MSK 7

Question 1

tibias posterior tendon dysfunction is what 
in who 
RF:
symptoms 
treatment 
no what

Answer 1

TP inserts into medial navicular and support medial arch. commonest cause of acquired of acquired flat foot.
elderly female obese.
htn, DM, steroid injection, seronegative arthropathies, idiopathic
pain/swelling posteriori to medial malleolus. change in foot shape. lateral wall impingement syndrome
physi o - insoles to support medial arch. surgery - tendon transfer
no steroid injections

Question 2

pes cavas is what
caused by what
what often accompanies it
treatment

Answer 2

abnormal high arch of foot
idiopathic, assoc w NM disease - CP, motor neuropathy, spoon bifida
claw toes
surgery complex

Question 3

tendoachilles tendonitis cause 
symptoms 
ix
treatment 
risk

Answer 3

repeated micro trauma, failure of collagen repair, overstraining, ciprofloxacin, RA, gout, CTD
pain in tendon/insertion into calcareous morning stiffness worse after activity and eases w heat
clinical. USS. MRI
rest. physio. heel raise. analgesia. self limiting
steroid injection -> rupture

Question 4

tendoachilles rupture cause
in who
synptoms
on examination

Answer 4

tendonitis predisposes. degen changes
pop heard - sudden deceleration w resisted muscle contraction. sudden pain and difficulty weight bearing
weakness of plantar flexion and palpable gap in tendon. simmonds test

Question 5

plantar fasciitis cause 
risk factors 
symptoms 
ix 
treatment

Answer 5

repeated stress/overload or degen
DM, obese, age, physical overload, abnormal foot shape, improper footwear
pain with walking felt on instep of foot with localised tenderness on palpitation of site. worse after exercising.
tinnels test for baxter nerve
rest. good shoes. stretches. gel filled heat pads. physio. steroid injections. self limiting 18-24 months

Question 6

hallux valgus is what 
cause 
can be what 
complications 
treatment

Answer 6

medial deviation of first metatarsal and lateral deviation of toe itself. F>M
idiopathic, family link, bilateral usually, commoner in RA
can be painful
rubbing of foot - bunion over 1st M+L head
ulceration and skin breakdown - 1st and 2nd toe rub
wider and deeper shoes, spacer between 1st and 2nd toe, surgery

Question 7

hallux rigidus is what
cause
treatment gold standard and others

Answer 7

OA of first 1st MTP
primary degen. secondary - osteochondral surgery
arthrodesis (fusion) - GS
conservative: stiff soled shoe removal of osteophyte. joint replacement

Question 8

claw hammer and ballot cause
symptoms
treatment

Answer 8

acquired imbalance between flexors and extensors
painful on footwear. corns and skin breakdown
toe sleeves and corn plates. tetonies, tendon transfer, fusion if stiff and painful

Question 9

rheumatoid foot

Answer 9

rare
synovitis proteinase and collagenase destruction of hyaline cartilage
manage pain

Question 10

mortons neuroma is what 
cause 
in who and where 
symptoms 
ix
treatment

Answer 10

degen fibrosis of digital nerve neuritis bifurcation

repeat trauma

F>M, 45-50s, commonly in 3rd space

burning pain and tingling into affected toes. worse on walking. feels like a pebble inside shoes
loss of sensation in affected web space. medial compression of metatarsal heads produces symp or click - mulders click

clinical dx but USS helps

conservative - insoles, injection, avoid high heels, op - excise