Adult Foot and Ankle

Question 1

what region of the foot does the meidal malleolus lie in?

Answer 1

medial hindfoot

Question 2

what region of the foot does the deltoid ligament lie in?

Answer 2

medial hindfoot

Question 3

what region of the foot does the sural nerve lie in?

Answer 3

lateral hindfoot

Question 4

another name for flat feet?

Answer 4

pes planus

Question 5

most common cause of acquired flat foot deformity in adults?

Answer 5

tibialis posterior dysfunction

Question 6

what does the tibialis posterior muscle run behind in the foot?

Answer 6

medial malleolus

Question 7

where does the tibialis posterior insert

Answer 7

navicular tuberosity

plantar aspect of medial and middle cuneiforms

Question 8

what does the tibialis posterior do

Answer 8

stabilises medial longitudinal arch
inversion
plantarflexion

Question 9

who tends to get tibialis posterior dysfunction?

Answer 9

obese middle aged women

Question 10

causes of tibialis posterior dysfunction?

Answer 10

hypertension
diabetes
steroid injection
seronegative arthropathies
idiopathic tendonosis

Question 11

clinical presentation of tibialis posterior dysfunction?

Answer 11

pain +/- swelling posterior to medial malleolus with:
change in foot shape
struggling to walk
noticeable hallux valgus
midfoot/ankle pain

Question 12

what would you see on examination of someone with type 1 TPD?

Answer 12

swelling
tenderness
slightly weak muscle power

Question 13

what would you see on examination of someone with type 2 TPD?

Answer 13

planovalgus

midfoot abduction

Question 14

treatment for TPD?

Answer 14

physiotherapy
NO steroids
orthoses
surgery

Question 15

commonest cause of pes cavus?

Answer 15

idiopathic

Question 16

other causes of pes cavus?

Answer 16

HSMN
CP
polio
spina bifida
club foot

Question 17

clinical presentation of pes cavus?

Answer 17

high arched foot with clawed toes

Question 18

clinical presentation of plantar fasciitis?

Answer 18

pain after rest that is exacerbated by exercise
swelling on plantarmedial aspect of heel
positive tinel’s test for baxter’s nerve

Question 19

causes of plantar fasciitis

Answer 19

physical overload eg exercise, obesity
seronegative arthritis
diabetes
planovalgus/cavovalgus

Question 20

treatment for plantar fasciitis?

Answer 20

NSAIDs
night splints
taping
physio
steroid injection

Question 21

does hallux valgus commonly present bilaterally or unilaterally?

Answer 21

bilaterally

Question 22

is hallux valgus more common in men or women?

Answer 22

women

Question 23

causes of hallux valgus?

Answer 23

familial
shoes
joint laxity
connective tissue disease
rheumatoid

Question 24

treatment for hallux valgus?

Answer 24

shoe modifications (non-op)
operative

Question 25

when would you consider surgery in someone with hallux valgus?

Answer 25

``` failure of other treatment pain lesser toe deformities lifestyle limititation overlapping ulceration ```

Question 26

how is the surgery for hallux valgus done?

Answer 26

osteotomy to break the bone and then move the head laterally

Question 27

what is hallux rigidus?

Answer 27

OA of 1st MTPJ

Question 28

surgical management of hallux rigidus?

Answer 28

joint replacement | fusion

Question 29

what causes rheumatoid foot?

Answer 29

synovitis increases proteinases and collagenases which impairs integrity of joint capsules and ligaments by destructing hyaline cartilage

Question 30

systemic effects of rheumatoid foot?

Answer 30

``` vasculitis ischaemia ulceration neuropathy immunosuppression anaemia ```

Question 31

why do you get flat feet in rheumatoid foot?

Answer 31

unstable subtalar joint causes the calcaneus to become valgus, this causes medial arch to collapse

Question 32

what is morton's neuroma?

Answer 32

degenerative fibrosis of digital nerve near it's bifurcation

Question 33

clinical presentation of mortons neuroma?

Answer 33

forefoot pain | burning and tingling in toes in middle aged people

Question 34

non surgical treatment of mortons neuroma?

Answer 34

insoles | injections

Question 35

surgical treatment of mortons neuroma?

Answer 35

excise

Question 36

how is mortons neuroma diagnosed?

Answer 36

USS | XR

Question 37

what happens when you excise the digital nerve?

Answer 37

no sensation in between toes

Question 38

what happens in achilles tendinosis?

Answer 38

repetitive microtrauma causes failure of collagen repair

Question 39

what drugs predispose you to achilles tendinosis?

Answer 39

ciprofloxacin | steroids

Question 40

clinical presentation of achilles tendinosis?

Answer 40

pain, morning stiffness, eases with heat/walking

Question 41

investigations for achilles tendinosis?

Answer 41

USS | MRI

Question 42

management for achilles tendinosis?

Answer 42

``` analgesia NSAIDs NO steroids orthotics physio maybe surgery ```

Question 43

what is the minimum age that you tend to see a tendo-achilles rupture in?

Answer 43

40

Question 44

most common cause of a tendo-achilles rupture?

Answer 44

pre-existing tendinosis | sudden deceleration with resisted calf contraction

Question 45

clinical presentation of a tendo-achilles rupture?

Answer 45

``` unable to bear weight weak plantar flexion palpable painful gap +ve simmond's test think someone has hit them ```

Question 46

what is simmond's test?

Answer 46

test for achilles tendonitis by squeezing calf

Question 47

name the types of surgery conducted on claw, hammer and mallet toes?

Answer 47

tenotomy tendon transfer fusion amputation

Question 48

most common movement causing an ankle sprain?

Answer 48

inversion on a planted foot

Question 49

does an ankle sprain or fracture take longer to heal?

Answer 49

sprain

Question 50

what ligaments are commonly affected in ankle sprain?

Answer 50

``` anterior talofibular (ATFL) calcaneofibular (CFL) lateral ligaments ```

Question 51

non-operative management for ankle sprain?

Answer 51

RICE | physio

Question 52

operative management for ankle sprain?

Answer 52

brostrum gould | chrisman snook

Question 53

when is an ankle fracture classed as unstable?

Answer 53

if it includes a medial malleolus fracture or deltoid ligament fracture

Question 54

treatment for an unstable fracture?

Answer 54

surgery

Question 55

treatment for a stable fracture?

Answer 55

cast and boot

Question 56

where does a pilon fracture happen?

Answer 56

distal tibia

Question 57

most common cause of a pilon fracture?

Answer 57

high energy fall/crash

Question 58

most common injury to the 5th metatarsal?

Answer 58

inversion