plantar fasciitis, pes planus,Hallux valgus, Lower limb lymphadenopathy, posterior tibial pulse and dorsalis pedis pulse

Question 1

What is plantar fasciitis?

Answer 1

Plantar fasciitis describes inflammation of the deep plantar fascia, also called the plantar aponeurosis.

Question 2

2. What causes plantar fasciitis?

Answer 2

Excessive training, particularly running, jogging, walking, jumping in volleyball, or training in bare feet, causes repetitive microtrauma, leading to inflammation, primarily at the attachment point of the plantar fascia to the calcaneus.

Question 3

3. What are the risk factors for plantar fasciitis?

Answer 3

Risk factors include obesity, prolonged standing, working on hard surfaces, and pes planus (flat feet).

Question 4

4. What is the clinical presentation of plantar fasciitis?

Answer 4

Patients typically present with unilateral or bilateral heel pain that worsens in the morning and after prolonged rest, and gradually lessens with activity. They might experience pain over the medial process of the calcaneal tuberosity, along the length of the sole of the foot, and on passive dorsiflexion of the toes.

Question 5

5. What are heel spurs, and how are they related to plantar fasciitis?

Answer 5

Heel spurs often coexist with plantar fasciitis, but it’s uncertain whether they cause or represent a secondary response to an inflammatory reaction.

Question 6

6. What is pes planus, and what causes it?

Answer 6

Pes planus, or flat feet, is the loss of the foot’s medial longitudinal arch. Flat feet can be classified as flexible or rigid, and they might be due to congenital ligament laxity, ligament breakdown, or denervation.

Question 7

7. How does flexible pes planus change over time in children?

Answer 7

In children, flexible pes planus typically resolves as they age when the fat pad is lost, ligaments grow and mature, and the normal arch develops.

Question 8

8. What is acquired pes planus, and what causes it?

Answer 8

Acquired pes planus is the persistence or development of flat feet in adulthood due to breakdown of foot supporting structures from conditions like obesity, trauma, arthropathies, or denervation.

Question 9

9. What symptoms are associated with pes planus, especially when problematic?

Answer 9

Pes planus is mostly asymptomatic but can lead to arch pain and later alter the biomechanics of the lower limbs, causing discomfort in various areas such as the midfoot, heel, lower leg, knee, hip, and back.

Question 10

10. How is pes planus diagnosed?

Answer 10

On examination, one can observe evidence of flat feet or excessive pronation, and the “too many toes” sign might be noticed when viewing the individual from the back.

Question 11

What is Hallux Valgus?

Answer 11

1. Hallux Valgus refers to a deformity where the proximal phalanx of the big toe deviates laterally on the first metatarsal.

Question 12

2. What are the primary characteristics of Hallux Valgus?

Answer 12

2. Key characteristics include lateral deviation of the big toe, internal rotation causing the toenail to face medially, bunion formation, and lateral shifting of the sesamoid bones.

Question 13

3. Enumerate the risk factors associated with the development of Hallux Valgus.

Answer 13

3. Risk factors include genetic predisposition, ligamentous laxity, inflammatory joint disease, pes planus, abnormal gait, and wearing poor footwear.

Question 14

4. How does Hallux Valgus typically manifest in individuals?

Answer 14

4. Manifestation includes pronounced medial protrusion of the toe causing difficulty in wearing shoes, chronic and sharp pain exacerbated by walking.

Question 15

5. What complications may arise due to the progression of Hallux Valgus?

Answer 15

5. Complications include blisters, ulcerations, irritated skin, limited toe mobility, and corns over other toes due to altered foot mechanics.

Question 16

6. Describe the association between inflammation and the bunion in Hallux Valgus.

Answer 16

6. The bunion is the inflamed and painful area overlying the medial metatarsophalangeal joint.

Question 17

7. What specific pain-related symptoms are commonly reported by individuals with Hallux Valgus?

Answer 17

7. Pain symptoms are chronic, sharp, worsened by walking, and accompanied by a burning sensation on the dorsal side of the deformity.

