Week 4 Flashcards
What are the four cardinal signs for osteoarthritis?
Loss of joint space
Osteophytes
Sclerosis
Subchondral cysts
What are the 3 stages of rocker when looking at gait?
1st: Heel strike to flat floor
2nd: mid stance
3rd: heel rise
Name two tests for gastrocsoleus?
Silverskiolds and thompson/simmonds
What condition is a normal variant, familial, has associated ligamentous laxity and requires no treatment in relation to foot and ankle?
Pes Planus
What is most common cause of acquired flatfoot deformity in adult which usually is present for years prior to diagnosis?
Tibialis posterior dysfunction
What muscle courses immediately posterior to medial malleolus and attaches on to navicular tuberosity and plantar aspect of medial and middle cuneiforms?
Tibialis posterior
What is the main role of tibialis posterior?
Primary dynamic stabiliser of medial longitudinal arch - elavtes arch
Invertor and plantar-flexor
What type of patient is tibialis posterior dysfunction likely to occur in?
Obese middle aged female - increases with age
Name some associated factors with tibialis anterior dysfunction?
- Flat foot
- Hypertension,
- Diabetes
- Steroid injection
- Seronegative arthropathies
In tibialis posterior dysfunction - where is pain or swelling usually found?
Posterior to medial malleolus
What condition involves a change in foot shape, diminished walking ability, dislike of uneven surfaces, more noticeable hallux valgus and lateral wall “impingement” pain?
Tibialis posterior dysfunction
What type of TPD is swelling, tenderness, slightly weak muscle power?
Type I
What type of TPD is planovalgus, midfoot abduction and passively correctable?
Type II
What type of TPD involves fixity and mortise signs?
Type III and IV
How is TPD treated?
Physiotherapy, insole to support medial longitudinal arch, orthoses occomodate foot shape
What foot and ankle condition often involves clawing of toes and can be caused by HSMN, CP, Polio, spina bifida, club foot
Pes Cavus
What foot and ankle condition involves start-up pain after rest, can be worse after exercise and has fullness or swelling plantarmedial aspect of heel. there can also be tenderness over plantar aspect of heel and/or plantarmedial aspect of heal?
Plantar fasciitis
What test is positive for plantar fasciitis?
Tinel’s test positive for Baxter’s nerve
What condition is related to: “heel spurs” and “heel pad pain syndrome”?
Plantar fasciitis
What are some causes of plantar fasciitis?
Physical overload, seronegative arthropathy, abnormal foot shape (planovalgus or cavovarus) or even improper footwear?
How do you treat plantar fasciitis?
NSAIDS, night splints, taping, heel cups or medial arch supports, steroid injection
Is plantar fasciitis self-limiting?
Yes 18-24 months
What foot and ankle condition increases with age, usually bilateral, 3F>1M and is common in adolescent subgroup?
Hallux valgus
What disease is a cause of hallux valgus?
Rheumatoid, general joint laxity/CTDs and splayed forefoot associated with loss of muscle tone and age
Name four problems experienced with hallux valgus?
- Transfer metatarsalgia
- Lesser toe impingement
- Pain, deformity, cosmesis
- Shoe difficulties
How is hallux valgus managed?
Non-operative (shoe modifications)
Operative - decrease HV anglw
What foot and ankle problem involves osteoarthritis of 1st MTPJ joint?
Hallux rigidus
Name two operative treatments for hallux rigidus?
Joint replacement
Fusion (arthrodesis)
What foot and ankle condition occurs early in Rh disease process and is the commonest problems requiring surgery affect the forefoot?
Rheumatoid foot
Name four features of the pathogenesis of rheumatoid foot?
- Synovitis
- Proteinases and collagenases
- Impaired integrity of joint capsule/ligaments
- Destruction of hyaline cartilage
What part of a rheumatoid foot involves: talocalcaneal interosseous ligament, unstable subtalar joint, calcaneus drifts into valgus, medial arch collapses, flat feet and often requires multiple joint fusions?
Hindfoot
What foot and ankle condition involves degenerative fibrosis of digital nerve near its bifurcation?
Mortons neuroma
What two clinical features are associated with mortons neuroma?
Forefoot pain (metatarsalgia) Burning and tingling in toes
What is the mean age for mortons neuroma?
45-50 (more common in females)
How is mortons neuroma treated operatively and non-=op?
Insoles, injections
Excise
