lower limb

Question 1

what is hallux valgus

Answer 1

deformity of the great toe due to medial deviation of 1st metatarsal and lateral deviation of toe

Question 2

what are the symptoms of hallux valgus

Answer 2

pain
rubbing may lead to bunion
ulceration

Question 3

what is the treatment of hallux valgus

Answer 3

prevention of bunions

surgery

Question 4

what is hallux rigidus

Answer 4

OA of 1st MTP joint

Question 5

what are the types of hallux rigidus, what causes them

Answer 5

primary = degenerative
secondary = osteochonadral injury

Question 6

what is the treatment of hallux rigidus

Answer 6

stiff soled shoes
removal of oestophytes = cheilectomy
arthrodesis = fusion of joint

Question 7

what is morton’s neuroma

Answer 7

repeated trauma to plantar interdigital nerves overlying inter-metatarsal ligaments causes inflammation leading to the formation of a neuroma

Question 8

what are the symptoms of morton’s neuroma

Answer 8

burning/tingling pain radiating to affected toes
loss of sensation web space
compression of metatarsal head results in click

Question 9

what is the investigation of morton’s neuroma

Answer 9

US

Question 10

what is the treatment of morton’s neuroma

Answer 10

offloading insoles
steroid/anaesthetic injections
excision

Question 11

where do metatarsal stress fractures commonly occur

Answer 11

2nd metatarsal = most common

3rd metatarsal

Question 12

what is the investigation of metatarsal stress fractures

Answer 12

bone scan

X-ray = after 3 weeks

Question 13

why can you not x-ray a metatarsal stress fractures before 3 weeks

Answer 13

reabsorption at fracture end and callus formation takes 3 weeks

Question 14

what is the classical history of an achilles rupture

Answer 14

sudden deceleration with resisted calf muscle contraction that caused sudden pain

Question 15

who commonly gets achilles rupture

Answer 15

middle aged or elderly people

Question 16

what are the causes of achilles rupture

Answer 16

repetitive strain = sport
degenerative
tendonitis

Question 17

what can commonly cause tendonitis

Answer 17

RA
gout
ciprofloxacin

Question 18

what are the symptoms of achilles rupture

Answer 18

pain at the achilles tendon or its site of insertion
difficulty weight bearing
palpable gap in tendon
+ve simmond’s test

Question 19

what is simmond’s test

Answer 19

no plantar flexion of foot when calf is squeezed

Question 20

what is the treatment of achilles rupture

Answer 20

rest
physio
cast

Question 21

what treatment should not been given in achilles rupture

Answer 21

steroid injections

Question 22

what is Plantar fasciitis

Answer 22

inflammation of the sole of the foot especially around the heel

Question 23

what causes Plantar fasciitis

Answer 23

repetitive stress/overload

degenerative condition

Question 24

what are the symptoms of Plantar fasciitis

Answer 24

pain on walking in the instep of the foot

localised tenderness

Question 25

what is the treatment of Plantar fasciitis

Answer 25

rest stretching gel filed heel pad steroid injections

Question 26

where does the Tibialis posterior tendon insert, what is its role

Answer 26

medial navicular supports the medial arch of the foot

Question 27

what is the treatment of Tibialis posterior tendon rupture

Answer 27

splint | surgery

Question 28

what is pes cavus

Answer 28

abnormally high arch of the foot

Question 29

what are the causes of pes cavus

Answer 29

idiopathic polio cerebral palsy spinal cord tethering in spina bifida

Question 30

what are the symptoms of pes cavus

Answer 30

claw toes pain usually asymptomatic

Question 31

what is the treatment of pes cavus

Answer 31

supple = soft tissue release and tendon transfer rigid = calcaneal osteotomy

Question 32

what causes claw toes

Answer 32

hyperextension at the MTPJ and PIPJ

Question 33

what causes hammer toes

Answer 33

hyperextension at the DIPJ

Question 34

what are the symptoms of claw and hammer toes

Answer 34

pain corns skin breakdown

Question 35

injury to the hip will produce pain where

Answer 35

groin which may radiate to the knee or buttock

Question 36

what is the first movement that is lost in hip injury

Answer 36

internal rotation

Question 37

what is a positive trendelenburg sign

Answer 37

when standing on one leg the pelvis drops on the side opposite to the standing leg

