MSK - Foot And Ankle Conditions

Question 1

What does ‘valgus’ mean?

Answer 1

Deviation of the distal limb away from the midline

Question 2

What does ‘varus’ mean?

Answer 2

Deviation of the distal limb towards the midline

Question 3

What is hallux valgus?

Answer 3

Deviation of the toe away from the midline leading to a protruding bump at the base of the toe (a ‘bunion’)

Question 4

Which group of patients most often gets hallux valgus?

Answer 4

Middle aged females

Question 5

What are the treatments fro hallux valgus?

Answer 5

Primary - change shoes, as shoes are often the cause of this problem
Secondary - metatarsal osteotomy (surgical realignment of the big toe bone)

Question 6

What is hallux rigidus?

Answer 6

Arthritis of the big toe joint, presents with pain in MTPJ and a lump over the joint

Question 7

What are the X-ray signs of arthritis in big toe?

Answer 7

• loss of joint space
• osteophytes
• cysts
• subchondral sclerosis

Question 8

Give some conservative treatments of arthritis in ankles

Answer 8

• braces
• shoe modifications
• painkillers
• activity modifications
• walking stick

Question 9

What is ankle arthrodesis?

Answer 9

Fusing the ankle joint with pins to treat arthritis. Patients are able to walk extremely well, although they are unable to point their foot completely.

Question 10

Which group of patients is most likely to suffer from an Achilles tendon rupture?

Answer 10

Typically people who are 30-50 who engage in sports

Question 11

How can a ruptured Achilles tendon be tested for?

Answer 11

Thompson’s/Simmond’s test:

Patient should have knee bent and rested on the side of the bed/chair. Grab the calf and squeeze it whilst pulling up. If the tendon is ruptured, the foot will not move. If undamaged, foot will move in direction of pull.

Question 12

What is planovalgus?

Answer 12

Flat feet (no arch). Mostly affects middle aged women

Question 13

Why are diabetics more at risk of foot injury?

Answer 13

They often have loss of sensation, so they may not realise that they have injured it

Question 14

What is Charcot arthropathy?

Answer 14

Progressive degeneration of a weight bearing joint, involving loss of bone stock, soft bone due to inflammation and a lack of pain. Leads to massive deformity and bone loss.

Question 15

Why are some diabetic patients often considered hard to treat?

Answer 15

• obese
• may have cognitive problems ‘candy brain’
• immunocompromised
• self neglect

Question 16

What is Talar shift?

Answer 16

Occurs when talus is not anatomically placed underneath the tibia. This occurs if either the medial malleolus is fractured or the deltoid ligament is ruptured. Most commonly talar shift refers to lateralisation of the talus under the tibia.

Question 17

What is a ‘claw toe’?

Answer 17

A toe that is contracted at the PIP and DIP joints due to tightened ligaments/tendons. Can affect 2nd, 3rd, 4th or 5th toes.

Question 18

What is a ‘hammer toe’?

Answer 18

A deformity of the proximal interphalangeal joint of the 2nd, 3rd or 4th toe causing it to be permanently bent, usually a result of poorly fitting shoes.

Question 19

What are the four ways in which our anatomy strengthens the foot?

Answer 19

1) shape of bones - they fit together like the keystone in an arch
2) inferior edges are held together with ligaments
3) ends of arch are held together with ligaments
4) arch is suspended from above by muscles