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MSK > Hindfoot Problems > Flashcards

Hindfoot Problems Flashcards

1
Q

5 types of hindfoot problems

A
  • Achilles tendonitis/tendinosis
  • Plantar fasciitis
  • Ankle osteoarthritis
  • Tibialis posterior dysfunction
  • Cavovarus foot
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2
Q

What is Achilles tendonitis/tendinosis

A

Degenerative/overuse condition with little inflammation

  • Tendonitis should be avoided
  • Tendinosis histopathological
  • Tendinopathy term to describe symptoms
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3
Q

4 types of Achilles tendinopathy

A
  • Insertional tendinopathy
  • Non-insertional tendinopathy
  • Bursitis
  • Paratendinopathy
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4
Q

Define insertional and non-insertional tendinopathy

A
  • Insertional = Within 2cm of insertion

- Non-insertion = 2-7cm of insertion

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5
Q

2 types of bursitis related to Achilles tendinopathy

A
  • Retrocalcaneal

- Superficial calcaneal

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6
Q

Define paratendinopathy

A

True inflammatory problem showing paratendonitis histologically

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7
Q

Aetiology of paratendinopathy

A
  • Commonest is athletic populations
  • Age group 30-40
  • Male:Female = 2:1
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8
Q

Aetiology of tendinopathy

A
  • Commonest in non-athletic population
  • Aged over 40
  • Obesity
  • Steroids
  • Diabetes
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9
Q

Symptom of Achilles tendinopathy

A
  • Pain during/following exercise
  • Recurrent episodes
  • Difficulty in fitting shoes
  • RUPTURE (don’t miss!)
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10
Q

How to diagnose Achilles tendinopathy

A
  • Clinical (tenderness, test for rupture)
  • US
  • MRI
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11
Q

How to test for rupture of Achilles tendon

A
  • Gently squeeze calf (soleus muscle)
  • If the squeeze makes the foot move then the Achilles is not fully ruptured
  • If no movement after squeeze then there is a complete rupture of the tendon

(Angle of the dangle + Matles)

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12
Q

Non-surgical Rx of Achilles tendinopathy

A
  • Activity modification/shoe with a slight heel
  • Physiotherapy (eccentric stretching)
  • Weight loss
  • Extra-corporeal shockwave treatment
  • Immobilisation (below knee cast)
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13
Q

Surgical Rx of Achilles tendinopathy

A
  • Gastrocnemius resection

- Release + debridement of tendon

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14
Q

Aetiology of plantar fasciitis

A
  • Unknown
  • Associated with high intensity or rapid increase in training
  • Running in poorly padded shoes or hard surfaces
  • Obesity
  • Occupations involving prolonged standing
  • Tight gastrocnemius muscle
  • Foot/lower limb rotational deformities
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15
Q

Symptoms of plantar fasciitis

A
  • Pain 1st thing in the morning
  • Pain on weight bearing after rest (post-static dyskinesia
  • Pain located at origin of fascia
  • Frequently long lasting (2 or more years)
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16
Q

DDx for plantar fasciitis

A
  • Nerve entrapment syndrome
  • Arthritis
  • Calcaneal pathology
17
Q

How to diagnose plantar fasciitis

A
  • Mainly clinical

- Occasionally X-ray, US and MRI

18
Q

Non-pharmacological Rx for plantar fasciitis

A
  • Rest/change training, ice
  • Orthoses
  • Physiotherapy
  • Weight loss
  • Night splinting
  • Stretching
  • Endoscopic/open surgery
19
Q

Pharmacological Rx for plantar fasciitis

A
  • NSAIDs
  • Corticosteroid injection (good short term but long term may make condition worse)
  • Nitric oxide
  • Extracorporeal shockwave therapy
  • Platelet rich plasma
  • Topaz plasma coblation
20
Q

Aetiology of ankle arthritis

A
  • 46 is the mean age of presentation
  • Commonly post-traumatic
  • Idiopathic
21
Q

Symptoms of ankle arthritis

A
  • Pain

- Stiffness

22
Q

How to diagnose ankle arthritis

A
  • Clinical
  • Radiographs
  • CT (exclude adjacent joint arthritis)
23
Q

Non-surgical Rx for ankle arthritis

A
  • Weight loss, activity modification
  • Physiotherapy
  • Analgesia
  • IA Steroids
24
Q

Surgical Rx for ankle arthritis

A
  • Arthrodesis, open/closed (Gold standard + good long term outcome)
  • Joint replacement
25
Q

Pros + cons of joint replacement in ankle arthritis

A

Pros
-Maintains ROM

Cons

  • Questionable long-term outcome, especially in high demand patients
  • Not easy to revise even to fusion
26
Q

How to diagnose tibialis posterior tendon dysfunction

A
  • Clinical

- MRI to assess tendon

27
Q

Rx of tibialis posterior tendon dysfunction

A
  • Orthotic (medial arch support)
  • Reconstruction of tendon (tendon transfer)
  • Triple fusion (subtalar, talonavicular and calcaneocuboid)
28
Q

Aetiology of diabetic foot ulcer

A
  • Diabetic neuropathy, patient unaware of trauma
  • Diabetic autonomic neuropathy (lack of sweating, dry/cracked skin, skin more sensitive to trauma)
  • Poor vascular supply
  • Lack of patient education
29
Q

Non-surgical Rx for diabetic foot ulcer

A

Prevention

  • Smoking
  • Diabetic control
  • Vascular supply
  • External pressure (shoes/splints)
  • Internal pressure (deformity)
30
Q

Surgical Rx for diabetic foot ulcer

A
  • Debride ulcers + get deep samples for microbiology
  • Correct any deformities to reduce pressure
  • Improve vascular supply
  • Amputation
31
Q

Prognosis of diabetic foot ulcer

A
  • 25% get amputation

- 5 year mortality is 50%

32
Q

Aetiology of Charcot neuroarthropathy

A
  • Any cause of neuropathy

- Diabetes is commonest cause

33
Q

Pathophysiology of Charcot neuroarthropathy

A

Neurotraumatic
-Lack of proprioception + protective pain sensation

Neurovascular
-Abnormal autonomic nervous system results in increase vascular supply + bone resorption

34
Q

Charcot neuroarthropathy is characterised by rapid bone destruction occurring in 3 stages.
What are those stages

A
  • Fragmentation
  • Coalescence
  • Remodelling
35
Q

How to diagnose Charcot neuroarthropathy

A
  • High index of suspicion
  • Consider any diabetic with a swollen foot (esp. w/ neuropathy)
  • Radiographs
  • MRI
36
Q

Symptoms of Charcot neuroarthropathy

A

Often painless

37
Q

Rx for Charcot neuroarthropathy

A

-Immobilise/non-weight bearing until acute fragmentation resolves
-Correct deformity
(deformity leads to ulceration=>infection=>amputation)

MSK (28 decks)

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