Question 38

what is femoracetabular impingement syndrome

Answer 38

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

Question 39

what are the types of femoracetabular impingement syndrome, what causes them

Answer 39

``` CAM = femoral deformity pincer = acetabular deformity mixed = femoral and acetabular deformity ```

Question 40

who commonly gets CAM femoracetabular impingement syndrome

Answer 40

young, athletic males | maybe be related to previous SUFE

Question 41

who commonly gets pincer femoracetabular impingement syndrome

Answer 41

females

Question 42

what are the symptoms of femoracetabular impingement syndrome

Answer 42

activity related pain in groin particularly on flexion and rotation difficulty sitting "c-sign"

Question 43

what is the investigations of femoracetabular impingement syndrome

Answer 43

X-ray CT MRI = damage to labarum + bony oedema

Question 44

what is the treatment of femoracetabular impingement syndrome

Answer 44

asymptomatic = observation symptomatic = surgery to remove deformity elderly/secondary OA = arthroplasty

Question 45

what is avascular necrosis, who is commonly affected

Answer 45

ischaemic necrosis of bone usually affecting adults

Question 46

what does avascular necrosis cause

Answer 46

necrosis of a segment of bone causing patchy sclerosis before subchondral collapse and irregularity of the articular surface

Question 47

where is the most common site for avascular necrosis to occur

Answer 47

hip

Question 48

what are the causes of avascular necrosis

Answer 48

primary = idiopathic | secondary - anything that causes clots or venous stasis

Question 49

what are the causes of secondary avascular necrosis

Answer 49

trauma secondary to fracture alcohol steroid injection

Question 50

what are the symptoms of avascular necrosis

Answer 50

insidious onset of groin pain pain worsened by stairs or impact normal exam 80% are bilateral

Question 51

what are the investigations of avascular necrosis

Answer 51

1st line = MRI | 2nd line x-ray

Question 52

what would be seen on a x-ray of avascular necrosis

Answer 52

"hanging rope sign" patchy sclerosis femoral head collapse

Question 53

what causes the "hanging rope sign" in avascular necrosis

Answer 53

lytic zone formed by granulation tissue from attempted repair

Question 54

what is the treatment of avascular necrosis

Answer 54

pre-collapse = drilling to decompress bone pst-collapse = joint replacement (THR)

Question 55

what is idiopathic transient osteonecrosis of the hip

Answer 55

local hyperaemia and impaired venous return with marrow oedema and intermediary pressure

Question 56

what are the symptoms of idiopathic transient osteonecrosis of the hip

Answer 56

progressive groin pain difficulty weight bearing usually unilateral

Question 57

who is commonly affected by idiopathic transient osteonecrosis of the hip

Answer 57

middle aged men | women in the late stages of pregnancy

Question 58

what are the investigations of idiopathic transient osteonecrosis of the hip

Answer 58

Xray MRI = gold standard bone scan

Question 59

what would you seen on the X-ray of idiopathic transient osteonecrosis of the hip

Answer 59

decreased bone density thinning of cortices persevered joint space

Question 60

what is the treatment of idiopathic transient osteonecrosis of the hip

Answer 60

will resolve itself in 6-9months | protected weight bearing

Question 61

what is gluteal cuff syndrome

Answer 61

inflammation of the trochanteric bursa

Question 62

what is gluteal cuff syndrome also known as

Answer 62

trochanteric bursitis

Question 63

who is commonly affected by gluteal cuff syndrome

Answer 63

females due to hip shape elderly people = degeneration young runners

Question 64

what covers the trochanteric bursa

Answer 64

IT (iliotibial) band

Question 65

what are the symptoms of gluteal cuff syndrome

Answer 65

pain/tenderness in lateral hip = region of greater trochanter pain when greater trochanter is palpated and on resisted abduction

Question 66

what are the investigations of gluteal cuff syndrome, what do they show

Answer 66

``` x-ray = normal MRI = shows the diseases but is not usually needed ```

Question 67

what is the treatment of gluteal cuff syndrome

Answer 67

physio anti-inflammatory drugs steroid injections

Question 68

who is commonly affected by proximal fracture of the femur

Answer 68

old women

Question 69

what are the causes of proximal fracture of the femur

Answer 69

young adults = high impact trauma | elderly = weakness