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Year 3 MSK pathologies > Orthopaedic foot and ankle pathologies > Flashcards

Orthopaedic foot and ankle pathologies Flashcards

1
Q

What are the treatment options for foot and ankle disease

When should you operate?

A 
Analgesia
shoe wear modification
Weight loss
physio
insoles and bracing

when non-operative management fails

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2
Q

What are some common diseases of the feet?

A

Bunions, plantar fascitis, achille tendonitis morton’s neuroma

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3
Q

What are some common diseases of the forefoot?

A 
Hallux valgus
Hallux rigidus
Lesser toe deformities
Morton's neuroma
Metatarsalgia
Rheumatoid Forefoot
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4
Q

What is hallux valgus?

Who gets it?

What are the symptoms?

A

Bunions, prominence of medial big toe tarsal

Genetic, foot wear, female preponderance

Pressure symptoms from show
Pain from crossing over of toes
Metatarsalgia

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5
Q

What is the pathogenesis of hallux valgus?

How do you diagnose hallux valgus?

A

Lateral angulation of big toe
Tendons pull realigned to lateral centre of toe,
Vicious cycle of increased pull creating an increased deformity
Sesamoid bones sublux- less weight goes through the big toe
As deformity progresses abnormalities of the lesser toes occur

Diagnosis- look at foot, X-rays

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6
Q

How do you treat hallux valgus

What are the two main surgical procedures for hallus valgu?

A

Non-operative- shoe wear modification, orthotics, activity modification, analgesia

Opearative- release lateral soft tissues, osteomy 1st metatarsal, generally goof outcome but recurrence inevitable

Scarf osteotomy- learn for exam
Basal osteotomy- esepcially this one

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7
Q

What is hallux rigitidis?

A 
Stiff big toe
Hallux limitus
Hallux non exntensus
Osteoarthrtits of 1st MTP joint
Bimodal distrubution age
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8
Q

Who gets hallux rigitidis?

What are the symptoms?

How do you diagnose it?

A

not known, possibly genetic, possinly multiple microtrauma

many asymptomatic, pain at extreme dorsiflexion, limits range of movement

clinical, x-rays

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9
Q

How do you manage hallux rigitidis?

A

non operative- activity modification, shoe wear with rigid sole, analgesia

Surgery- Cheilectomy, arthrodesis, arthroplasty

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10
Q

What is a cheilectomy?

What is the gold standard for hallux rigitidus treatment?

What are the benefits/risks with are there with 1st MTPJ hemiarthoplasty

A

Surgery to remove a small piece of bone to increase dorsiflexion

1st MTPJ fusion

Good ROM, high failure rate, better for lwo demenad patients

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11
Q

What are common issues of the lesser toe?

What causes them?

A

Claw toes
Hammer toes
Mallet toes

hyper flexion at the PIP joints

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12
Q

Who gets lesser foot deformities

What are the symptoms of a lesser foot deformity?

A

imbalance between flexors/extensors
shoe wear
Neurological/rheumatoid arthrits
idiopathic

deformity
Pain from dorsum
Pain from plantar side(as toe is pushed down)

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13
Q

What is the treatment for lesser toe deformities?

A

non operative- activity modification
Shoe wear- falt shoes with high toe
Orthotic insoles

Opearative- flexor to extesnor transfer
Fusion of interphalangeal joint
Shortening osteomy of metatarsal

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14
Q

What is mortons neuroma?

A

Inflamation, swelling, severe pain and numbnes caused my a lesion to the nerve between digits

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15
Q

Who gets mortons neuroma?

What are the symptoms of mortons neuroma?

A

Mechanically induced degenrative neurtopathy
Affects females ages 40-60
Frequently associated with wearing high heeled shoes
Common digital nerves relatively tethered to one metarsal and movement in adjacent metatarsals causing a mechanical shear

Symptoms- typically affects 3rd following by 2nd webspace/toes
Neuralgic burning pain into toes
Intermittent
Altered sensation in webspace

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16
Q

How do you diagnose mortons neuroma?

How do you treat it?

A

clinical, mulder’s click, USS, MRI

injection for small lesions
Surgery- excise lesion
Leads to numbness, recurrence, 30% have pain post op

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17
Q

What is metatarsalgia?

A

Symptom not a diagnosis
Careful examination should localise course
Synovitis, bursitis, arthritis, neuralgia
Neuromata, freibergs disese
If no obvious cause consider tight gastrocnemius

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18
Q

How do you treat rheumatoid forefoot (inflammation that causes toes to be messed up)

A

non-operative- shoewear orthotics/activity etc

operative- many descrbed techniques, current gold standard, 1st MTPJ arthodesis, 2nd-5th toe excision arthroplasty

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19
Q

What are some common pathologies of the forefoot

A

Ganglia
Osteoarthritis
Plantar fibomatosis

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20
Q

What are dorsal foot ganglia

Who gets them
What are the symptoms?

A

Arise from joint or tendon sheath

Idiopathic, underlying arthritis, underlying tendon pathology

Symptoms- pain from pressure from show wear
pain from underlying problem

21
Q

How are they treayed

A

Aspiration
Bible bashing

Excise

High rate of return (50%)

22
Q

What are the categories of midfoot arthritis

How is it treated?

