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Year 2 Clinical > Regional Adult Orthopaedics: Pelvis and Lower Limb Master Deck > Flashcards

Regional Adult Orthopaedics: Pelvis and Lower Limb Master Deck Flashcards

1
Q

Presentation of pathology pain?

A

Typically, produces pain in the groin which may radiate to the knee (both supplied by the obturator nerve)

May also cause buttock pain (this must be differentiated from lumar spine and SI joint pathologies)

May present purely as knee pain, part. SUFE

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2
Q

Other causes of groin pain?

A

Hernia (inguinal or femoral)

Tendonitis (esp. adductor tendonitis)

Pubis symphisis dysfunction

High lumbar disc prolapse (with L1/2 radiculopathy) - rare

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3
Q

Examination findings with hip pathology?

A

Reduced ROM with LOSS OF INTERNAL ROTATION (often the 1ST SIGN)

+ve Trendellenburg test (weakness of the abductors, gluteus medius and minimus, due to altered hip mechanics or weakness from chronic disuse)

Shortened lower limb (seen in severe OA, Perthes disease, SUFE or AVN/fracture)

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4
Q

Difference between total hip arthroplasty and total hip replacement?

A

Almost synonymous, except THA is a broader term that inc. hip resurfacing

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5
Q

How long do hip replacements last?

A

Loosening of one/more of the prosthetic components

In a low-demand elderly patient, the cup can last 15 years and the stem 20 years

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6
Q

How does THR loosening occur?

A

Wear particles from the bearing surface cause an inflammatory response at the interface; macrophages release inflammatory mediators that stimulate osteoclasts to resorb bone

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7
Q

Conservative measures for hip arthritis?

A
  • Simple analgesics and physio
  • Stick use (reduces force on the joint)
  • Weight reduction
  • Modified activities

If these fail to work, THA can be considered

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8
Q

Early local complications of hip surgery?

A

Infection

Dislocation

Sciatic nerve injury

Leg length discrepancy

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9
Q

Early general complications of hip surgery?

A

Medical comps. from surgery (MI, chest infection, UTI, hypovolaemia)

DVT and PE

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10
Q

Late local complications of hip surgery?

A

Early loosening

Late infection (haematogeneous spread from a distant site)

Late dislocation

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11
Q

Why is THR avoided in young patients?

A

More likely to require revision surgery as higher demand

Subsequent surgeries are more complex, have higher complication rates and poorer functional outcomes

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12
Q

Types of AVN?

A

Primary (idiopathic)

Secondary due to:
• Alcohol abuse
• Steroid use
• Hyperlipidaemia
• Thrombophilia
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13
Q

Presentation of AVN of the hip joint?

A

Groin pain

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14
Q

Ix for AVN of the hip joint?

A

Early stages may only be seen on MRI

Later stages show PATCHY SCLEROSIS of the weight-bearing area of the femoral head, with a lytic zone underneath formed by granulation tissue from attempted repair; the lytic zone forms the classic “HANGING ROPE sign” on X-ray

Femoral head may then collapse with irregularity of the articular surface and secondary OA

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15
Q

Treatment options for AVN of the hip joint?

A

If detected early (pre-collapse) - drill holes made in femoral neck and into the abnormal area of the head can relieve P, promote healing and prevent collapse

If collapse has occurred, the only surgical option is THR

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16
Q

Describe trochanteric bursitis

A

AKA greater trochanteric pain syndrome (similar to rotator cuff problems)

Broad tendinous insertion of the abductor muscles is under considerable strain and can suffer from tendonitis and degeneration, leading to tendon tears

Trochanteric bursa can also become inflamed

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17
Q

Symptoms and signs of trochanteric bursitis?

A

Pain and tenderness in the region of the greater trochanter

Pain on resisted abduction

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18
Q

Treatment of trochanteric bursitis?

A

Analgesia, anti-inflammatories and physio (to strengthen other muscles and avoid abductor weakness)

Steroid injections

No surgical treatment has a proven benefit

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19
Q

Joints of the knee?

A

Medial and lateral compartments of the tibiofemoral joint AND the patellofemoral joint (fibula DOES NOT participate in the knee joint)

These communicate with each other as one synovial knee joint

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20
Q

What are the menisci?

A

Fibrocartilaginous menisci are within the tibiofemoral joint and these ensure congruence between the concave femoral condyles and the flat tibial plateau

Important “shock absorbers” that distribute load evenly

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21
Q

4 main ligaments of the knee and their functions?

