Adult foot and ankle disorders

Question 1

What does a larger calcaneous allow us to do

Answer 1

Propel ourselves away

Question 2

what are the anatomical structures in the lateral and hindfoot

Answer 2

distal fibula and fibula shaft
ankle lateral gutter and syndesmosis
lateral wall calcaneous 
perpnei
CFL and ATFL
sural nerve

Question 3

What is the most commonly sprained ligament in the ankle

Answer 3

AFTL

Question 4

What anatomical structures are in the medial and hindfoot

Answer 4

Medial malleolus 
Anteriomedial tibiotalar joint 
Deltoid ligament 
PTT (tom), FDL (dick), FHL (harry)
Posterior tibial artery

Question 5

What anatomical structures are found in the posterior ankle and hindfoot

Answer 5

Achilles tendon
Calcaneal insertion
Retrocalcaneal space 
Peroneal tendons 
FHL
EDL 
Saphenous Nerve

Question 6

What anatomical structures are located in the plantar topography

Answer 6

2nd MT Base 
5th MT Base 
Tibialis P. Insertion
Master knot of Henry 
Cuboid tunnel

Question 7

How exposed should a patient be when examining the foot and ankle

Answer 7

Bare to the knee

Question 8

What is Pes Planus more commonly known as

Answer 8

Flat Feet

Question 9

Describe the Jack’s test

Answer 9

Push the child’s big toe up. If a nice arch is formed, the test is positive

Question 10

What is the most common cause of acquired flatfoot deformity in adults

Answer 10

Tibialis Posterior Dysfunction

Question 11

How do you test for Tibialis Posterior Dysfunction

Answer 11

Get the patient to go up on their tiptoes

Question 12

Where does the tibialis posterior lie

Answer 12

Immediately posterior to the medial malleolus attaching on the navicular tuberosity and plantar aspect of medial and middle cuneiforms

Question 13

What is the main function of tibialis posterior

Answer 13

To elevate the arch

Question 14

What group of patients are a higher risk of developing tubialis posterior

Answer 14

Obese middle aged females

Increases with age

Question 15

What is the common presentation of tibias posterior dysfunction

Answer 15

Pain and / or swelling posterior to medial malleolus

They may notice the foot has begun to change shape

Question 16

What are some of the treatment options for TPD

Answer 16

Physiotherapy
Insole to support the arch
NO STEROID INJECTIONS
surgery

Question 17

What is Pes Cavus more commonly known as

Answer 17

High arches

Question 18

What is the common cause for Pes Cavus

Answer 18

Idiopathic

Question 19

What is the best treatment for Pes Cavus

Answer 19

Surgery

Question 20

What type of injuries are common in Pes Cavus

Answer 20

Ankle sprains

Question 21

Describe the pain caused by plantar fasciitis

Answer 21

Pain after rest
Can be worse after exercise
Tenderness over the plantar aspect of heel
EXTREMELY PAINFUL

Question 22

Plantar fasciitis has what test positive and what is this test for

Answer 22

Tinel’s test for Baxter’s nerve

Question 23

What are some of the causes of plantar fasciitis

Answer 23

Physical overload 
excessive exercise or weight 
Seronegative arthropahy
Diabetes 
Abnormal foot shape 
Improper foot wear

Question 24

What is the treatment for plantar fasciitis

Answer 24

NSAIDS
Night splints
Taping/ resting
Usually self management

Question 25

Describe Hallux Valgus

Answer 25

The great toe points laterally and has subsequent effects of the rest of the forefoot

Question 26

Describe the incidence of Hallux Valgus

Answer 26

Increases with age Usually bilateral Females more than males Adolescent subgroup

Question 27

Describe the aetiology of Hallux Valgus

Answer 27

``` Some familial Shoes General joint laxity Rheumatoid Splayed forefoot associated with loss of muscle tone and age ```

Question 28

What are the non-operative options for Hallux Valgus

Answer 28

shoe modification and padding

Question 29

What is the aim in operating on Hallux Valgus

Answer 29

Aim to realign the hallux and decreased the HV angle | Correct any lesser toe deformities at same time

Question 30

Describe the operation for Hallux Valgus

Answer 30

Break the bone and move the head laterally

Question 31

What is Morton's neuroma

Answer 31

Degenerative fibrosis of digital nerve near its bifurcation

Question 32

Describe the presenting complaint from a patient with Morton's neuroma

Answer 32

Burning and tingling in the toes

Question 33

What is tendinosis

Answer 33

A tendonopathy

Question 34

What is the management of Tendo-Achilles Tendinosis

Answer 34

``` Activity modifications/ analgesia NSAIDs Shockwave therapy Orthotics Physio Surgery ```

Question 35

What age group are at a higher risk of Tendo-Achilles Rupture

Answer 35

Usually over 40s

Question 36

Describe the clinical presentation of Tendo-Achilles Rupture

Answer 36

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

Question 37

Describe how the Simmonds test is performed

Answer 37

The patient kneels on a chair and you squeeze their calf. If the foot does not move this is a positive Simmonds test

Question 38

What is the management for Tendo-Achilles Rupture

Answer 38

Operative Non operative Both involve an extended recovery/ cast time Functional outcome normally good

Question 39

What are the 4 different type of deformed toes that you can get

Answer 39

Hammer Claw Curly Mallet

Question 40

In all 4 toe deformities, what is the underlying problem

Answer 40

Slight hyperextension of PTJ

Question 41

What are the common presentations of ankle sprains

Answer 41

Pain, bruising and tenderness

Question 42

What is the management for a sprained ankle

Answer 42

``` Analgesia Rest Ice Compression Elevation ```

Question 43

What does the Weber Classification show

Answer 43

The location of the fracture

Question 44

What is the problem with the Weber Classification

Answer 44

It does not take the Malleolus into account

Question 45

When do we operate on a Pilon Fracture

Answer 45

Rarely straight away - usually wait 1 week