Question 18

8. What are corns and how are they related to Hallux Valgus?

Answer 18

8. Corns are thickened skin over the proximal interphalangeal joints of other toes due to altered foot mechanics.

Question 19

9. Why is Hallux Valgus more common in biological females?

Answer 19

9. Its prevalence increases with age, and females experience a higher frequency of the risk factors.

Question 20

10. How might the progression of Hallux Valgus lead to foot mobility issues?

Answer 20

10. Progression results in pain, skin complications, and limited mobility due to toe misalignment.

Question 21

What is lymphadenopathy and its association with the lower limb?

Answer 21

1. Lymphadenopathy refers to an abnormality in the size, number, or consistency of lymph nodes due to various conditions like infection or malignancy. In the lower limb, medial foot infections primarily cause inguinal lymphadenopathy, while lateral foot infections lead to popliteal lymphadenopathy followed by inguinal lymphadenopathy.

Question 22

2. Describe the lymphatic drainage of the lower limb.

Answer 22

2. Lower limb drainage consists of superficial and deep lymphatic vessels. The superficial system, divided into medial and lateral tracts, drains the skin and subcutaneous tissue. The medial track follows the great saphenous vein to the superficial inguinal lymph nodes, bypassing the popliteal nodes. The lateral tract drains the lateral leg and foot, draining into both popliteal and inguinal nodes. The deep system follows arteries and receives lymph from lower limb muscles and deep vessels, entering the popliteal lymph nodes.

Question 23

3. Explain how to palpate the posterior tibial pulse.

Answer 23

3. The posterior tibial pulse can be palpated by pressing the fingers behind the medial malleolus, in the space between the malleolus and Achilles tendon, just above the calcaneus. Passive inversion of the foot helps relax the flexor retinaculum for better palpation.

Question 24

4. Detail the process of locating the dorsalis pedis pulse.

Answer 24

4. The dorsalis pedis artery continues from the anterior tibial artery, passing anterior to the ankle joint between the malleoli, underneath the inferior extensor retinaculum, and to the first interosseous space. It can be felt by starting between the malleoli and moving fingertips roughly a third to halfway toward the web space between the first and second toes, slightly lateral to the extensor hallucis longus tendon.

Question 25

5. What significance do weak or absent pulses hold, and what can they indicate?

Answer 25

5. Weak or absent pulses suggest vascular insufficiency due to arterial diseases, often caused by arterial occlusions. Various factors such as obesity, edema, trauma, or compressive lesions can contribute to this issue. Non-palpable pulses are a late sign of acute arterial occlusion, which may require urgent medical attention.

Question 26

What is plantar fasciitis and how does it typically present?

Answer 26

Plantar fasciitis is inflammation of the deep plantar fascia due to repetitive microtrauma. It presents with unilateral or bilateral heel pain, worse in the morning and after prolonged rest.

Question 27

Define pes planus and explain its characteristics.

Answer 27

Pes planus signifies the loss of the medial longitudinal arch of the foot, flexible or rigid. Usually, it resolves in childhood, but it might progress into adulthood due to the breakdown of supporting structures like the tibialis posterior muscle and spring ligament.

Question 28

What is hallux valgus, and what are its associated symptoms?

Answer 28

Hallux valgus is a lateral deviation of the big toe on the first metatarsal. It presents with a medial deformity of the first metatarsophalangeal joint, progressively worsening, associated with pain, redness, and paraesthesia.

Question 29

Describe the occurrence of lymphadenopathy in the lower limb based on foot lesions.

Answer 29

Infections in the medial foot cause inguinal lymphadenopathy, whereas lateral foot lesions may cause both popliteal and inguinal lymphadenopathy.

Question 30

Explain how to palpate the posterior tibial pulse.

Answer 30

The posterior tibial pulse can be felt by pressing fingers behind the medial malleolus in the space between the malleolus and Achilles tendon, just above the calcaneus.

Question 31

Describe the process of palpating the dorsalis pedis pulse.

Answer 31

The dorsalis pedis pulse is palpated by starting at the midpoint between the two malleoli and pressing fingertips roughly a third to halfway from this point to the web space between the first and second toe, just lateral to the extensor hallucis longus tendon.

Question 32

What are claw and hammer toes?

