Lower Limb Conditions- FOOT AND ANKLE

Question 1

What is hallux valgus

Answer 1

Deformity of the big toe, medial deviation of the first metatarsal and lateral deviation of the toe

Question 2

Risk factors of hallux valgus

Answer 2

Familiar tendency, RA, inflammatory arthropathies, NM diseases, CTDs, increased joint laxity

Question 3

Symptoms of hallux valgus

Answer 3

Pain, bunion formation, shoe difficulties, transfer metatarsalgia, lesser toe impingement, ulceration

Question 4

Treatment of hallux valgus

Answer 4

Shoe modifications, paddling, surgery (sarf/akin osteotomy)

Question 5

What is hallux rigidus

Answer 5

Osteoarthritis of the first metatarsal phalangeal joint

Question 6

Treatment of hallux rigidus

Answer 6

Stiff sole shoes (metal bar), removal of osteophytes, gold standard= arthrodesis

Question 7

What is Morton’s Neuroma

Answer 7

Degenerative fibrosis of the digital nerve near to its bifurcation

Question 8

Pathogenesis of Morton’s Neuroma

Answer 8

Repeated trauma to the ligaments over the nerve causes inflammation, swelling and neuroma formation

Question 9

Causes of Morton’s Neuroma

Answer 9

Can be caused by wearing high heels and is often linked to bursitis

Question 10

Symptoms of Morton’s Neuroma

Answer 10

Burning and tingling in toes (usually 3rd and 4th), metatarsalgia (walking on a pebble)

Question 11

Diagnosis of Morton’s Neuroma

Answer 11

Mulder’s click test, loss of sensation in affected web space

US= swollen nerve

Question 12

Treatment of Morton’s Neuroma

Answer 12

Offloading insole, metatarsal pad, steroid anaesthetic injections, surgery (excision)

Question 13

Causes of Tendo-achilles tendinosis

Answer 13

Repetitive strain due to sports causing frequent micro trauma with not enough time for collagen repair resulting in loss of fibre alignment and degeneration of the tendon

Question 14

Risk factors for Tendo-achilles tendinosis

Answer 14

Overtraining, quinolone antibiotics, RA, inflammatory arthropathies, gout

Question 15

Symptoms for tendo-achilles tendinosis

Answer 15

Pain, morning stiffness, eases with heat + walking

Question 16

Treatment for tendo-achilles tendinosis

Answer 16

Usually self-limiting, NO STEROI DINJECTIONS, analgesia, NSAIDS, shockwave therapy, orthotics/heel raise/splints/boots/physio, surgery= tendon decompression

Question 17

Causes + Symptoms of Tendo-achilles rupture

Answer 17

Sudden deceleration with resisted calf muscle contraction causing a sudden pain, unable to weight bear, weak plantar flexion

Question 18

Diagnosis of Tendo-achilles rupture

Answer 18

Palpable painful gap, Simmonds test (positive calf squeeze, no plantar flexion of foot when squeezed)

Question 19

What is claw toe

Answer 19

Hyperextension at MTP joint, hyeprflexion at DIP and PIP joints

Question 20

What is hammer toe

Answer 20

Hyperextension at MTP joint, hyeprflexion at PIP and hypertension at DIP

Question 21

Where is the tibialis posterior tendon located

Answer 21

Posterior to the medial malleolus and inserts on the navicular tuberosity

Question 22

Function of tibialis posterior tendon

Answer 22

Stabilises and elevates the medial arch

Question 23

Symptoms of tibialis posterior dysfunction

Answer 23

Pain and swelling posterior to medial malleolus + can change the shape of the foot

Question 24

Treatment of tibialis posterior dysfunction

Answer 24

Physiotherapy, insoles to support arch, orthoses, splint to prevent rupture

Question 25

What is pes cavus and what causes it

Answer 25

Abnormally high arch of the foot can be idiopathic or neurological (HSMN, CP, spina bifida, polio, club foot)

Question 26

What is plantar fasciitis

Answer 26

Inflammation of the plantar fascia

Question 27

Cause of plantar fasciitis

Answer 27

Repetitive physical overload

Question 28

RF of plantar fasciitis

Answer 28

Excessive weight, diabetes, seronegative arthropathy, abnormal footshape

Question 29

Symptoms of plantar fasciitis

Answer 29

Strat up pain after rest, worse after exercises, swelling of plantar medial aspect of heel

Question 30

Diagnosis of plantar fasciitis

Answer 30

Tinel's test positive for Baxter's nerve

Question 31

Treatment of plantar fasciitis

Answer 31

Self-limiting- can need rest, stretching exercises, NSAIDS, night splints, taping, heel cup/medial arch supports, physiotherapy

Question 32

Differentiate between the two types of planovalgus

Answer 32

Flexible- normal variant in children, can be familial or idiopathic, due to ligamentous laxity or gastrosoleus complex tightness, positive jack test (big toe dorsiflexion forms arch) Fixed- bony abnormality, tarsal coalition can require surgery

Question 33

Who gets metatarsal stress fractures and in what toes

Answer 33

Dancers, runners, soldiers in 2nd then 3rd metatarsal

Question 34

When might metatarsal stress fracture be seen on XR

Answer 34

After 3 weeks when callus has formed

Question 35

Treatment of metatarsal stress fracture

Answer 35

6-12 weeks rest in a rigid soled boot

Question 36

Causes of ankle sprains

Answer 36

Inversion twisting on a planted foot

Question 37

Ligaments most affected in ankle sprain

Answer 37

Anterior talofibular and calcaneofibular (AFTL and CFL)

Question 38

Describe Weber Classification

Answer 38

Describes ankle fractures in relation to the syndesmosis between the tibia and fibula A- below B-on C-above

Question 39

Treatment of ankle sprains

Answer 39

RICE, physio, surgery= Brostrum Gould

Question 40

Describe stable ankle fractures

Answer 40

Distal fibular fractures with no medial malleolar fractures or deltoid ligament rupture, treated with walking cast/splint for 6 weeks

Question 41

Describe unstable ankle fractures

Answer 41

Distal fibular fractures with deltoid ligament rupture treated with ORIF

Question 42

What is talar shift

Answer 42

Increased space within the ankle mortise, can lead to post traumatic OA requires reduction and internal fixation

Question 43

What is talar tilt

Answer 43

Bottom of the tibia and top of the talus are non-parallel

Question 44

What does talar shift + talar tilt indicate

Answer 44

Deltoid ligament rupture unless medial malleolar fracture

Question 45

What is a midfoot/lisfranc fracture

Answer 45

Fracture + dislocation of the base of the second metatarsal, causes dislocation of other metatarsal and no ligament holds the bone in place

Question 46

Symptoms of lisfranc fracture

Answer 46

Very swollen, bruised foot, unable to weight bear

Question 47

Treatment of lisfranc fracture

Answer 47

Open/closed reduction + fixation with screws

Question 48

Where are metatarsal fractures common

Answer 48

Base of 5th metatarsal

Question 49

Who is clubfoot more common in

Answer 49

Boys

Question 50

What is clubfoot

Answer 50

Congenital structural deformity in foot formed in 7th week gestation, in utero abnormal alignment of joints between talus, calcaneus and navicular --> contractors of the soft tissue --> ankle equines

Question 51

Treatment for clubfoot

Answer 51

Ponseti technique casts for 5-6 weeks --> tenotomy of achilles tendon --> boot and bar to prevent recurrence