lower limb Flashcards
what is hallux valgus
deformity of the great toe due to medial deviation of 1st metatarsal and lateral deviation of toe
what are the symptoms of hallux valgus
pain
rubbing may lead to bunion
ulceration
what is the treatment of hallux valgus
prevention of bunions
surgery
what is hallux rigidus
OA of 1st MTP joint
what are the types of hallux rigidus, what causes them
primary = degenerative secondary = osteochonadral injury
what is the treatment of hallux rigidus
stiff soled shoes
removal of oestophytes = cheilectomy
arthrodesis = fusion of joint
what is morton’s neuroma
repeated trauma to plantar interdigital nerves overlying inter-metatarsal ligaments causes inflammation leading to the formation of a neuroma
what are the symptoms of morton’s neuroma
burning/tingling pain radiating to affected toes
loss of sensation web space
compression of metatarsal head results in click
what is the investigation of morton’s neuroma
US
what is the treatment of morton’s neuroma
offloading insoles
steroid/anaesthetic injections
excision
where do metatarsal stress fractures commonly occur
2nd metatarsal = most common
3rd metatarsal
what is the investigation of metatarsal stress fractures
bone scan
X-ray = after 3 weeks
why can you not x-ray a metatarsal stress fractures before 3 weeks
reabsorption at fracture end and callus formation takes 3 weeks
what is the classical history of an achilles rupture
sudden deceleration with resisted calf muscle contraction that caused sudden pain
who commonly gets achilles rupture
middle aged or elderly people
what are the causes of achilles rupture
repetitive strain = sport
degenerative
tendonitis
what can commonly cause tendonitis
RA
gout
ciprofloxacin
what are the symptoms of achilles rupture
pain at the achilles tendon or its site of insertion
difficulty weight bearing
palpable gap in tendon
+ve simmond’s test
what is simmond’s test
no plantar flexion of foot when calf is squeezed
what is the treatment of achilles rupture
rest
physio
cast
what treatment should not been given in achilles rupture
steroid injections
what is Plantar fasciitis
inflammation of the sole of the foot especially around the heel
what causes Plantar fasciitis
repetitive stress/overload
degenerative condition
what are the symptoms of Plantar fasciitis
pain on walking in the instep of the foot
localised tenderness
what is the treatment of Plantar fasciitis
rest
stretching
gel filed heel pad
steroid injections
where does the Tibialis posterior tendon insert, what is its role
medial navicular
supports the medial arch of the foot
what is the treatment of Tibialis posterior tendon rupture
splint
surgery
what is pes cavus
abnormally high arch of the foot
what are the causes of pes cavus
idiopathic
polio
cerebral palsy
spinal cord tethering in spina bifida
what are the symptoms of pes cavus
claw toes
pain
usually asymptomatic
what is the treatment of pes cavus
supple = soft tissue release and tendon transfer
rigid = calcaneal osteotomy
what causes claw toes
hyperextension at the MTPJ and PIPJ
what causes hammer toes
hyperextension at the DIPJ
what are the symptoms of claw and hammer toes
pain
corns
skin breakdown
injury to the hip will produce pain where
groin which may radiate to the knee or buttock
what is the first movement that is lost in hip injury
internal rotation
what is a positive trendelenburg sign
when standing on one leg the pelvis drops on the side opposite to the standing leg
what is femoracetabular impingement syndrome
abnormal femoral neck and/or acetabular results in contact of the femoral neck on the edge of the acetabulum during movement damaging the labarum and cartilage
what are the types of femoracetabular impingement syndrome, what causes them
CAM = femoral deformity pincer = acetabular deformity mixed = femoral and acetabular deformity
who commonly gets CAM femoracetabular impingement syndrome
young, athletic males
maybe be related to previous SUFE
who commonly gets pincer femoracetabular impingement syndrome
females
what are the symptoms of femoracetabular impingement syndrome
activity related pain in groin particularly on flexion and rotation
difficulty sitting
“c-sign”
what is the investigations of femoracetabular impingement syndrome
X-ray
CT
MRI = damage to labarum + bony oedema
what is the treatment of femoracetabular impingement syndrome
asymptomatic = observation
symptomatic = surgery to remove deformity
elderly/secondary OA = arthroplasty
what is avascular necrosis, who is commonly affected
ischaemic necrosis of bone usually affecting adults
what does avascular necrosis cause
necrosis of a segment of bone causing patchy sclerosis before subchondral collapse and irregularity of the articular surface
where is the most common site for avascular necrosis to occur
hip
what are the causes of avascular necrosis
primary = idiopathic
secondary - anything that causes clots or venous stasis
what are the causes of secondary avascular necrosis
trauma secondary to fracture
alcohol
steroid injection
what are the symptoms of avascular necrosis
insidious onset of groin pain
pain worsened by stairs or impact
normal exam
80% are bilateral
what are the investigations of avascular necrosis
1st line = MRI
2nd line x-ray
what would be seen on a x-ray of avascular necrosis
“hanging rope sign”
patchy sclerosis
femoral head collapse
what causes the “hanging rope sign” in avascular necrosis
lytic zone formed by granulation tissue from attempted repair
what is the treatment of avascular necrosis
pre-collapse = drilling to decompress bone
pst-collapse = joint replacement (THR)
what is idiopathic transient osteonecrosis of the hip
local hyperaemia and impaired venous return with marrow oedema and intermediary pressure
what are the symptoms of idiopathic transient osteonecrosis of the hip
progressive groin pain
difficulty weight bearing
usually unilateral
who is commonly affected by idiopathic transient osteonecrosis of the hip
middle aged men
women in the late stages of pregnancy
what are the investigations of idiopathic transient osteonecrosis of the hip
Xray
MRI = gold standard
bone scan
what would you seen on the X-ray of idiopathic transient osteonecrosis of the hip
decreased bone density
thinning of cortices
persevered joint space
what is the treatment of idiopathic transient osteonecrosis of the hip
will resolve itself in 6-9months
protected weight bearing
what is gluteal cuff syndrome
inflammation of the trochanteric bursa
what is gluteal cuff syndrome also known as
trochanteric bursitis
who is commonly affected by gluteal cuff syndrome
females due to hip shape
elderly people = degeneration
young runners
what covers the trochanteric bursa
IT (iliotibial) band
what are the symptoms of gluteal cuff syndrome
pain/tenderness in lateral hip = region of greater trochanter
pain when greater trochanter is palpated and on resisted abduction
what are the investigations of gluteal cuff syndrome, what do they show
x-ray = normal MRI = shows the diseases but is not usually needed
what is the treatment of gluteal cuff syndrome
physio
anti-inflammatory drugs
steroid injections
who is commonly affected by proximal fracture of the femur
old women
what are the causes of proximal fracture of the femur
young adults = high impact trauma
elderly = weakness