A

Anterior cruciate (ACL) - prevent abnormal internal rotation of the tibia

Posterior crucitate (PCL) - prevents hyperextension and anterior translation of the femur

Medial collateral (MCL) - resists valgus force

Lateral collateral (LCL) - resists varus force and abnormal external rotation of the tibia

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22
Q

Types of arthritis of the knee?

A

Seropositive and seronegative inflammatory arthritides

OA:
• Primary - no obvious causative factors but it may have genetic influences and hobbies/occupation
• Secondary

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23
Q

Causes of early OA?

A

Previous meniscal tears

Ligament injuries, esp. ACL deficiency

Malalignment:
• Genu varum - medial compartment OA
• Genu valgum - lateral compartment OA

Patellofemoral dysfunction and instability predisposes to patellofemoral OA

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24
Q

Treatment of knee arthritis?

A

Knee replacement - patient with substantial pain and disability where conservative Mx is not helping:
• Total knee replacement
• Partial knee replacement

Younger patients OR heavy manual workers with isolated medial compartment OA due to varus knees:
• Consider osteotomy of the proximal tibia - shifts load to the lateral compartment

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25
Q

Complications of knee arthritis surgery?

A

Infection, thrombosis and medical comps

Unexplained pain

Low risk of joint dislocation

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26
Q

Context of meniscal tears?

A

Classically with a twisting force on a loaded knee, e.g: turning at football and squatting

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27
Q

Presentation of a meniscal tears?

A

Pain localised to the medial (mostly) OR lateral joint line; effusion develops the following day

Pain and mechanical symptoms (catching sensation or locking with difficulty straightening the knee)

Knee may feels as though it will give way if a loose meniscal fragment is caught in the knee while walking

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28
Q

Definition of true knee locking?

A

Mechanical block to full extension caused by a torn meniscus flipping and becoming stuck in the intercondylar notch

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29
Q

Describe locking in meniscal tears

A

Locking may not always occur if the torn area if unable to flip and become caught

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30
Q

What is pseudo-locking?

A

NOT A SIGN OF MENISCAL INJURY but may be due to arthritis; tends to occur after rising from sitting

Knee becomes “stuck” with temp. difficulty in straightening the joint; this either spontaneously resolves OR the patient has a trick manoeuvre that relieves it

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31
Q

Examination findings of a meniscal tear?

A

Effusion

Joint line tenderness

Pain on tibial rotation localising to the affected compartment (STEINMANN’S TEST - +ve for an ACUTE meniscal tear)

A locked knee with a displaced bucket handle meniscal tear will have a 15 degree springy block to full extension

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32
Q

Ix for meniscal tears?

A

MRI

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33
Q

Why are medial meniscus tears more common than lateral?

A

Medial meniscus is more fixed and less mobile

The force for pivoting movements if centred on the medial compartment

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34
Q

Patterns of meniscal tears?

A

Longitudinal

Radial (poor blood supply)

Oblique

Horizontal

Large longitudinal tears may cause a “BUCKET HANDLE TEAR”, where a large meniscal fragment can flip up and become stuck in the intercondylar notch - causes LOCKING and inability fully extend the knee

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35
Q

Describe degenerative meniscal tears

A

Meniscus weakens with age and may tear spontaneously or with an innocuous injury

Likely the 1st stage in many cases of knee OA

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36
Q

How can degenerative meniscal tears be distinguished from acute tears?

A

Degenerative tears are Steinmann’s -ve; likely to have assoc. signs of OA

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37
Q

Treatment of degenerative meniscal tears?

A

Symptoms do not improve with resection so cannot be treated with arthroscopy

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38
Q

Why do the menisci have limiting healing potential?

A

Only have an arterial supply on the OUTER THIRD

Also decreases with age (poor over 25-30 years old) and with increased time from the injury

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39
Q

Which mensical tears can be considered for repair?

A

Only reasonably new longitudinal tears inv. the outer 1/3rd in a younger patient

Repair inv. suturing the meniscus to its bed

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40
Q

Treatment of meniscal tears that are not eligible for repair?

A

Pain and inflammation settles with time

Steroid injections can help in the early period

If pain/mechanical symptoms do not settle in 3 months - athroscopic partial menisectomy (however knees with signs of OA on X-ray or MRI are unlikely to benefit as menisectomy can increase stress on damaged surfaces)

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41
Q

Context and presentation of ACL ruptures?

