Hindfoot problems Flashcards
What are the symptoms of achilles tendinosis?
Pain, esp during or following exercise
Recurrent episodes
Difficulty fitting shoes
Rupture
What are the causes of achilles tendinopathy?
Degeneration
Overuse
What is achilles tendinopathy associated with?
Over 40
Obesity
Steroids
Diabetes
What is achilles paratendinopathy associated with?
30-40 year olds
Athletic populations
How is achilles tendinosis diagnosed?
Clinical- tenderness and test for rupture
Investigations- US, MRI
What is the clinical test for achilles rupture?
Simmonds test
What is the non operative treatment of achilles tendinosis?
Activity modification Weight loss Shoe wear Physio Extracorporeal shock wave treatment Immobilisation
What shoes are used in achilles tendinosis?
Slight heel
What are the operative managements of achilles tendinosis?
Gastrocnemius resection
Release and debridement of tendon
What is plantar fasciitis associated with?
Athletes Obesity Prolonged standing Foot/lower limb rotation deformities Tight gastro-coleus complex
What is plantar fasciitis in athletes associated with?
High intensity or rapid increase in training
Running in poorly padded shoes or on hard surfaces
What are the signs and symptoms of plantar fasciitis?
Pain at origin of plantar fascia- first thing in morning, weight bearing after rest
Long lasting
What is the differential diagnosis for plantar fasciitis?
Nerve entrapment syndromes
Arthritis
Calcaneal pathology
How is plantar fasciitis diagnosed?
Clinically
Occasionally- X-rays, US, MRI
What are the treatments for plantar fasciitis?
Rest, change training Stretching Ice NSAIDs Orthoses Physio Weight loss Corticosteroid injections Night splinting
What are the new/3rd line treatments of plantar fasciitis?
Extracorporeal shock wave therapy Topaz plasma collation Nitric oxide Platelet rich plasma Endoscopic/open surgery
Who is ankle arthritis seen in?
Over 40s
Commonly post traumatic
What are the signs and symptoms of ankle arthritis?
Pain
Stiffness
How is ankle arthritis diagnosed?
CLinical
Xray
CT
What is the non operative management of ankle arthritis?
Weight loss Activity modification Analgesia Physio Steroid injections
What are the operative treatments of ankle arthritis?
Arthrodesis- gold standard
Joint replacement
What does posterior tibial tendon dysfunction cause?
Acquired flat foot planovalgus
What are the signs and symptoms of posterior tibial tendon dysfunction?
Lateral or medial pain
Flatt foot
Inward rolling ankle
Turning out of toes
How is posterior tibial tendon dysfunction diagnosed?
Largely clinical
MRI to assess tendon
