A
  • Pain
  • Stiffness
21
Q

Diagnosis of ankle arthritis?

A
  • CLinical
  • Radiographs
  • CT scan - to exclude adjacent joint arthritis
22
Q

Non-operative manangement of ankle arthritis?

A
  • Weight loss
  • Activity mods
  • Analgesia
  • Physiotherapy
  • Steroid injections
23
Q

Operative management of ankle arthritis?

A
  • If symptoms are exclusively anterior then arthroscopic anterior debridement
  • Arthrodesis - open or arthroscopic
    • gold standard
    • good long term outcome
  • Joint replacement
    • maintain range of movement
24
Q

What is posterior tibial tendon dysfunction?

A
  • Acquired adult flat foot planovalgus
  • Relatively Common
  • Under-recognised
  • 4 stages
  • Largely clinical diagnosis – double & single heel raise.
  • Medial or lateral pain
  • Orthoses or surgery
25
Q

How is the diagnosis made for posterior tibial tendon dysfunction?

A
  • Clinical
  • MRI to assess tendon
26
Q

Management for posterior tibial tendon dysfunction?

A
  • Orthotics: medial arch support
  • Reconstruction of tendon
  • Triple fusion [subtalar, talonavicular and calcaneocuboid]

MSK (33 decks)

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