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Year 2- MSK > Orthopaedics Foot conditions > Flashcards

Orthopaedics Foot conditions Flashcards

1
Q

In general, what are the non-operative management options for foot and ankle conditions?

A

Analgesia
Shoe wear modification
Activity modification
Weight loss
Physiotherapy
Orthotics e.g. insoles and bracing

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2
Q

What is hallux valgus also known as?

A

Bunions

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3
Q

What happens in hallux valgus?

A

Lateral deviation of big toe so it sits and rubs on second toe

->google picture

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4
Q

Cause of hallux vulgus?

A

Genetics
Footwear

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5
Q

Who is more likely to develop hallux valgus?

A

Women > men

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6
Q

Symptoms of hallux valgus?

A

Pressure symptoms from shoe wear
Pain from crossing over of toes
Metatarsalgia

->often bilateral

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7
Q

Pathogenesis of Hallux Valgus?

A

Lateral angulation of great toe as tendons pull which worsens alignment

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8
Q

Diagnosis of hallux valgus?

A

Examination
X-rays to determine severity of bony deformity

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9
Q

Non-operative management of hallux valgus?

A

Shoe wear modification- wider toes boxes
Orthotics to offload pressure and correct deformity
Activity modification
Analgesia

->conservative measure much preferred to operative treatment

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10
Q

Operative management for hallux valgus may be carried out if non-operative management fails.
What can be done?

A

Release of lateral soft tissues
Osteotomy of 1st metatarsal +/- proximal phalanx

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11
Q

Hallux rigidis?

A

Stiff big toe caused by osteoarthritis of 1st MTP joint

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12
Q

Symptoms of hallux rigidus?

A

Many asymptomatic
Pain- often at extreme dorsiflexion
Limitation of range of movement

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13
Q

Diagnosis of hallux rigidus?

A

History and examination
Radiographs

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14
Q

Non-operative management of hallux rigidus?

A

Activity modification
Shoe wear with a rigid sole
Analgesia

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15
Q

Surgical management of hallux rigidus?

A

Cheilectomy- particularly when pain on dorsiflexion
Arthrodesis
Arthroplasty

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16
Q

Gold standard of operative treatment for hallux rigidus?

A

1st MTPJ fusion

->permanent, very good option for young athletic patient

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17
Q

What are the three classical lesser toes deformities?

A

Claw toes
Hammer toes
Mallet toes

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18
Q

Claw toes?

A

Flexion at proximal and distal interphalangeal joint

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19
Q

Hammer toe?

A

Flexion at proximal interphalangeal joint and dorsiflexion at MTP joint

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20
Q

Mallet toe?

A

Flexion at distal interphalangeal joint - often pain of nail impinging of sole of their shoes

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21
Q

Causes of lesser toe deformitiers?

A

Imbalance between flexors/extensors w/ flexors being more active
Footwear
Neurological
Rheumatoid arthritis

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22
Q

Which specific lesser toe deformity has more of a neurological link?

A

Claw toes

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23
Q

Symptoms of lesser toe deformities?

A

Deformity
Pain from dorsal and plantar side

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24
Q

Non-operative treatment of lesser toe deformities?

A

Activity modification
Footwear- flat shoes with high toe box to accommodate deformity
Orthotic insoles

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25
Q

Operative treatment for lesser toe deformaities?

A

Flexor to extensor transfer
Fusion of interphalangeal joint
Release of metatarsophalangeal joint
Shortening osteotomy of metatarsal

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26
Q

Morton’s neuroma?

A

Thickening of tissue which surrounds the digital nerve leading to the toes

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27
Q

Cause of Morton’s neuroma?

A

Mechanically induced degenerative neuropathy
High heel shoes

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28
Q

Who tends to be affected by Morton’s neuroma?

A

Women 40-60

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29
Q

Where does Morton’s neuroma tend to affect>?

A

3rd webspace most common, followed by 2nd webspace

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30
Q

Symptoms of Morton’s neuroma?

A

Neuralgic burning pain in toes- intermittent
Altered sensation in webspace

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31
Q

Diagnosis of Morton’s neuroma?

A

Clinical
Ultrasound best, MRI good- but not very helpful

32
Q

Which clinical test is used in Morton’s neuroma?

A

Mulder’s click

->probably best diagnostic test

33
Q

Management of Morton’s neuroma?

A

Steroid injection for small lesions
Surgery- excision of lesion including section of normal nerve

->surgery can cause numbness and reoccurrence

34
Q

Metatarsalgia?

A

Any pain coming from forefoot

->symptom, not a condition!

35
Q

Non-0opertaive treatment for rheumatoid forefoot?

A

Shoewear
Orthotics
Activity modification

36
Q

Gold standard operative treatment for rhematoid forefoot?

A

1st MTPJ fusion
2-5th toe arthroplasty

37
Q

Dorsal foot ganglia?

A

Lump of foot arising from joint or tendon sheath

38
Q

Aetiology of dorsal foot ganglia?

A

Idiopathic
Underlying arthritis
Underlying tendon pathology

39
Q

Symptoms of dorsal foot gangllion?

A

Pain- either from pressure from shoes or underlying problem

40
Q

Non-operative management of dorsal foot ganglia?

A

Footwear modification
Aspiration of fluid- like in ganglion of hand, viscous fluid comes out and this can be used to confirm diagnosis too

41
Q

Operative treatment of dorsal foot ganglia?

A

Excision

->v poor prognosis and leaves scar which can rub on shoe

42
Q

Causes of mid-foot arthritis?

A

Post-traumatic arthritis
Osteoarthritis
Rheumatoid arthritis

43
Q

Treatment of midfoot arthritis?