A

Usually occur with a high rotational force, like turning upper body laterally on a planter foot (leads to internal rotaiton on the tibia), e.g: in sports

POP is heard and patient develops haemarthrosis WITHIN AN HOUR and deep pain in knee

Chronically, patient has ROTATORY INSTABILITY with their knee GIVING WAY when turning on a planted foot

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42
Q

Examination findings with ACL rupture?

A

Knee swelling (haemarthrosis or effusion)

Excessive anterior translation of the tibia on the anterior drawer test and Lachman test

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43
Q

Variable presentation of ACL ruptures?

A

1/3 of patients compensate well and can continue sports

1/3 manage by avoiding certain movements but may not be able to do high impact sports

1/3 do poorly with frequent giving way even with normal daily activities

OLDER PATIENTS ARE MORE LIKELY TO COMPENSATE/COPE

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44
Q

Treatment of ACL ruptures?

A

Physio (helps compensation)

Primary repair for the torn ACL is ineffective

Most have reconstruction + rehabilitation:
• Sports players
• Those who have a desire to do sport again + no help with physio

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45
Q

Context and presentation of PCL ruptures?

A

Can be due to a direct blow to the anterior tibia with the knee flexed or hyperextended, e.g: motorcycle crash

PCL RUPTURES ARE UNCOMMON IN ISOLATION

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46
Q

Treatment of PCL ruptures?

A

In a multi-ligament injured knee - reconstruction

If an isolated PCL rupture surgical reconstruction only for those:
• With severe laxity and recurrent instability with frequent hyperextension
• Feeling unable to descend stairs (with anterior subluxation of the femur)

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47
Q

Context of MCL ruptures?

A

Usually due to valgus stress injuries, e.g: rugby tackle from the side; higher forces can also damage the ACL and risk lateral tibial plateau fracture

FAIRLY COMMON

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48
Q

Symptoms and signs of MCL rupture?

A

Laxity and pain on valgus stress with tenderness over the origin/insertion of the MCL

49
Q

Treatment of MCL ruptures?

A

Acute tears - hinged knee brace

Chronic MCL instability - MCL tightening or reconstruction with tendon graft

50
Q

Context of LCL ruptures?

A

Varus stress injury that may/may not damage the PCL; often part of multi-ligament injuries

High incidence of common peroneal/fibular nerve injury from excessive stretch AND a high incidence of popliteal artery intimal/complete tear

51
Q

Treatment of LCL ruptures?

A

Usually surgical:
• Early repair
• Late reconstruction with tendon graft

52
Q

Treatment of multi-ligament knee injuries?

A

Surgical reconstruction due to the degree of instability

53
Q

Describe complete knee dislocations

A

Result in rupture of all 4 of the knee ligaments

High incidence of neurovascular injury

54
Q

Treatment of complete knee dislocations?

A

Reduced as an EMERGENCY; may require external fixation for temporary stabilisation

Regularly check foot circulation, as intimal tears can occur that later thrombose (if required, vascular stenting or bypass)

Reperfusion may cause compartment syndrome, esp. after prolonged ischaemia and a fasciotomy may be required

Patients usually need multi-ligament reconstruction

55
Q

Context of osteochondral and chrondral injuries?

A

Impaction or shear of the articular surfaces OR due to a direct blow; ongoing pain and effusion after a knee injury warrants further Ix

Defect in the surface of the knee may fill with fibrocartilage, which is not as good as hyaline but is better than nothing

56
Q

Treatment of osteochondral and chondral injuries?

A

Acute injuries inv. large osteochondral fragments with a substantial proportion of bone - fix with pins

If from a non-weight bearing area OR have little bone attached - remove arthroscopically

Microfracture- if a defect has bare bone at its base, holes can be made to induce bleeding and promote fibrocartilage formation from stem cells differentiating into chondroblasts

Mosaicplasty - osteochondral plugs (from non‐weight bearing areas) are plugged into the defect

Culturing chondrocytes from a sample of hyaline cartilage on a biological membrane and suturing this onto the defect

57
Q

Constituents of the extensor mechanism of the knee?

A

Tibial tuberosity, the patellar tendon, quadriceps tendon and quadriceps muscles

58
Q

Cause of extensor mechanism ruptures?

A

Patellar OR quadriceps tendon can rupture with rapid contractile force, e.g: lifting a heavy weight, after a fall OR spontaneously (with a severely degenerate tendon)

59
Q

Occurrence of extensor mechanism ruptures?

