foot & ankle

Question 1

what is pes planus?

Answer 1

normal variant, associated with ligamentous laxity. It’s the loss of the medial longitudinal arch of the foot.

Question 2

Jack’s test

Answer 2

push big toe in the air of child & a nice arch should appear

Question 3

what is tibialis posterior dysfunction the most common cause of?

Answer 3

acquired flatfoot deformity in adult

Question 4

what is the tibialis posterior the primary dynamic stabiliser of?

Answer 4

medial longitudinal arch - elevates arch

also an invertor & plantar-flexor

Question 5

what is tibialis posterior due to?

Answer 5

tendinosis of unknown aetiology

Question 6

what is seen clinically in tibias posterior dysnfunction?

Answer 6

Pain and/or swelling posterior to medial malleolus – very specific 
Change in foot shape
Diminished walking ability/balance
Dislike of uneven surfaces
More noticeable hallux valgus
Lateral wall “impingement” pain

Question 7

how do you treat tibialis posterior dysfunction?

Answer 7

Physiotherapy
Insole to support medial longitudinal arch
NO steroid injections
Orthoses to accommodate foot shape
Bespoke footwear
Surgery

Question 8

what is pes cavus?

Answer 8

human foot type in which the sole of the foot is distinctly hollow when bearing weight, often with clawing of toes

Question 9

what kind of pain is seen in plant fasciitis?

Answer 9

start up pain after rest, can be worse after exercise

Question 10

what’s seen on the plantar medial aspect of the heel?

Answer 10

fullness/swelling

Question 11

what test is positive in plantar fasciitis?

Answer 11

Tinel’s test positive for Baxter’s nerve

Question 12

tinel’s test

Answer 12

a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or “pins and needles” in the distribution of the nerve

Question 13

how would you treat plantar fasciitis?

Answer 13

NSAIDS
Night splints
Taping
Heel cups or medial arch supports
Physiotherapy – eccentric exercise programme
Steroid injection
Surgery – 50% success, better if acute onset

Question 14

what is hallux valgus

Answer 14

often referred to as a “bunion” is a deformity of the big toe

Question 15

what problems can occur with hallux valgus

Answer 15

Transfer metatarsalgia
Lesser toe impingement
Pain, deformity, cosmesis
Shoe difficulties

Question 16

how is hallux values managed?

Answer 16

operative - osetotomies

non-operative - shoe modifications

Question 17

what is hallux rigidus?

Answer 17

OA of 1st MTPJ

Question 18

wha is the operative management of hallux rigidus?

Answer 18

joint replacement

fusion

Question 19

what is a morton’s neuroma?

Answer 19

Degenerative fibrosis of digital nerve near it’s bifurcation

Question 20

what would a patient feel in morton’s neuroma?

Answer 20

Get forefoot pain (metatarsalgia)

Burning and tingling in toes

Question 21

when do people usually get morton’s neuroma?

Answer 21

45-50

Question 22

what is tendo-achilles tendinosis?

Answer 22

Repetitive microtrauma, failure of collagen repair with loss of fibre alignment/structure, hypovascular region 2-6cm proximal to insertion

Question 23

how is tendo-achilles tendinosis managed?

Answer 23

Activity modifications/analgesia
NSAIDS
Shockwave therapy
Orthotics
Physio
Surgery

Question 24

what kind of mechanism would cause tendo-achilles rupture?

Answer 24

sudden deceleration with resisted calf contraction

Question 25

what would be seen clinically in tendso-achilles rupture

Answer 25

Unable to bear weight
Weak plantar flexion
Palpable painful gap
Positive calf squeeze (Simmonds) test