Ankle and foot conditions

Question 1

What is achilles tendinitis?

Answer 1

Inflammation of the achilles tendon

Question 2

What causes achilles tendinitis?

Answer 2

Small tears in collagen fibres in tendon

Question 3

What factors contribute to achilles tendinitis?

Answer 3

Sudden increase in activity e.g. running

Poor footwear

Question 4

What are the symptoms of achilles tendinitis?

Answer 4

Pain when walking

Question 5

What causes achilles tendon rupture?

Answer 5

Forceful plantarflexion

Question 6

What factors predispose to achilles tendon rupture?

Answer 6

Achilles tendinitis

Question 7

What is felt immediately after achilles tendon rupture?

Answer 7

Calf pain

Sudden dorsiflexion, passive

Question 8

Why does a lump appear in the calf with achilles tendon rupture?

Answer 8

Due to shortening of the
medial and lateral heads of gastrocnemius
soleus

Question 9

How do you test for achilles tendon rupture?

Answer 9

Gap in achilles tendon is visible and palpable in posterior distal leg

Individuals cannot plantarflex against resistance

Thompson’s test

Question 10

What is the Thompson’s test?

Answer 10

Patient kneeling on chair - knee is flexed 90degrees
Squeeze calf
Foot should plantar flex

Question 11

How are the results of Thompson’s test interpreted?

Answer 11

If foot doesn’t plantarflex

means achilles tendon is ruptured

Question 12

How is achilles tendon rupture treated?

Answer 12

Non-surgical repairs for most people

Surgical repairs for very active people e.g. athletes

Question 13

Clawed toes tend to involve which toes of the foot?

Answer 13

Lateral four toes

Question 14

What are the joints like with clawed toes?

Answer 14

Hyperextension at MTP joints

Flexion of DIP joints

Question 15

What is the dorsal surface of the toes like with clawed toes? Why?

Answer 15

Callosities on dorsal surface

due to pressure from shoes

Question 16

What is the plantar surface of the toes like with clawed toes? Why?

Answer 16

Callosities on metatarsal heads
and tip toes
because are having to bear more weight

Question 17

What are the joints like with hammered toes?

Answer 17

Hyperextension at MTP
Flexion at PIP joints
Hyperextension at DIP joints

Question 18

What causes the formation of hammer toes?

Answer 18

Weakness of lumbricals and interosseus muscles
which normally flex MTP joints
and extend IP joints
(don’t panic it’s the same as the hand)

Question 19

What is the dorsal surface like with hammered toes?

Answer 19

Callosities on dorsal surface

due to pressure from shoes

Question 20

What are the types of flatfoot?

Answer 20

Flexible

Rigid

Question 21

What is flexible flatfoot?

Answer 21

Lack of medial arch of foot

but only when weight bearing

Question 22

When is flexible flatfoot normal?

Answer 22

In children

Question 23

Why is flexible flatfoot normal in children?

Answer 23

Thick subcutaneous fat in sole of foot

Ligaments of foot are not completely developed yet

Question 24

What causes flexible flatfoot in adults?

Answer 24

Weakened ligaments of foot

Question 25

What is rigid flatfoot?

Answer 25

Lack of medial arch of foot all the time

Question 26

What causes rigid flatfoot?

Answer 26

Bone deformity Dysfunction of tibialis posterior muscle - supports arch usually

Question 27

What are the symptoms and signs of rigid flatfoot?

Answer 27

Pain behind medial malleolus, due to damage to tibialis posterior muscle Heel protrudes laterally when walking

Question 28

Is flatfoot more common in males or females?

Answer 28

Females

Question 29

What causes ankle sprain?

Answer 29

Partial or complete tear in ligaments of ankle joint

Question 30

What is the mechanism of an ankle sprain?

Answer 30

Foot is plantarflexed Weight bearing Then is excessively inverted

Question 31

Which ligaments of the ankle joint are most commonly damaged?

Answer 31

Lateral ligament - anterior talofibular - posterior talofibular - calcaneofibular

Question 32

Why are the lateral ligaments most commonly damaged?

Answer 32

Resist excessive inversion, so become damaged by it Weaker than medial ligaments

Question 33

Which lateral ligament is at most risk of irreversible damage in an ankle sprain?

Answer 33

Anterior talofibular ligament

Question 34

What is the mechanism of a 5th metatarsal fracture?

Answer 34

Sudden excessive inversion of foot | fibularis brevis muscle avulses base of metatarsal 5

Question 35

5th metatarsal fractures often occurs alongside with...? | Why?

Answer 35

Ankle sprains | Because they both involve excessive inversion

Question 36

What is a Pott's fracture-dislocation of the ankle joint?

Answer 36

Fracture of medial malleolus lateral malloelus and in some cases distal tibia too

Question 37

What is the mechanism of a Pott's fracture dislocation? - 3 stages to it

Answer 37

Forced eversion of foot pulls of medial ligament avulses medial malleolus Talus moves laterally breaks off lateral malleolus Tibia forced anteriorly breaks of distal tibia

Question 38

What is the medical term for a bunion?

Answer 38

Hallux valgus

Question 39

What does valgus mean?

Answer 39

Deviation away from midline | lateral deviation

Question 40

What causes hallux valgus?

Answer 40

Pressure from footwear Degenerative joint disease

Question 41

What is the appearance of hallux valgus?

Answer 41

Lump at first MTP joint

Question 42

Why does the lump form?

Answer 42

Pressure and friction against head of metatarsal 1 causes subcutaneous bursa to form become inflamed

Question 43

How do the bones displace in hallux valgus?

Answer 43

First metatarsal shifts medially | Phalanges of big toe shift laterally

Question 44

Hallux valgus is more common in males or females?

Answer 44

Females

Question 45

What is a complication of diabetes mellitus?

Answer 45

Diabetic neuropathy - damage to nerves | gives loss of peripheral nerve functiond

Question 46

Why are people with diabetes mellitus at increased risk of foot injuries?

Answer 46

Lose sensation of pain | Injuries in foot go unnoticed

Question 47

Which injuries in particular are people with diabetes mellitus at increased risk of?

Answer 47

Ulcers Infections of wounds Damage to joints

Question 48

Where is the common fibular nerve at most risk of injury? Why?

Answer 48

When it winds around the neck of the fibula | because it's most superficial at this point

Question 49

How is the common fibular nerve often injured?

Answer 49

Fracture of neck of fibula Injury of knee joint causing stretching of nerve

Question 50

What are the consequences of common fibular nerve injury?

Answer 50

Motor function loss - anterior leg muscles - supplied by deep fibular nerve - lateral leg muscles - supplied by superficial fibular nerve Sensory loss - anterior and lateral leg, dorsum of foot - supplied by superficial and deep fibular nerves - upper lateral leg - supplied by lateral sural nerve

Question 51

What is a characteristic sign of common fibular nerve injury? Why?

Answer 51

Foot drop loss of dorsiflexion by anterior leg muscles loss of eversion by lateral leg muscles gives unopposed plantarflexion