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ms 1 - 2nd shift > Causes of Foot and Ankle Pain > Flashcards

Causes of Foot and Ankle Pain Flashcards

1
Q

Disease of the epiphysis that starts with necrosis (osteonecrosis) and fragmentation followed by repair and regeneration

(mostly in children)

A

Osteochondritis

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2
Q

3 types of Osteochondritis

A

Kohler disease

Freiberg disease

Sever disease

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3
Q

Osteonecrosis of the tarsal navicular bone

Begins about the 4-5 years old

A

Kohler’s disease

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4
Q

Trauma can be a contributory factor

Unknown

A

Etiology of Kohler’s disease

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5
Q

Limp

Tenderness and thickening over the affected navicular

A

Symptoms of Kohler’s disease

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6
Q

Radiograph – small bone, dense and of irregular outline

A

Dx of Kohler’s Disease

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7
Q

Protection of diseased bone from excessive traumatization

Support of longitudinal arch

Immobilize foot in slight inversion through a plastic cast

A

Treatment of Kohler’s disease

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8
Q

Avascular necrosis most commonly of the second metatarsal head in which a portion or all of the metatarsal head loses its structural integrity

blood supply to part of the bone of the metatarsal head for whatever reason is diminished or cut off

also called Freiberg’s infraction

is more common in adults

A

Freiberg’s disease

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9
Q

Unilateral pain worse with activity
ROM with limitation
Most common sight is over 2nd metatarsal
+ tenderness

A

Signs and symptoms of Freiberg’s disease

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10
Q

self limiting

A

Treatment of Freiberg’s disease

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11
Q

Osteonecrosis of the calcaneal apophysis

common cause of heel pain (in children)

thought to be an overuse injury of the calcaneal apophysis in a growing child

A

Sever’s disease

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12
Q

commonly seen in immature athletes participating in running & jumping sports

frequently seen just before or during peak growth

A

Epidemiology

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13
Q

pain in the area of the calcaneal apophysis in an immature athlete

pain increased with activity or impact

stretch of the triceps surae exacerbates heel pain

can display warmth, erythema, & swelling

A

Symptoms of Sever’s disease

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14
Q

tight Achilles tendon

positive squeeze test (pain with medial-lateral compression over the tuberosity of the calcaneus)

pain over the calcaneal apophysis

A

Physical exam of Sever’s disease

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15
Q

self-limiting entity that resolves with maturation and the closure of the apophysis

Avoid too much activity until the closure of the epiphysis

A

Treatment of Sever’s disease

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16
Q

accumulation of uric acid in the joint.

Deposition of uric acid crystal

A

Gout

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17
Q

byproduct of protein, the more we eat protein/meat,the higher our uric acid becomes

A

Uric acid

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18
Q

60% of initial attack of gout involves the

A

1st MTP or great toe

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19
Q

what you call gout affecting the 1st MTP

A

Podagra

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20
Q

severe excruciating pain in the foot(unable to walk or put on shoes), swelling, warmth, redness

A

Signs of gout

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21
Q

Incidence of gout

A

Very common in middle aged men. (Hereditary)

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22
Q

Characterized by sudden attacks of sharp pain well localized affecting the web space between 3rd and 4th followed by 2nd and 3rd

A

Interdigital Neuroma (Morton’s Toe)

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23
Q

thickening of the common digital nerve at its bifurcation in the web space;

Repeated trauma to the nerve by metatarsal head

A

cause of morton’s toe

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24
Q

Metatarsal arch support (metatarsal pads)

Stretching

A

Conservative treatment of Morton’s toe

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25
Q

Surgery for excision of enlarged segment of nerve

A

If morton’s toe is not relieved by conservative management

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26
Q

Called march or fatigue fracture

Fracture of metatarsal shaft usually 2nd or 3rd due to repeated stress from unaccustomed amount of walk

Pain on the area increasing in a week or more as callus forms

Common in army recruits during basic training

Can also involved other bones as calcaneus, femur, tibial or fibula

A

Stress Fracture

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27
Q

Dx of Stress fracture

A

x-ray

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28
Q

Rest

Adhesive strapping

Use of anterior arch pad and metatarsal pad

A

Treatment of stress fracture

29
Q

Lateral angulation of the great toes at the MTP

Associated with enlargement of the medial side of the head of the first metatarsal (bunion)

Medial deviation of the first metatarsal bone and lateral deviation of the great toe

A

Hallux Valgus

30
Q

Causes

hereditary, contracture of the flexor and extensor hallucis longus;
Pointed shoe + tiptoe= forcing big toe to go laterally

