Adult Foot and Ankle Disorders

Question 1

What is the test to see how tight the gastrocneumius is?

Answer 1

Silverskiolds- dorsiflfexion with a straight leg and then with knee bent

Question 2

What is the common name for pes planus?

Answer 2

flat feet

Question 3

How can you tell flexible flat feet from inflexible?

Answer 3

flexible flat feet form an arch when the patient tip-toes

Question 4

What is the most common cause of acquired flat feet in adults?

Answer 4

tibialis posterior dysfunction

Question 5

What is the course of the tibialis posterior?

Answer 5

courses immediately posterior to medial malleolus and attaches on to the plantar aspect of medial and middle cuneiforms and navicular

Question 6

What are the functions of tibialis posterior?

Answer 6

invertor; plantar-flexor; stabilises the medial longitudinal arch- elevates arch

Question 7

Who is tibialis posterior dyfunction typically seen in ?

Answer 7

obese middle aged females (increases with age)

Question 8

What are the conditions associated with tibialis posterior dysfunction?

Answer 8

hypertension; diabetes; seronegative arthropathies; tendinosis

Question 9

What are the symtpons of tibialis posterior dysfunction?

Answer 9

pain and/or swelling posterior to medial malleolus; change in foot shape; diminshed walk ability/blanace and dislike of uneven surfaces; more noticeable hallux valgus; lateral wall “impingement” pain

Question 10

What are the treatment options of tibialis posterior dysfunction?

Answer 10

PT; insoles to support medial longitudinal arch

Question 11

What is pes cavus?

Answer 11

high arched feet

Question 12

What are the causes of pes cavus?

Answer 12

mainly idiopathic but neurological- CP; polio; spina bifida

Question 13

How does plantar fasciitis present?

Answer 13

start-up pain after rest:usually when wake-up; fullness or swelling and tenderness plantarmedial aspect of heel; sharp stabbing pain

Question 14

What causes plantar fasciitis?

Answer 14

physical overload; seronegatvie arthropathy; diabetes; abonrmal foot shape; improper footwear

Question 15

What are the treatments for plantar fasciitis?

Answer 15

NSAIDs; PT; heel cups or medial arch supports

Question 16

What is the prognosis for plantar fasciitis?

Answer 16

usually self-limiting over 18-24 months

Question 17

Why can hallux valgus be caused by flat feet?

Answer 17

if feet are always falling inwards, hallux tries to ocmpensate

Question 18

Who gets hallux valgus?

Answer 18

increases ewith age; usually bilateral; females 3x more than males

Question 19

What can cause hallux vlagus?

Answer 19

familial; shoes; general joint laxity; RA

Question 20

What are the problems associated with hallux valgus?

Answer 20

transfer metersalgia;lesser toe impingement; pin; deformity; shoe difficulties

Question 21

What is transfer metatarsalgia?

Answer 21

2nd toe has to take over main weight bearing and this causes pain

Question 22

What is the management for hallux valgus?

Answer 22

shoe modificatiosn, padding etc; operative-osteotomy

Question 23

What is hallux rigidus?

Answer 23

OA of 1st MTPJ

Question 24

What are the operative options for hallux rigidus?

Answer 24

joint replacement and fusion

Question 25

What is the pathogenesis of rheumatoid foot?

Answer 25

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

Question 26

What is morton's neuroma?

Answer 26

degenerative fibrosis of digital nerve near its bifurcation

Question 27

What are the symptoms of mortons neuroma?

Answer 27

forefoot pain (metatarsalgia); burning and tingling in toes

Question 28

Who gets mortons neuroma/

Answer 28

45-50 years; F>M

Question 29

What occurs with tendo-achilles tendinosis?

Answer 29

repetitive microtrauma, failure of collagen repair with loss of fibre alignment/structure

Question 30

What are the symptoms of achilles tendinosis?

Answer 30

pain; morning stiffness, eases with heat/ walking

Question 31

What are implicated as causes for achilles tendinosis?

Answer 31

over-training, some drugs- ciprofloxacin, steroids;

Question 32

What are the treatment options for achilles tendinosis?

Answer 32

activity modifications/analgesia/ NSAIDs; shockwave therapy; orthotics; PT; surgery

Question 33

What is seen on presentation of an achilles rupture?

Answer 33

sudden decelration with resisted calf contraction; unable to weight bear; weak plantar flexion; palpable painful gap; positive calf squeeze- if foot fails to flex (simmonsds test)

Question 34

Who gets an achilles rupture?

Answer 34

usually over 40s; pre-existing tendinosis

Question 35

What causes claw, hammer and mallet toes?

Answer 35

an acquired imbalance between flexors and extensores

Question 36

What happens with claw toes?

Answer 36

hyperextension; flexion; flexion

Question 37

What happens with mallet toe?

Answer 37

flexion only at DIP

Question 38

What happens with hammer toe?

Answer 38

hyperextension; flexion; normal

Question 39

What is the management for claw, hammer and mallet toes?

Answer 39

surgery- tenonotomes tendon transger; fusion

Question 40

What type of trauma causes an ankle sprain?

Answer 40

twisting forces- commonly inversion or twisting forces on a planted foot

Question 41

What is the presentation of an ankle sprain?

Answer 41

pain; bruising and tenderness

Question 42

What happens with an ankle sprain?

Answer 42

the elastic limit of ligaments is reached which causes a tear

Question 43

What is the management for ankle sprains?

Answer 43

RICE- rest; ice; compression and elevation; PT

Question 44

What are the classifications for ankle fractures?

Answer 44

Webers- A- below syndesmoses B- around syndesmoses C- above the syndesmoses

Question 45

What is significant about Weber class C fractures?

Answer 45

unstable until proven otehrwise

Question 46

What is a stable ankle fracture?

Answer 46

a distal fibula fracture with no medial malleolus fracture or deltoid ligament rupture

Question 47

What causes an ankle fracture to be unstable?

Answer 47

medial malleolus fracture or deltoid ligament rupture, talar shift

Question 48

What is a Pilon fracture?

Answer 48

A fracture involving the distal end of the tibia at its articulation at the ankle joint

Question 49

What usually causes a 5th metatarsal fracture?

Answer 49

an inversion injury

Question 50

What is a Lisfranc fracture?

Answer 50

an injury where one or more of the metatarsals are dislocated from the tarsal bones

Question 51

What often causes a calcaneus fracture?

Answer 51

landing on heal when falling from a height

Question 52

What is it important to do with a calcaneus fracture?

Answer 52

check for other injuries