Hindfoot pathology Flashcards
What are some common hindfoot problems?
- Achilles tendonitis/tendinosis
- Plantar fasciitis
- Ankle osteoarthritis
- Tibialis posterior dysfunction
- Cavovarus foot
What is achilles tendonopathy?
- Degenerative/overuse condition with little inflammation
What is insertional tendonopathy?
- Effects the tendon within 2cm of the point of insertion on the bone
- [Effects the lower segment of the tendon]
What is non-insertional/mid substance tendonopathy?
Effects the tendon 2-7cm from the site of insertion
What is achilles bursitis?
What are the two types of achilles bursitis?
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
What is paratendonopathy?
True inflammatory problem showing paratendonitis histologically
What is the aetiology of paratendonopathy?
- Most common in athletic populations
- Age group 30-40
- Male:Female, 2:1
What is the aetiology of tendonopathy?
- Most common in non-athletic populations
- >40 yrs old
- Obesity/steroids/DM risk factors
SSx of achilles tendonopathy?
- Pain during exercise
- Pain following exercise
- Recurrant episodes
- Difficulty fitting shoes
- Rupture can occur too
How do we diagnose achilles tendonopathy?
- Test for rupture
- Tenderness
- USS
- MRI
What is the test for ruptured achilles?
Simmonds test
What is the treatment for achilles tendonopathy?
Non-operative
- Activity mods
- Weight loss
- Footwear mods
- Physiotherapy
- Immobilsation
Operative
- Gastrocnemius recession
- Release and debridement of tendon
What is plantar fasciitis[fasciosis]?
Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen, asvascularity
What is the aetiology of plantar fasciitis?
- 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
SSx of plantar fasciitis?
- 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
Differential for plantar fasciitis?
- Nerve entrapment syndrome
- Arthritis
- Calcaneal pathology
How is the diagnosis made for plantar fasciitis?
- Mainly clinical
- Xrays, USS, MRI are occasionally used!
Treatment for plantar fasciitis?
- Rest, change training
- Stretching
- ice
- NSAIDS
- Orthoses
- Physiotherapy
- Weight loss
What is the aetiology of ankle arthritis?
- Mean age of presentation is 46
- Commonly post-traumatic
- Idiopathic
SSx of ankle arthritis?
- Pain
- Stiffness
Diagnosis of ankle arthritis?
- CLinical
- Radiographs
- CT scan - to exclude adjacent joint arthritis
Non-operative manangement of ankle arthritis?
- Weight loss
- Activity mods
- Analgesia
- Physiotherapy
- Steroid injections
Operative management of ankle arthritis?
- 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
What is posterior tibial tendon dysfunction?
- 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
How is the diagnosis made for posterior tibial tendon dysfunction?
- Clinical
- MRI to assess tendon
Management for posterior tibial tendon dysfunction?
- Orthotics: medial arch support
- Reconstruction of tendon
- Triple fusion [subtalar, talonavicular and calcaneocuboid]
