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MSK > Adult Foot and Ankle Disorders > Flashcards

Adult Foot and Ankle Disorders Flashcards

1
Q

how has the big toe changed over time and why?

A

has become bigger and more vertical to allow weight bearing and ability to push off

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2
Q

where are the peroneal tendons and what do they do?

A

lateral foot
support the ankle (often affected by a sprain)
everts the foot

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3
Q

what are the most commonly affected structures in an ankle sprain?

A

CFL and ATFL

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4
Q

what is the acronym for the structures of the medial hindfoot?

A

Tom Dick and Harry

tp fdl fhl

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5
Q

what are the features of the medial and hindfoot?

A 
medial malleolus
anteromedial tibiotalar joint
deltoid ligament
PTT, FDL, FHL
posterior tibial artery
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6
Q

what are the features of the lateral and hindfoot?

A

…

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7
Q

what are the features of the posterior ankle and hindfoot?

A 
achilles tendon
calcaneal insertion
retrocalcaneal space
peroneal tendons
FHL
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8
Q

what are the features of the anterior ankle?

A 
anterior ankle joint
superficial peroneal nerve
EHL
EDL
saphenous nerve
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9
Q

what are the 5 nerves of the foot?

A 
saphenous
superficial peroneal/fibular
deep peroneal/fibular
tibial (branches into 2)
sural nerve
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10
Q

what are the features of the plantar surface of the foot?

A 
heel pad
5th metatarsal base
plantar fascia
metatarsal heads
Tib posterior insertion
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11
Q

what are the 3 rockers of gait?

A 
1st = heel strike to flat foot
2nd = mid stance
3rd = heel rise
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12
Q

what is Thompson/simmons test and what doe sit show?

A

gentle squeeze on calf muscles should produce a slight movement of the toes
indicates achilles tendon rupture if no movement occurs

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13
Q

when does the arch in the foot normally appear?

A

6-7 years

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14
Q

is flat feet always abnormal?

A

no

usually normal unless asymmetrical

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15
Q

what does tibialis posterior dysfunction cause?

A

most common cause of acquired flatfoot syndrome in adults

can be present for years before diagnosis

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16
Q

what is the presenting symptom in tibialis posterior dysfunction?

A

cant push off properly when walking, can be difficult and painful (esp. on uneven ground)
usually in elderly
pain +/- swelling posterior to medial malleolus (very specific)
change in foot shape
noticeable hallux valgus
lateral wall impingement pain
midfoot and ankle pain

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17
Q

what is the course of tibialis posterior?

A

..

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18
Q

what are the risk factors for tibialis posterior dysfunction?

A 
obese middle aged female
age
flat foot
hypertension
diabetes
steroid injection
seronegative arthropathies
idiopathic tendonitis
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19
Q

how is TPD treated?

A 
physio often enough if caught early with insole to support medial longitudinal arch
steroid injections?
orthoses to accommodate foot shape
bespoke footwear
surgery
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20
Q

what is pes cavus?

A

high arch??

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21
Q

what causes pes cavus?

A

mostly idiopathic

can be neurological (HSMN, CP, Polio, spina bifida, club foot)

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22
Q

what can pes cavus affect?

A

can cause clawing of toes

23
Q

how is pes cavus treated?

A

surgery if complex

24
Q

what are the symptoms of plantar fasciitis?

A

start up pain after rest

can be worse after exercise

25
Q

…..

A

…..

26
Q

what causes plantar fasciitis?

A 
physical overload (exercise, weight etc)
seronegative arthropathy
diabetes
abnormal foot shape
improper foot shape
27
Q

how is plantar fasciitis treated?

A 
NSAIDs
night splints
taping
heel cups/arch supports
physiotherapy
steroid injections
ECSWL
surgery rarely
usually self limiting
28
Q

what is a bunion?

A

deformity at first MTP joint

AKA hallux valgus

29
Q

what are the risk factors for bunions?

A 
age
female
some are familial
shoes
general joint laxity
rheumatoid
splayed forefoot
30
Q

what causes pain in bunions?

A

medial nerve
from bursur
intrinsic pain in the joint (wear and tear as its not functioning properly)
big toe becomes non function so you load through the other 4 toes

31
Q

how is hallux valgus treated?

A

non-surgical - shoes, padding etc

surgical - not always a great outcome

32
Q

what problems can occur with hallux valgus?

A

transfer metatarsalgia
lesser toe impingement
pain, deformity, cosmesis
shoe difficulties

33
Q

how is hallux valgus surgery performed?

A

scarf/akin procedure

break the bone and move the head laterally

34
Q

what is hallux rigidus?

A

OA of the first MTP joint (big toe)

35
Q

what causes hallux rigidus?

A

general wear and tear

36
Q

how is hallux rigidus managed?

A

usually settles a bit with time
non-operative - footwear, support etc
operative - joint replacement and fusion of the joint

37
Q

how does rheumatoid arthritis affect the foot?

A

90% of cases affect the feet
occurs early in disease
usually affects the forefoot
can deform the toes

38
Q

describe the pathogenesis of rheumatoid foot?

A

synovitis > proteinases and collagenases > impaired integrity of joint capsules/ligaments > destruction of hyaline cartilage

39
Q

what is charcots foot?

A

weakening of the bones in the foot in people with neuropathy (mainly diabetic)

40
Q

how is charcots foot managed?

A

mainly conservative

surgery in some cases if conservative measures fail?

41
Q

what can happen in charcots foot?

A

worsening deformity, ulceration, osteomyelitis

midfoot instability

42
Q

what must be considered in charcots foot surgery?

A

optimise co-morbidities (diet etc)
soft tissue envelope from previous surgery
location of the deformity
timing
presence of infection or osteomyelitis (don’t operate if present)

43
Q

what type of surgery is done in charcots foot?

A

fixation surgery
primary internal, primary external or combination of both
or staged reconstruction

44
Q

when is external fixation used?

A

high risk patients with poor soft tissue envolope

45
Q

what are the issues with external fixation?

A

metal scaffold is unpleasant and difficult for the patient
exposed to shear not axial forces
can injure other leg during sleep etc

46
Q

what is mortons neuroma?

A

degenerative fibrosis of digital nerve near its bifurcation (between 3rd and 4th does)

47
Q

what are the features of mortons neuroma?

A 
forefoot pain (metatarsalgia)
burning and tingling in the toes
48
Q

who does mortons neuroma usually occur in?

A

middle aged females

49
Q

how is mortons neuroma diagnosed?

A

examination - painful when squeezed

US

50
Q

how is mortons neuroma managed?

A

non-surgical (insoles, injections)

surgical - excision

51
Q

what is tendo-achilles tendinosis?

A

repetitive microtrauma, failure of collagen with loss of fibre alignment/structure
commonly causes by over training (running)

52
Q

what are the features of tendo-achilles-tendinosis?

A

pain
morning stiffness
eases with heat and walking

53
Q

how is tendo-achilles tendinosis treated?

A

…

MSK (66 decks)

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