orthopaedics: foot and ankle Flashcards
what is hallux valgus
inflammation bursa on medial metatarsal –> bunion
how does hallux valgus arise
joint is out of placed and rubs with shoe
who commonly gets hallux valgus
females, elderly, people with RA, inflamm arthritis and NM disease
what are the symptoms of hallux valgus
bunion, ulceration between big toe and second toe, hallux can override the second toe
what non-surgical treatment can be done for hallux valgus
wearing wider shoes and a spacer to prevent bunions and rubbing
what is hallux rigidus
OA of first MTPJ
how do you manage hallux rigidus conservatively
stuffed soled shoes, metal bar in shoes, removal of oseotphytes
how do you manage hallux rigidus surgically and what does it involve
arthrodesis (first line), fusing joints, no joint motion afterwards
what is morton’s neuroma
interdigital nerves on top of ligaments become damaged after repeated trauma, become inflammed and swollen and form a neuroma
what are symptoms of morton’s neuroma
pain and burning in affected toes, loss of sensation in web space, Mudler’s click test
how do you diagnose morton’s neuroma
USS
how do you treat morton’s neuroma
offloading insole, steroids and local anaesthetic injection, excision
where are you likely to get a metatarsal stress fracture
2nd and 3rd metatarsal
who gets metatarsal stress fracture
runners, soldiers, dancers, hill walkers
how do you identify metatarsal stress fracture
x rays and bone scans
how do you treat metatarsal stress fractures
rest and rigid sole boot
how do you get tendonitis
strain from sport, degenerative, quinolone ABs’, RA or inflamm arthropathies
what symptoms are there of tendonitis
pain at insertion of tendon tendon itself, swelling, eases with walking, morning stiffness
how do you treat tendonitis
normally self-limiting, physio, NSAIDs, heel raises, splint/ boot
how do you treat tendonitis surgically
tendon decompression or rupture
who normally gets achilles tendon rupture and how
middle aged/ older, sudden deceleration with resisted calf muscle
what causes achilles tendon rupture (pathology)
degeneration or recurrent tendonitis
how do you treat achilles tendon rupture non-operatively
casts –> good outcomes
how do you treat achilles tendon rupture operatively
suture repair of damaged tendon, cast afterwards
what causes plantar fasciitis
repetitive stress or degeneration
what are symptoms of plant fasciitis
pain after rest, worse when exercising, tinkle’s test positive, localised tenderness on palpation site (heel and medial)
what can cause plantar fasciitis
diabetes, obesity, poor cushioning, over exercise
how do you treat plantar fasciitis
usually self-limiting, NSAIDs, physio, stretching, gel pads, steroid injections
what do you never do in achilles tendonitis and why
steroid injection as it risks rupture
what is flat foot
normal variation where medial arch does not develop
what can cause flat foot
familial, ligament laxity
what does flat foot increase risk of
tendonitis
what are secondary causes of flat foot
tibialis posterior tendon rupture, RA, diabetes
where does tibialis posterior tendon attach on to
medial navicular tuberosity and plantar cuneiforms
what can cause tibialis posterior tendon dysfunction
flat foot, elderly, obese, diabetes, hypertension, steroids, inflam arthritis
how can repeated stress cause tibialis posterior tendon dysfunction
stress –> tendonitis –> rupture
how can RA cause tibialis posterior tendon dysfunction
RA –> synovitis –> rupture
what are symptoms of tibialis posterior tendon dysfunction
pain and swelling in medial malleolus, harder to walk and balance esp uneven ground, hallux valgus, midfoot ankle pain
how do you treat tibialis posterior tendon dysfunction
splint, physio, insole, surgical decompression
what are complications of tibialis posterior tendon dysfunction
flat foot, OA of hindfoot
what is pes cavus
normal variant causing abnormally high arch
what neuromuscular conditions can cause pes cavus
sensory and motor neuropathy, cerebral palsy, polio, spina bifda
what normally accompanies pes cavus
claw toes
how do you treat pes cavus
soft tissue release and tendon transfer, severe need arthrodesis
what causes claw and hammer toes
imbalance between flexor and extensor tendons causing hyperextension at joints
what symptoms can be present with claw and hammer toes
can be painful and rub causing corns and bleeding
what treatment can be done for claw and hammer toes
plasters and sleeves, tendon transfer, arthrodesis, amputation
