Minor lower limb conditions Flashcards
Chondromalacia Patellae
- what’s this
- test
- Ix
- management
Chondromalacia Patellae
- Predominantly young women
- Patellar aching after prolonged sitting or climbing
stairs
- Pain on patellofemoral compression: Clarke’s test
- Ix: no abnormality on X-ray
- Rx: vastus medialis strengthening
What’s Baker’s cyst?
- cause
- presentation if rupture
Baker’s Cyst
- Popliteal swelling arising between the medial head of gastrocnemius and semimembranosus muscle
- Herniation from joint synovium
- Usually secondary to OA
- Rupture: acute calf pain and swelling
Management of Baker’s cyst
- Identify and optimize management of any underlying condition (Gout, Osteoarthritis, and Rheumatoid arthritis)
- If the cyst is asymptomatic → no treatment is required
*Explain that excision is generally not recommended as the Baker’s cyst may resolve by treating any underlying condition.
- If symptoms are troublesome:
- Consider simple analgesia (such as paracetamol or ibuprofen)
- Direct aspiration of a Baker’s cyst in primary care is not recommended
When do we refer patients with Baker’s Cyst to secondary care?
consider referral to a rheumatologist or orthopaedic surgeon for further assessment and treatment:
- If the diagnosis of a popliteal fossa swelling is unclear.
- If symptoms are troublesome despite conservative measures, or the cyst is very large.
- If specialist treatment of underlying disease of the knee joint is required.
What’s Hallus Valgus?
Hallux Valgus
- Great toe deviates laterally @ MTP joint
- Pressure of MTP against shoe → bunion
- ↑ wt. bearing @ 2nd metatarsal head
Management of Hallus
Conservative: bunion pads, plastic wedge between
great and second toes
Surgical: metatarsal osteotomy
(indicated when pain is continued and significant deformity)
What’s Morton’s metatarsalgia/neuroma?
- treatment
Morton’s Metatarsalgia / Neuroma
• Pain from pressure on an interdigital neuroma
between the metatarsals
• Pain radiates to medial side of one toe and lateral side of another
Management: neuroma excision
Ix and Dx for hallux
- weight - bearing radiograph
- diagnostic: finding hallux valgus → angle >15°
Presentation of Achille’s Tendon rupture
- common sporting injury
- tendon ‘give’ or ‘snap’ + sudden onset of pain
- palpable gap in the tendon
- Simmond’s test positive → when calf is squeezed the feet does not move
Management of Achille’s tendon rupture
- conservative: plaster case
- surgery: re-joining the ends of tendon
Plantar fascitis
- cause
Cause: a strain of the attachment of the plantar fascia to the calcaneum
Presentation of plantar fasciitis
- pain occurs when the heel strikes the ground when walking
- examination: tender point on the heel
Management of plantar fascitis
- firm pad in the shoe
- steroid injection
- physiotherapy