A

Non-operative- surprise, surprise, footwear modification, activity, modification, orthotics
Injections- x-ray guided

Opertaive-fusion

44
Q

Plantar fibromatosis?

A

Progressive connective tissue proliferation of the superficial plantar aponeurosis of the foot

->known as Dupuytrens of the foot, looks like a lump in the middle of palmar aspect of foot basically

45
Q

Symptoms of Plantar fibromatosis?

A

Usually asymptomatic unless very large or on weightbearing area

46
Q

Treatment of Plantar fibromatosis?

A

Non-operative = same
Operative= excision (but 80% reoccurrence)
Radiotherapy (same recurrence)

Combination of radiotherapy and surgery for best results if non-operative management does not work

47
Q

Achilles tendoitis?

A

Degenerative/overuse condition with little inflammation

->term tendonitis can be confusing due to little inflammation, will now call achilles tendinopathy

48
Q

Aetiology of Achilles tendinopathy?

A

Paratendonopathy- common in athletic populations
Tendonopathy- common in non-athletic populations

->think of para as in Paralympian = athletics or something

49
Q

Causes of tendonopathy which can cause Achilles tendinopathy?

A

Age
Obesity
Steroids
Diabetes

50
Q

Symptoms of Achilles tendinopathy?

A

Pain during or following exercise
Recurrent episodes for a few weeks which then settle but comes back
Difficulty fitting shoes

->do not miss a ruptured Achilles tendon!!! early treatment much better

51
Q

Diagnosis of Achilles tendinopathy?

A

Clinical for tenderness and testing for rupture
Ultrasound or MRI to see extent of condition

52
Q

Test for achilles tendon rupture?

A

Simmonds test

->gently squeezing calf, no movement in Achilles tendon rupture

53
Q

Non-opertaive treatment of Achilles tendinopathy?

A

Activity modification
Weight loss
Shoe modification
Physio
Extra-corporeal shockwave treatment- vibrates tissues and promotes healing
Immobilisation in below the knee cast

54
Q

Operative treatment of Achilles tendinopathy?

A

Gastrocnemius recession
Release and debridement of tendon

55
Q

Plantar fasciosis/fasciitis?

A

Chronic degenerative change, fibroblast hypertrophy, absent inflammatory cells and dysfunctional blood vessels

56
Q

What can cause Plantar fasciosis/fasciitis?

A

Athletes with high intensity or rapid increase in training
Running with poorly padded shoes on hard surfaces
Obesity
Prolonged standing

57
Q

Symptoms of Plantar fasciosis/fasciitis?

A

Pain first thing in the morning
Pain on weight bearing after rest

->typical presentation, diagnosis often made based on this history, ultrasound and MRI sometimes used

58
Q

Treatment of Plantar fasciosis/fasciitis?

A

Rest, change training
Stretching
Ice
NSAIDs
Orthoses- heel pads
Physio
Weight loss
Injections- good for short term
Night splinting

59
Q

What are some of the newer treatments which can used for Plantar fasciosis/fasciitis instead of operation?

A

Extracorporeal shockwave therapy
Topaz plasma coblation
Nitric oxide

60
Q

Ankle arthritis is most common when?

A

In older age but mean age is 46
Commonly post-traumatic

61
Q

Symptoms of ankle arthritis?

A

Pain and stiffness

62
Q

Diagnosis of ankle arthritis?

A

Clinically by restricted movement, pain
Radiographs and CT can be useful to look at the ankle and adjacent joints

63
Q

Non-operative management of ankle arthritis?

A

Weight loss
Activity modification
Analgesia
Physiotherapy
Steroid injections

64
Q

Gold standard of ankle arthritis surgery?

A

Arthrodesis (fusion)- either open or arthroscopic

65
Q

Tiabialis posterior tendon dysfunction?

A

Progressive condition, acquired adult flat foot planovalgus

66
Q

Diagnosis of Tiabialis posterior tendon dysfunction?

A

Largely clinical- double and single heel raises used to see if patient can stand on their tiptoes

MRI to assess tendon

67
Q

Treatment of Tiabialis posterior tendon dysfunction?

A

Orthotics- medial arch support
Surgery in latter stages- reconstruction of tendon or triple fusion

68
Q

Valgus?

A

Force pushing in towards centre of body

69
Q

Varus?

A

Force that pushing out away from centre of body

70
Q

Diabetic foot ulcers often occur because of what?

A

Well diabetes…but because patient looses sensation and feet and cannot feel pain caused by ulceration so can go missed for ages

71
Q

Treatment of diabetic foot ulcers?

A

Prevention better than cure e.g. well fitting shoes, regular cleaning and inspection of feet
Modify the main detriments to healing e.g. improve diabetic control, smoking cessation, infection control, nutrition

72
Q

What is involved in surgical treatment of diabetic foot ulcers?

A

Improve vascular supply
Debride ulcers and get samples for microbiology

Amputation if severe

73
Q

Cause of Charcot’s foot?

A

Any cause of neuropathy
Diabetes- commonest cause

74
Q

Charcot neuroarthropathy is characterised by rapid bone destruction occurring in three stages.
What are these three stages?

A

Fragmentation
Coalescence
Remodelling

75
Q

Diagnosis of Charcot neuroarthropathy?

A

Radiographs
MRI scan
Any diabetic with acutely swollen erythematous foot, Charcot neuroarthropathy especially with neuropathy, diagnosis until proven otherwise

76
Q

Management of Charcot neuroarthropathy?

A

Prevention better
Acute inflammatory phase= immobilisation
Correct deformity

77
Q
A

Year 2- MSK (36 decks)

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