Answer 32

Claw and hammer toes are conditions that deform the four smaller toes, leaving them in a curved position. Claw toes involve hyperextension at the MTPJ with flexion at the PIPJ and DIPJ. Hammer toes exhibit PIPJ flexion, DIPJ extension, and a neutral MTPJ.

Question 33

What are the common clinical features associated with claw and hammer toes?

Answer 33

Claw and hammer toes can be painful and cause discomfort. They tend to rub against footwear, leading to issues such as corns and skin breakdown.

Question 34

How can skin problems associated with claw and hammer toes be prevented?

Answer 34

Toe ‘sleeves’ and corn plasters are effective in preventing skin issues arising from claw and hammer toes.

Question 35

What are the surgical management options available for claw and hammer toes?

Answer 35

Surgical solutions include tenotomy (division of an overactive tendon), tendon transfer, arthrodesis (PIPJ), or, in severe cases, toe amputation.

Question 36

What is the primary cause of claw and hammer toes?

Answer 36

Claw and hammer toes occur due to an acquired imbalance between the flexor and extensor tendons of the toes.

Question 37

What characterizes the symptoms of plantar fasciitis?

Answer 37

The symptoms include start-up pain after rest on the instep of the foot, particularly at the origin of the plantar aponeurosis on the distal plantar aspect of the calcaneal tuberosity. The pain can worsen after exercise.

Question 38

What signs might be observed during an examination for plantar fasciitis?

Answer 38

Clinical signs of plantar fasciitis might include fullness or swelling on the plantarmedial aspect of the heel, localized tenderness on palpation of the plantar aspect of the heel and/or plantarmedial aspect of the heel. Additionally, a positive Tinel’s test for Baxter’s nerve could be observed.

Question 39

How is plantar fasciitis diagnosed?

Answer 39

Diagnosis of plantar fasciitis is mainly clinical, based on the patient’s history and physical examination.

Question 40

What are the recommended management approaches for plantar fasciitis?

Answer 40

Treatment may include rest, NSAIDs for pain relief, night splints, taping, heel cups, or medial arch supports. Physiotherapy involving Achilles and plantar fascia stretching exercises is also beneficial. Corticosteroid injections can help alleviate symptoms. However, symptoms may persist for up to two years. Surgical release of the plantar fascia is an option but involves risks, including injury to the plantar nerves, and its overall effectiveness remains uncertain.

Question 41

What are the risk factors associated with the development of plantar fasciitis?

Answer 41

Risk factors for plantar fasciitis include repetitive stress or overload, excessive exercise, obesity, diabetes, age-related changes in the cushioning heel fat pad, abnormal foot shapes (such as splanovalgus or cavovarus), and frequent walking on hard floors with poor cushioning in shoes.

Question 42

What defines plantar fasciitis?

Answer 42

Plantar fasciitis is inflammation of the plantar fascia, a thick connective tissue that attaches to the calcaneus (heel bone) and extends along the sole of the foot, connecting to the flexor tendons of the toes.

Question 43

What are the typical symptoms of plantar fasciitis?

Answer 43

Patients commonly present with a gradual onset of heel pain on the plantar aspect, particularly worse with pressure, walking, or prolonged standing. They also experience tenderness upon palpation of the affected area.

Question 44

What are the management options for plantar fasciitis?

Answer 44

Management includes rest, ice application, analgesia (such as NSAIDs for pain relief), physiotherapy to alleviate symptoms, and steroid injections, which can be painful and rarely lead to plantar fascia rupture or fat pad atrophy.

Question 45

What are the potential specialist interventions for plantar fasciitis?

Answer 45

Rarely, specialist interventions may include extracorporeal shockwave therapy or surgical procedures when conservative treatments fail to alleviate symptoms.

Question 46

What characterizes hallux valgus?

Answer 46

Hallux valgus is a condition involving the deviation of the first metatarsal bone medially and the big toe laterally, resulting in a deformity of the great toe.

Question 47

What are the aetiological factors associated with hallux valgus?