A

Post raumatic
Osteoarthits
Rheumatoid

Non operative- shoe wear, orhtotics
Injections-x-ray guided
Operative-fusion

23
Q

What is plantar fibromatosis

A

Dupuytren’s of the foot
Progressive
usually asymptomatic unless very large of in weight bearing area

24
Q

How is plantar fibromatosis treated?

A

Non operative- avoid pressure
Excision (80% recurrence)
Radiotheraoy
Combination radiotherapy and surgery

25
Q

What are some common pathologies of the hindfoot?

A 
Achilles tendonitis
Plantar fascitis
Ankle osteoarthritis
Ankle osteoarthritis
Tibialis posterior dysfunction tion
Cavovarus foot
26
Q

What is achilles tendonitis?

A

Degernative/overuse condition with very little inflammation
can be caused bu bursitis, non insertional/mid substance issues
Insertional tendinopathy
Paratendinopathy

27
Q

Who gets achilles tendinopathy?

A 
Athletic populations aged 30/
More likely in males
Obesity
steroids
diabetes
28
Q

What are the symptoms of achilles tendinopathy?

A 
Pain durin exercis
Pain following exercise
Recurrent epiosdes
Difficulty fitting shoes
RUPTURE
29
Q

How do you diagnose achilles tendinopathy?

A

Clinical- tenderness, test for rupture

Investigations- USS, MRI

30
Q

What is the treatment of achilles tendinopathy?

A

Non-operative- activity modification, weight loss, modify shoes, Physio

Operative treatment- gastricnemius rescession, release and debride tendon

31
Q

What is plantar fascitis?

A

Chronic degenerative changem fibroblast hypertrophy, disorgansied and dysfuncitonal lood vessles and colalgen
microtears

32
Q

What causes plantar fasciatis?

A 
Not known
Atheltes high intesnity/ rapid increases
Running with poorly padded shoes
Obesity
Prolonged standing
Foor rotational deformities
Tight gastro-soleus complex
33
Q

What are the symptoms of plantar fascitis?

A

Pain first thing in the morning
Pain on weight bearinfg after rest
Pain at origin of plantar fascia
Frequently long lasting

34
Q

What are differentials fro plantar fascitis

A

Nerve entrapment
Arthtrits
Calcaneal pathology

Mainly clincial
Occasionally X-rays USS and MRI

35
Q

How do you treat plantar fascitis?

A 
Restm change training
Stretch achilles
Ice
NSAIDS
orthoses- heel pads
Physio
Weight loss
Injections
Night splints
36
Q

What are some new age treatments of plantar fascitis?

A 
Extracorpeal shockwave therapy
Topaz plasma coblation
Nitric oxide
Platlet rich plasma
Endoscopic/ open surgery
37
Q

Who gets ankle arthritis?

What are the symptoms?

A

Mean age of presentaiton is 46 years
Commonly post traumatic
idiopathic

Pain/stiffness

38
Q

How do you diagnose ankle arthritis?

What is the non operative management?

A

Clinical, radiographs, CT scan (exclude adjacent joitn arthrits)

Non operatie management- weight loss, activity modification, analgesia, physio, steroid injection

39
Q

What is the operative management of ankle arthritis?

A

Athroscopic anterior debridement- only for anterior symptoms

Athrodesis(ankle fusion) gold standard

Joint replacement- maintains ROM, long term outocmes?, not easy to fix

40
Q

What is tibiali posterior tendon dysfunction

A 
Acquired adult flat foor planovalgus
Relatively common
under recognsied
4 stages
Largely clinical diagnosis- double and single heel raise
Medial or lateral pain
Orthoses or surgery
41
Q

What is the double single limb heel raise?

How is it diagnosed

How is it managed

A

Heels go from varus to valgus and they rise

Clinical, MRI to assess tendon

Orthotics-medial arch support
Reconstruction of tendon (tendon transfer)
Triple fusion (subtalar, talonavicular and calcaneocuboid)
42
Q

How does a diabetic foot ulcer develop?

A 
DIabetic neuropathy
lack of sweting
dry cracked skin
skin more sensitive to minro trauma
Poor vascular supply
Lack of patient education
43
Q

How do you treat a diabetic foot ulcer?

A 
Prevention
Modify the main detriments to healing
Diabetic control
Smoking
Vascular supply
External pressure (splints, shoes, weight bearing)
Internal pressure
Infection, nutrition
44
Q

What surgical options are available for a diabetic foot ulcer?

A

Improve vascular supply
Debride ulcers and get deep samples from microbiology
Correct any deformity to offload area
Amputation

45
Q

What is charcot neuropathy?

A

Rapid bone destruction in 3 areas,

fragmentation, coalescene and remodelling

46
Q

Who gets charcots neuropathy

What are the theories of pathophysiology?

A

Any causes of neuropathy
Diabetes commonest cause
Historically originally described and most common with syphillis

Lack of proprioception and protective pain sensation
Neurovascualr- abnormal autonomic nervous system results in increased vascular supply bone resorption

47
Q

How is charcots neuropathy diagnosed?

A

High index of suspicion, consider an diabetic with swollen erythematous foot, espicially with neuropathy
Radiographs
MRI

48
Q

How is charcots foot managed?

A

Prevention
Immobilisation-non weight bearing until fragmentation resolves
Deformity leads to ulceration lead to amputation

49
Q

What is the minimum knowledge for exams?

A

BOA syllabus

Year 3 MSK pathologies (34 decks)

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