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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
Operative treatment for lesser toe deformaities?
Flexor to extensor transfer Fusion of interphalangeal joint Release of metatarsophalangeal joint Shortening osteotomy of metatarsal
26
Morton's neuroma?
Thickening of tissue which surrounds the digital nerve leading to the toes
27
Cause of Morton's neuroma?
Mechanically induced degenerative neuropathy High heel shoes
28
Who tends to be affected by Morton's neuroma?
Women 40-60
29
Where does Morton's neuroma tend to affect>?
3rd webspace most common, followed by 2nd webspace
30
Symptoms of Morton's neuroma?
Neuralgic burning pain in toes- intermittent Altered sensation in webspace
31
Diagnosis of Morton's neuroma?
Clinical Ultrasound best, MRI good- but not very helpful
32
Which clinical test is used in Morton's neuroma?
Mulder's click ->probably best diagnostic test
33
Management of Morton's neuroma?
Steroid injection for small lesions Surgery- excision of lesion including section of normal nerve ->surgery can cause numbness and reoccurrence
34
Metatarsalgia?
Any pain coming from forefoot ->symptom, not a condition!
35
Non-0opertaive treatment for rheumatoid forefoot?
Shoewear Orthotics Activity modification
36
Gold standard operative treatment for rhematoid forefoot?
1st MTPJ fusion 2-5th toe arthroplasty
37
Dorsal foot ganglia?
Lump of foot arising from joint or tendon sheath
38
Aetiology of dorsal foot ganglia?
Idiopathic Underlying arthritis Underlying tendon pathology
39
Symptoms of dorsal foot gangllion?
Pain- either from pressure from shoes or underlying problem
40
Non-operative management of dorsal foot ganglia?
Footwear modification Aspiration of fluid- like in ganglion of hand, viscous fluid comes out and this can be used to confirm diagnosis too
41
Operative treatment of dorsal foot ganglia?
Excision ->v poor prognosis and leaves scar which can rub on shoe
42
Causes of mid-foot arthritis?
Post-traumatic arthritis Osteoarthritis Rheumatoid arthritis
43
Treatment of midfoot arthritis?
Non-operative- surprise, surprise, footwear modification, activity, modification, orthotics Injections- x-ray guided Opertaive-fusion
44
Plantar fibromatosis?
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
Symptoms of Plantar fibromatosis?
Usually asymptomatic unless very large or on weightbearing area
46
Treatment of Plantar fibromatosis?
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
Achilles tendoitis?
Degenerative/overuse condition with little inflammation ->term tendonitis can be confusing due to little inflammation, will now call achilles tendinopathy
48
Aetiology of Achilles tendinopathy?
Paratendonopathy- common in athletic populations Tendonopathy- common in non-athletic populations ->think of para as in Paralympian = athletics or something
49
Causes of tendonopathy which can cause Achilles tendinopathy?
Age Obesity Steroids Diabetes
50
Symptoms of Achilles tendinopathy?
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
Diagnosis of Achilles tendinopathy?
Clinical for tenderness and testing for rupture Ultrasound or MRI to see extent of condition
52
Test for achilles tendon rupture?
Simmonds test ->gently squeezing calf, no movement in Achilles tendon rupture
53
Non-opertaive treatment of Achilles tendinopathy?
Activity modification Weight loss Shoe modification Physio Extra-corporeal shockwave treatment- vibrates tissues and promotes healing Immobilisation in below the knee cast
54
Operative treatment of Achilles tendinopathy?
Gastrocnemius recession Release and debridement of tendon
55
Plantar fasciosis/fasciitis?
Chronic degenerative change, fibroblast hypertrophy, absent inflammatory cells and dysfunctional blood vessels
56
What can cause Plantar fasciosis/fasciitis?
Athletes with high intensity or rapid increase in training Running with poorly padded shoes on hard surfaces Obesity Prolonged standing
57
Symptoms of Plantar fasciosis/fasciitis?
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
Treatment of Plantar fasciosis/fasciitis?
Rest, change training Stretching Ice NSAIDs Orthoses- heel pads Physio Weight loss Injections- good for short term Night splinting
59
What are some of the newer treatments which can used for Plantar fasciosis/fasciitis instead of operation?
Extracorporeal shockwave therapy Topaz plasma coblation Nitric oxide
60
Ankle arthritis is most common when?
In older age but mean age is 46 Commonly post-traumatic
61
Symptoms of ankle arthritis?
Pain and stiffness
62
Diagnosis of ankle arthritis?
Clinically by restricted movement, pain Radiographs and CT can be useful to look at the ankle and adjacent joints
63
Non-operative management of ankle arthritis?
Weight loss Activity modification Analgesia Physiotherapy Steroid injections
64
Gold standard of ankle arthritis surgery?
Arthrodesis (fusion)- either open or arthroscopic
65
Tiabialis posterior tendon dysfunction?
Progressive condition, acquired adult flat foot planovalgus
66
Diagnosis of Tiabialis posterior tendon dysfunction?
Largely clinical- double and single heel raises used to see if patient can stand on their tiptoes MRI to assess tendon
67
Treatment of Tiabialis posterior tendon dysfunction?
Orthotics- medial arch support Surgery in latter stages- reconstruction of tendon or triple fusion
68
Valgus?
Force pushing in towards centre of body
69
Varus?
Force that pushing out away from centre of body
70
Diabetic foot ulcers often occur because of what?
Well diabetes...but because patient looses sensation and feet and cannot feel pain caused by ulceration so can go missed for ages
71
Treatment of diabetic foot ulcers?
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
What is involved in surgical treatment of diabetic foot ulcers?
Improve vascular supply Debride ulcers and get samples for microbiology Amputation if severe
73
Cause of Charcot's foot?
Any cause of neuropathy Diabetes- commonest cause
74
Charcot neuroarthropathy is characterised by rapid bone destruction occurring in three stages. What are these three stages?
Fragmentation Coalescence Remodelling
75
Diagnosis of Charcot neuroarthropathy?
Radiographs MRI scan Any diabetic with acutely swollen erythematous foot, Charcot neuroarthropathy especially with neuropathy, diagnosis until proven otherwise
76
Management of Charcot neuroarthropathy?
Prevention better Acute inflammatory phase= immobilisation Correct deformity
77

Year 2- MSK (36 decks)

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