A

Patellar tendon ruptures tend to occur in younger age group (<40 years)

Quadriceps tendon ruptures tend to occur in older patients (>40 years)

60
Q

Predisposing factors to extensor mechanism ruptures?

A

Hx of tendonitis, chronic steroid use/abuse, diabetes, RA and chronic renal failure

Quinolone antibiotics (CIPROFLOXACIN) can cause tendonitis and risk tendon ruptures

61
Q

Examination findings of extensor mechanism ruptures?

A

Assessment of ANY ACUTE KNEE INJURY should inc. STRAIGHT LEG RAISE

Usually have a palpable gap in the extensor mechanism (this may not be obvious in obese patients)

62
Q

Ix for extensor mechanisms ruptures?

A

X-ray - high (PT rupture) or low (quads rupture) lying patella

US can confirm extent of injury

63
Q

Treatment of extensor mechanism ruptures?

A

Steroid injections for tendonitis of the extensor mechanism of the knee should be avoided (high risk of tendon rupture)

Treatment of complete and substantial partial tears is surgical:
• Tendon-to-tendon repair
• Reattachment of the tendon to the patella

64
Q

What is patellofemoral dysfunction?

A

Disorders of the patellofemoral articular resulting in anterior knee pain :
• Chondromalacia patellae (softening of the hyaline cartilage)
• Adolescent anterior knee pain
• Lateral patellar compression syndrome

65
Q

Describe the cause of patellofemoral dysfunction

A

Quadriceps muscle tends to pull the patella in a slight lateral direction; in some people, excessive lateral force produces anterior knee pain and the lateral facet of the patella is compressed against the lateral wall of the distal femoral trochlea

66
Q

Occurrence of patellofemoral dysfunction?

A

More common in women (wider hips so more lateral pull of the quadriceps, part. during adolescence, due to a greater degree of ligamentous laxity)

Other pre-disposing factors inc:
• Joint hypermobility
• Genu valgum
• Femoral neck anteversion

67
Q

Symptoms of patellofemoral dysfunction?

A

Anterior knee pain, worse going downhill

Grinding/clicking sensation at the front of the knee after prolonged sitting, causing PSEUDO-LOCKING where the knee acutely stiffens in a flexed position (in contrast to the true locking in a bucket handle meniscal tear)

68
Q

Treatment of patellofemoral dysfunction?

A

Most improve with physiotherapy (rebalances quad muscles)

Taping can alleviate symptoms

Surgery is a last resort

69
Q

Context of patellar instability/dislocation?

A

Can occur with a direct blow or sudden twist of the knee

Patella almost always displaced laterally and may spontaneously reduce when the knee is straightened; rarely, may have to be manually manipulated into position

70
Q

Ix findings in patellar instability?

A

When the patella dislocates, medial patellofemoral ligament tears and osteochondral fracture may occur as the medial facet of the patella strikes the lateral femoral condyle:
• Small opacification on X-ray.

Lipohaemarthrosis occurs with characteristic X-ray appearance

71
Q

Predisposing factors to patellar instability?

A

Ligamentous laxity

Female gender

Shallow trochlear groove

Genu valgum

Femoral neck anteversion

High-riding patella (patella alta)

72
Q

Treatment of patellar instability?

A

If recurrent dislocation is frequent, tibial tubercle transfer or medial patellofemoral ligament (MPFL) reconstruction with tendon autograft may help.

73
Q

Occurrence of patellar instability?

A

Risk of recurrent instability decreases with age and physio

Risk of recurrent dislocation after 1st time is 10%

74
Q

Types of ankle OA?

A

Primary (idiopathic)

Secondary, e.g: due to previous injury, part. in football players

75
Q

Describe ankle OA

A

Repeated dorsiflexion may cause anterior damage with osteophyte formation; anterior osteophytes can cause pain on dorsiflexion, resulting in impingement

Pain on dorsiflexion may be improves with removal of osteophytes (AKA cheilectomy)

76
Q

What is hallux valgus?

A

Deformity of the great toe due to:
• Medial deviation of the 1st metatarsal
• Lateral deviation of the toe itself

Unclear aetiology

77
Q

Occurrence of hallux valgus?

A

More common in FEMALES (4:1) and there is often a FAMILIAL TENDENCY

Incidence increases with age although it may occur in adolescence

Wearing of shoes has been implicated but no evidence

More common in RA patients, other inflammatory arthropaties and some neuromuscular diseases, e.g: MS, cerebral palsy

78
Q

Symptoms and signs of hallux valgus?