Answer 47

The exact cause of hallux valgus is unknown, although higher incidence is noted in females, increased age, and possible familial tendencies. It’s more prevalent in conditions such as rheumatoid arthritis and other inflammatory arthropathies, along with certain neuromuscular diseases.

Question 48

What are the clinical features associated with hallux valgus?

Answer 48

Hallux valgus is often bilateral and can cause pain due to joint incongruence, making it difficult to wear closed shoes. A widened forefoot may lead to the development of bunions, ulceration, or skin breakdown between the great toe and second toe. Severe cases might involve the great toe overriding the second toe, resulting in joint pain indicative of osteoarthritis or defunctioned first ray, leading to poor balance.

Question 49

How is hallux valgus managed?

Answer 49

Conservative measures include wearing wider and deeper shoes to prevent bunions, and using a spacer in the first web space to prevent toe rubbing. Surgical management involves procedures like osteotomies to realign bones and soft tissue interventions. Surgical correction is indicated when conservative methods fail, and lifestyle limitation or functional issues are observed. However, surgery may alter foot biomechanics, and it’s crucial to understand that approximately 30% of patients may not be satisfied with the outcomes. Surgical correction in adolescents carries a risk of deformity recurrence later in life.

Question 50

What is the medical term for bunions?

Answer 50

Bunions are medically termed as “hallux valgus,” where “hallux” refers to the big toe and “valgus” pertains to the angle of the deformity.

Question 51

Where is the bony lump located in a bunion?

Answer 51

A bunion is a bony lump formed at the metatarsophalangeal joint (MTP) at the base of the big toe.

Question 52

What causes bunions to develop?

Answer 52

The exact cause of bunions is unclear. However, they are associated with the angling of the first metatarsal bone medially and the big toe laterally, resulting in inflammation and enlargement of the MTP joint.

Question 53

How can the extent of a bunion deformity be assessed?

Answer 53

Weight-bearing X-rays can be used to evaluate the severity of the bunion deformity.

Question 54

What are the conservative and definitive treatments for bunions?

Answer 54

Conservative management involves using wide, comfortable shoes, and pain relief through analgesics. Bunion pads can be used to protect the bunion from friction caused by footwear. Surgery is the definitive treatment, aiming to realign the bones and correct the deformity, with various surgical options based on individual factors.

Question 55

What is the primary cause of hallux rigidus?

Answer 55

Hallux rigidus is primarily caused by osteoarthritis (OA) affecting the first metatarsophalangeal joint (MTPJ).

Question 56

What are the common symptoms associated with hallux rigidus?

Answer 56

The common symptoms of hallux rigidus include painful first MTP joint, stiffness, and increased pain during activity, particularly when wearing certain types of shoes.

Question 57

What signs might be observed during examination in hallux rigidus?

Answer 57

Clinical signs of hallux rigidus might include the presence of a dorsal exostosis (bone spur) and hyperextension of the interphalangeal joint (IPJ) of the toe.

Question 58

What imaging is used for diagnosing hallux rigidus?

Answer 58

Weight-bearing X-rays, including anteroposterior (AP), lateral, and oblique views, are used for diagnosis.

Question 59

What are the conservative and surgical treatments for hallux rigidus?

Answer 59

Conservative treatment involves weight loss, pain relief through analgesics and NSAIDs, and activity modification. Wearing stiff-soled shoes or inserting a metal bar into the sole of the shoe can limit motion at the MTPJ. In cases where dorsal osteophytes impinge during dorsiflexion, cheilectomy (removal of osteophytes) might help. However, arthrodesis, the surgical fusion of the joint, is considered the gold standard for advanced cases. It eliminates joint movement, alleviates pain, but restricts high heel use. Joint replacements are also used but come with high failure rates.

Question 60

What characterizes pes cavus?

Answer 60

Pes cavus is described as an abnormally high arch of the foot.

Question 61

What conditions or factors are often associated with pes cavus?

Answer 61

Pes cavus can be idiopathic, but it is commonly related to neuromuscular conditions such as Hereditary Sensory and Motor Neuropathy, cerebral palsy, unilateral polio, and spinal cord tethering from spina bifida occulta.

Question 62

What are the typical clinical features of pes cavus?

