What is the most common cause of acquired flatfoot deformity in adults?
Tibialis posterior dysfunction
Which patients tend to be affected by tibialis posterior dysfunction?
Obese
Female
Increasing age - usually middle aged
Hypertension
Diabetes
History of steroid injections
Seronegative arthropathies
What is the cause of the laxity here?
Left foot pes planus caused by tibialis posterior dysfunction
Arch has flattened so the foot everts
What are the signs and symtpoms of tibialis posterior dysfunction?
Pain and/or swelling posterior to medial malleolus – very specific
Change in foot shape
Diminished walking ability/balance
Dislike of uneven surfaces
More noticeable hallux valgus
Lateral wall “impingement” pain
How can a flexible pes planus be distinguished from a non-flexible pes planus?
Arch is still formed in flexible pes planus when standing on toes
What are the treatment options for tibialis posterior dysfunction?
Physiotherapy
Insole to support medial longitudinal arch
Orthoses to accommodate foot shape
Bespoke footwear
Surgery
Which treatment should not be given for tibialis posterior dysfunction?
Steroid injections
Which classification is used to describe ankle fractures?
Weber's classification
Which kind of ankle fractures are stable?
Distal fibula fracture with no medial malleolus fracture or deltoid ligament rupture
Which ankle fractures are unstable?
Distal fibula fracture with medial malleolus fracture or deltoid ligament rupture
What is the treatment of a stable ankle fracture?
Cast or splint for around 6 weeks
When is rupture of the deltoid ligament suspected?
Bruising and tenderness medially
What is the usual treatment of unstable ankle fractures?
Open reduction internal fixation
What is the treatment of an unstable ankle fracture if there is any talar shift or talar tilt, and why?
Anatomical reduction and rigid internal fixation
Used to minimise the risk of development of OA
What is a pilon fracture?
A fracture of the distal tibia involving its articular surface
What is a Jones fracture?
A fracture of the proximal end of the 5th metatarsal bone
Why can a Jones fracture be problematic?
Higher risk of non-union (around 25%) due to poor blood supply
How do fractures to the base of the 5th metatarsal tend to occur?
Inversion injury with an avulsion fracture at the insertion of the peroneus brevis tendon
How do calcaneal fractures occur, and what other injuries should be looked for?
Fall from height onto heel
Therefore, also look for spinal injuries
What is at risk of developing following a calcaneal fracture?
Compartment syndrome of the foot
What is the prognosis of a calcaneal fracture dependant on?
Degree of involvement of subtalar joint
Degree of communition
When is subtalar arthodesis a treatment option following a calcaneal fracture?
Development of chronic pain from subtalar joint damage
Osteoarthrtitis
How do fractures of the talus tend to occur?
Forced dorsiflexion from rapid deceleration
e.g. RTA, aircraft crash
What is at risk of developing following a talar fracture-dislocation or subluxation?
AVN of the talus
What is a Lisfranc fracture?
A fracture of the base of the 2nd metatarsal is associated with dislocation of the base of the 2nd metatarsal with or without dislocation of the other metatarsals at the tarso‐metatarsal joints
What is the usual presentation of a Lisfranc fracture?
Grossly swollen and bruised foot
Unable to weight bear
May have normal Xray - CT scan if in doubt
What is the treatment for a Lisfranc fracture?
Closed or open reduction with screw fixation
What is the treatment for multiple displaced fractures of the metatarsals?
Stabilisation with K wires
How does plantar fasciitis present?
Heel pain
Fullness or swelling medially to heel
Can be worse after exercise or starting up after rest
What would indicate plantar fasciitis on examination?
Positive tinel's test for Baxters nerve
Swelling medially to heel