A

May be painful due to joint incongruence

Widened forefoot may rub the foot against shoes, causing an inflamed bursa over the medial 1st metatarsal head (BUNION)

Great and second toes may rub - ulceration and skin breakdown

In severe cases, hallux may override the second toe

79
Q

Treatment of hallux valgus?

A

Conservative:
• Wear wider and deeper shoes to prevent painful bunions
• Use a spacer in the 1st web space to stop rubbing between the great and second toes

Surgical Mx (tends to disappoint cosmetically):
• Osteotomy - realign bones
• Soft tissue procedures - tighten slack tissues and release tight tissues

80
Q

Complications of hallux valgus surgery?

A

Dissatisfaction

Pain in the metatarsal heads (metatarsalgia)

81
Q

What is hallux rigidus?

A

OA of the 1st MTPJ that may be:
• Primary (degenerative)
• Secondary to osteochondral injury

82
Q

Treatment of hallux rigidus?

A

Conservative:
• Wear stiff-soled shoes to limit motion at MTPJ
• Insert metal bar into the sole of the shoe
• If osteophytes impinge during dorsiflexion in early cases, cheilectomy may help

Surgery - GOLD STANDARD IS ARTHRODESIS (using total joint replacement or metal hemi-arthroplasties); successful fusion should alleviate pain with a sacrifice of no motion and no wearing heels

83
Q

Complications of 1st MTPJ arthrodesis?

A

Metal hemi-arthroplasties have high failure rates and, once failure occurs, salvage surgery is difficult with disappointing results

84
Q

Describe Morton’s neuroma

A

Plantar interdigital nerves (from the medial and lateral plantar nerves), overlying the intermetatarsal ligaments, can be subjected to repeated trauma, becoming inflamed and swollen (forms a neuroma)

85
Q

Symptoms of Morton’s neuroma?

A

Burning pain and tingling radiating into the affected areas

3rd interspace nerve is most commonly involved, followed by the 2nd

86
Q

Occurrence of Morton’s neuroma?

A

Women affected 4x more (high heels are implicated)

87
Q

Examination finding with Morton’s neuroma?

A

Loss of sensation in affected web space

Medio-lateral compression of the metatarsal heads may reproduce symptoms OR produce a characteristic “click” (MULDER’S CLICK TEST)

88
Q

Ix for Morton’s neuroma?

A

US can demonstrate swollen nerve

89
Q

Treatment of Morton’s neuroma?

A

Conservative:
• Use of a metatarsal pad or offloading insole
• Steroid and local anaesthetic injections can relieve symptoms and aid diagnosis

Excision of the neuroma (but some patients continue to have pain and there is a small risk of recurrence)

90
Q

Describe metatarsal stress fracture

A

Usually in the 2nd metatarsal, followed by the 3rd

May occur in runners, in soldiers (prolonged marches), dancers or during distance walking in people who are not used to it

91
Q

Ix for metatarsal stress fractures?

A

X-ray may not demonstrate a fracture for ~3 weeks, until resorping at the fracture ends occurs OR callus begins to appear

Bone scan can confirm diagnosis

92
Q

Treatment of metatarsal stress fractures?

A

Prolonged rest for 6-12 weeks in a rigid soled boot is required to allow healing and resolution of symptoms

93
Q

Causes of tendonitis of the Achilles tendon?

A

Can occur due to:
• Repetitive strain (from sports), which leads to peritendonitis
• Degenerative process with intra-substance microtears
• Quinolone antibiotics, e.g: Ciprofloxacin
• RA, other inflammatory arthropathies
• Gout

94
Q

Symptoms of achilles tendonitis?

A

Pain may be in the main substance of the Achilles tendon OR at its insertion into the calcaneus

95
Q

Treatment of Achilles tendonitis?

A

Rest, physio, use of a heel raise to offload the tendon and splints/boot

Resistant cases may benefit from tendon decompression and resection of paratenon but scars in this area can be problematic and the conditions tend to be self-limiting

96
Q

Why should steroid injections not be used for Achilles tendonitis?

A

RISK OF TENDON RUPTURE, as tendonitis already predisposes to rupture

97
Q

Occurrence of Achilles tendon rupture?

A

Tends to occur in middle-aged or older groups and is usually due to degenerative changes within the tendon OR recent tendonitis

98
Q

Symptoms of Achilles tendon rupture?

A

Sudden deceleration with resisted calf muscle contraction, e.g: lunging at squash, leads to SUDDEN PAIN (akin to being kicked in the back of the leg) and difficulty weight-bearing

99
Q

Examination findings of Achilles tendon rupture?