Answer 62

Patients with pes cavus might experience pain in the arch of the foot, and it’s often accompanied by claw toes.

Question 63

What imaging is used for diagnosing pes cavus?

Answer 63

Diagnosis involves weight-bearing X-rays of the foot and, if a tumor is suspected, an MRI of the spine might be recommended.

Question 64

What treatment options are available for pes cavus?

Answer 64

Management for pes cavus can involve soft tissue releases and tendon transfer if the condition is flexible. However, more rigid cases may necessitate calcaneal osteotomy or, in severe instances, arthrodesis.

Question 65

What is meant by “in-toeing” in the context of walking or standing?

Answer 65

“In-toeing” refers to a child’s feet pointing toward the midline when walking or standing.

Question 66

How might in-toeing manifest in children, especially when running or walking?

Answer 66

Children exhibiting in-toeing are often perceived as clumsy, and their shoes tend to wear out quickly due to the abnormal foot positioning.

Question 67

What are the primary causes of in-toeing in children?

Answer 67

Internal tibial torsion and metatarsus adductus are among the various causes of in-toeing in children.

Question 68

What is femoral neck anteversion in the context of in-toeing?

Answer 68

The femoral neck normally has slight anteversion, but excessive femoral neck anteversion can cause an appearance of in-toeing (and also knock knees).

Question 69

Is excessive femoral neck anteversion generally considered for surgical intervention?

Answer 69

No, the degree of apparent in-toeing due to excessive femoral neck anteversion typically doesn’t warrant surgical intervention.

Question 70

What causes flat feet in children?

Answer 70

Flat feet in children can be a normal variation affecting up to 20% of the population, with factors like familial tendency, ligamentous laxity, and less commonly acquired issues like tibialis posterior tendon stretch, rheumatoid arthritis, or diabetes with Charcot foot.

Question 71

What defines mobile/flexible flat feet, and when might this condition be a concern?

Answer 71

Mobile/flexible flat feet are those where the flattened medial arch forms when the great toe is dorsiflexed (Jack test) or when the patient tip-toes. It might be a concern in adults related to tibialis posterior tendon dysfunction.

Question 72

What distinguishes rigid flat feet from flexible ones, and what could it imply?

Answer 72

Rigid flat feet do not form an arch even with load or great toe dorsiflexion, suggesting an underlying bony abnormality like tarsal coalition, or potentially an underlying inflammatory or neurological disorder.

Question 73

Are medial arch support orthoses needed for flexible flat feet in children?

Answer 73

No, medial arch support orthoses are generally not required for flexible flat feet in children as this condition is usually considered a normal variant.

Question 74

What complications might flat-footed individuals face?

Answer 74

Flat-footed individuals could be at higher risk for tibialis posterior tendonitis.

Question 75

Which toe is most commonly affected by curly toes?

Answer 75

The fifth toe is most frequently affected by curly toes.

Question 76

Is intervention usually necessary for curly toes?

Answer 76

No, most cases of curly toes will correct without intervention. However, persistent cases causing discomfort in shoes or occurring in adolescence may require surgical correction.

Question 77

What is the typical manifestation of curly toes?

Answer 77

Curly toes present with minor overlapping and curling of the affected toes.

Question 78

What might be done in cases where curly toes cause discomfort or persist into adolescence?

Answer 78

Surgical correction might be necessary for cases causing discomfort or that persist into adolescence.

Question 79

What are the characteristics of curly toes that necessitate intervention?

Answer 79

Curly toes causing persistent discomfort or issues with wearing shoes may require intervention, typically in the form of surgical correction.

Question 80

What is the characteristic deformity seen in club foot (talipes equinovarus)?

Answer 80

Club foot involves ankle equinus (plantarflexion), supination of the forefoot, and varus alignment of the forefoot due to abnormal alignment of the talus, calcaneus, and navicular joints.

Question 81

How is the Ponsetti technique utilized in the management of club foot?

Answer 81

The Ponsetti technique involves splinting and casting. Deformities are progressively corrected in stages, held in plaster casts, and changed every 5 or 6 weeks.

Question 82

What percentage of children with club foot require a tenotomy of the Achilles tendon for full correction?