A

No plantarflexion of the foot when squeezing the calf (Simmond’s test)

100
Q

Treatment of Achilles tendon rupture?

A

Controversial

Non-operative Mx (good functional outcome and avoids wound problems):
• Series of casts in the equinous position (ankle plantarflexed with the toes pointing down, as this closes the gap in the torn tendon) over ~8 weeks

Operative repair (restores tension of the tendon and may have lower re-rupture rate):
• Followed with a series of casts for ~8 weeks
101
Q

What is plantar fasciitis?

A

Self-limiting repetitive stress/overload/degenerative conditions of the foot

102
Q

Symptoms of plantar fasciitis?

A

Pain with walking on the instep of the foot (at the origin of the plantar aponeurosis on the distal plantar aspect of the calcaneal tuberosity) with localized tenderness on palpation of this site

103
Q

Risk factors for plantar fasciitis?

A

DIABETES, obesity

Frequent walking on hard floors with poor cushioning in shoes

Cushioning heel pad atrophies with age

104
Q

Treatment of plantar fasciitis?

A

Symptoms can take UP TO 2 YEARS to resolve:

  • Rest, Achilles and plantar fascia stretching exercises and a gel filled heel pad may help
  • Corticosteroid injection may also alleviate symptoms
  • Surgical release of the plantar fascia may have little value risks injury to the plantar nerves
105
Q

What is pes planus?

A

Can be a normal variation affecting up to 20% of the population, where the medial arch does not develop in childhood (developmental flat feet)

Acquired flat feet may be due to tibialis posterior tendon stretch/rupture, RA or diabetes with Charcot foot (neuropathic joint destruction).

106
Q

Risk factors for pes planus?

A

Familial tendency

Patients with generalized ligamentous laxity are more likely to have flat feet

107
Q

Complications of flat feet?

A

May be at higher risk of tendonitis of the tibialis posterior tendon

108
Q

Treatment of flat feet?

A

Developmental flat feet do not usually result in any problems and do not require any specific treatment

109
Q

Describe tibialis posterior tendon dysfunction

A

Inserts predominantly onto the medial navicular and supports the medial arch of the foot (as well as being a plantarflexor and invertor of the foot)

It is under repeated stress and, part. with degeneration, can develop tendonitis, elongation and eventually rupture

Synovitis (RA) can also result in tendon rupture

110
Q

Treatment of tibialis posterior tendon dysfunction?

A

Splint with a medial arch support to avoid rupture; if this fails, surgical decompression and tenosynovectomy may prevent rupture

If the foot remains supple with no OA present, a tendon transfer may be performed to try to prevent secondary OA, with a calcaneal osteotomy, to reduce stress often performed

Once OA ensues, the most appropriate surgical treatment, if symptoms are severe, is arthrodesis

111
Q

Signs of elongation/rupture of the tibialis posterior tendon?

A

Loss of the medial arch with resulting valgus of the heel and flattening of the medial arch of the foot

112
Q

Complications of tibialis posterior tendon dysfunction?

A

Degenerative OA of the hindfoot and midfoot

113
Q

What is pes cavus?

A

Abnormally high arch of the foot; may be idiopathic but is often related to NM conditions inc:
• Hereditary Senory and Motor Neuropathy
• Cerebral palsy
• Polio (unilateral)
• Spinal cord tethering from spina bifida occulta

Claw toes often accompany pes cavus

114
Q

Treatment of pes cavus?

A

Pain from pes cavus may be treated with soft tissue releases and tendon transfer (lateral transfer of tibialis anterior) if supple

OR

Calcaneal osteotomy if more rigid

Severe cases may require arthrodesis

115
Q

Why do claw and hammer toes occur?

A

ACQUIRED imbalance between the flexor and extensor tendons

116
Q

Describe claw toes

A

Hyperextension at MTPJ with hyperflexion at PIPs and DIPs

117
Q

Describe hammer toes

A

Similar to claw toes but hyperextension at the DIPs

118
Q

Other symptoms of claw and hammer toes?

A

Can be painful

Rubbing on footwear can cause corns and skin breakdown

119
Q

Treatment of claw and hammer toes?

A

Toe “sleeves” and corn plasters can prevent skin problems

Surgical solutions inc. tenotomy (division of an overactive tendon), tendon transfer, arthrodesis (PIPJ) or toe amputation

Year 2 Clinical (119 decks)

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