Answer 82

About 80% of children require a tenotomy of the Achilles tendon to maintain full correction after using the Ponsetti technique.

Question 83

What happens once full correction is achieved in a child with club foot?

Answer 83

After full correction, the child is placed in a brace consisting of boots attached to a bar, worn 23 hours a day for 3 months, and used during sleep until the age of 3 to 4 to prevent recurrence.

Question 84

Is late deformity in club foot easy to correct, and how is it managed?

Answer 84

Late deformity in club foot is challenging to correct and often requires extensive surgery with less satisfactory results. Delayed presentations are very rare in modern healthcare systems.

Question 85

Where is the fat pad located that is affected by fat pad atrophy?

Answer 85

Fat pad atrophy affects the fat pad under the calcaneus (heel of the foot).

Question 86

What can cause fat pad atrophy in the foot?

Answer 86

Atrophy of the fat pad can occur due to age-related changes, repetitive impacts from activities like running or walking, and inflammation from activities such as jumping or obesity. Local steroid injections used to treat plantar fasciitis can also cause fat pad atrophy.

Question 87

How are the symptoms of fat pad atrophy similar to those of plantar fasciitis?

Answer 87

Symptoms of fat pad atrophy, like plantar fasciitis, include pain and tenderness over the plantar aspect of the heel. These symptoms worsen with activities, especially when barefoot on hard surfaces.

Question 88

What diagnostic method can measure the thickness of the fat pad?

Answer 88

The thickness of the fat pad can be measured using an ultrasound scan.

Question 89

What are the primary management strategies for fat pad atrophy?

Answer 89

Management involves wearing comfortable shoes, utilizing custom insoles, adapting activities to avoid high heels, and, if appropriate, pursuing weight loss.

Question 90

What is Morton’s Neuroma?

Answer 90

Morton’s Neuroma is a benign thickening of a plantar digital nerve caused by irritation, leading to the formation of a neuroma.

Question 91

Which nerves are commonly involved in Morton’s Neuroma, and where is the most common location for this condition to occur?

Answer 91

The plantar interdigital nerves, specifically the third interspace nerve, are most commonly involved in Morton’s Neuroma, followed by the second interspace.

Question 92

What are the typical symptoms experienced by individuals with Morton’s Neuroma?

Answer 92

Symptoms include burning pain and tingling sensations that radiate to the affected toes, which can worsen due to footwear and improve when shoes are removed.

Question 93

How can Mulder’s click test be performed, and what does it suggest in the context of Morton’s Neuroma?

Answer 93

Mulder’s click test involves medio-lateral compression of the metatarsal heads and may produce a characteristic ‘click’ or reproduce the patient’s symptoms.

Question 94

What are the management options for Morton’s Neuroma?

Answer 94

Management includes conservative measures such as rest, ice, stretching calf muscles, metatarsal pads, weight loss if needed, and activity modification. Steroid injections and, if necessary, surgical excision of the neuroma might be considered in persistent cases after initial interventions.

Question 95

What is Morton’s Neuroma and where is the abnormal nerve usually located?

Answer 95

Morton’s Neuroma refers to nerve dysfunction between the toes, primarily between the third and fourth metatarsals in the intermetatarsal space of the foot.

Question 96

How does Morton’s Neuroma commonly present, and what symptoms are associated with this condition?

Answer 96

Common presentations include pain in the affected area at the front of the foot, a sensation of a lump in the shoe, and sensations like burning, numbness, or “pins and needles” in the distal toes.

Question 97

What tests or examinations can be used to diagnose Morton’s Neuroma?

Answer 97

Diagnostic tests include deep pressure applied to the affected area, the metatarsal squeeze test, and Mulder’s sign, which causes pain or a clicking sensation upon manipulation of the foot. Confirmatory tests like ultrasound or MRI can be used to visualize and confirm the diagnosis.

Question 98

What are the management options for Morton’s Neuroma?

Answer 98

Management strategies include activity modification (like avoiding high heels), analgesia (such as NSAIDs), insoles, weight loss if necessary, steroid injections, radiofrequency ablation, and in some cases, surgical options like excision of the neuroma.