A

Hallux Valgus

31
Q

proper fitted shoes and repeated over correction of stretching

A

treatment for mild hallux valgus

32
Q

excision of the bursa

A

surgical treatment of hallux valgus

33
Q

elongation of the ligaments on the medial side on the medial side of EHL

A

Silver operation

34
Q

resection of the proximal half of the first phalanx; procedure of choice

A

Keller or Schanz operation

35
Q

reset the bone to return to straight position

A

Osteotomy

36
Q

Medial angulation of the great toe at the MTP

A

Hallux Varus

37
Q

Causes

trauma, infection, muscle imbalance, paralysis of adductor hallucis, insertion of the adductor hallucis tendon have been relead may also be cause of hallux varus

A

Hallux Varus

38
Q

Surgical release the contracture structure on the medial side of toe

Other – osteotomy of metatarsal head and use of the 2nd extensor hallucis brevis in the presence correct alignment

A

Treatment for Hallux varus

39
Q

dorsiflexion of the MTP and plantar flexion

contracture of the IP; most common affected is 2nd toe; due to overactivity or tightness or due to use of a narrow she at the end of the second toe

A

Hammer Toe

40
Q

hyperextension of the metatarsophalangeal joint and flexion contracture of both the proximal and distal interphalangeal joint

A

Claw Toe

41
Q

simple flexion contracture of the DIP

A

Mallet Toe

42
Q

Sprain on the first metatarsophalangeal joint secondary to forceful dorsiflexion or sometimes forceful plantarflexion

Involves the plantar capsule and ligament

A

Turf Toe

43
Q

Pain and tenderness with swelling of the 1st MTP
Pain is worse with movement of joint
Persistent symptoms lead to decrease ROM

A

Signs and symptoms of Turf’s toe

44
Q

Radiograph to r/o bony injury

A

Dx of turf’s toe

45
Q

RICE (rest, ice, compress, elevate)
- Sometimes PRICE (protect, rest, ice, compress, elevate)

Taping to limit motion of the joint

Use stiff soled shoes

A

Treatment of turf’s toe

46
Q

Fracture of the diaphysis of the 5th metatarsal bone

Due to inversion – plantarflexion injury or due to stress fracture of the area

Common in sprinters and jumpers

A

Jone’s Fracture

47
Q

Pain on the lateral aspect of the forefoot

+ tenderness localized at proximal 5th metatarsal bone

A

Clinical picture of Jone’s fracture

48
Q

NSAID for pain management

Cast immobilize until pain and swelling subsides (6-8 weeks)

Screw fixation so patient can return to work

A

Treatment of turf’s toe

49
Q

fibrous band on the bottom of the foot that connects the heel bone to each of the toes

A

plantar fascia

50
Q

Four plantar foot muscles originate from the volar calcaneus

A

Adductor hallucis
Quadratus plantae
Flexor digitorum brevis
Abductor digiti minimi

51
Q

Overload of these muscles can cause enthesopathy at the calcaneus causing heel pain and lateral inflammation and pain in the plantar fascia

the plantar fascia becomes irritated and inflamed. This causes pain in the heel and arch of the foot

A

Plantar Fasciitis

52
Q

epidemiology of plantar fascitis

A

affects men and women equally

53
Q

obesity (high BMI)

decreased ankle dorsiflexion in a nonathletic population (tightness of the foot and calf musculature)

weight bearing endurance activity (dancing, running)

A

risk factors of plantar fascitis

54
Q

Non operative treatment of Plantar fascitis

A

Pain control, splinting & therapy (stretching) programs

55
Q

first line treatment of plantar fascitis

A

Modalities

56
Q

plantar fascia-specific stretching and Achilles tendon stretching

anti-inflammatories or cortisone injections
- corticosteroid injections can lead to fat pad atrophy or plantar fascia rupture

foot orthosis
- examples include cushioned heel inserts, prefabricated shoe inserts, night splints, walking casts
- short leg casts can be used for 8-10 weeks

A

Modalities– first line treatment of Plantar Fascitis

57
Q

Second line of treatment

Chronic heel pain lasting longer than 6 months when other treatments have failed

A

Shock wave treatment

58
Q

A compressive neuropathy caused by compression of the tibial nerve

Counterpart of the carpal tunnel in the hand

A

Tarsal Tunnel Syndrome

59
Q

Posterior tarsal tunnel formed by

A

flexor retinaculum
calcaneus (medial)
talus (medial)
abductor hallucis (inferior)

60
Q

contents include (Tom, Dick And Very Nervous Harry)

A

tibial nerve
posterior tibial artery and vein
FHL tendon
FDL tendon
tibialis posterior tendon

61
Q

types of impingement

A

intrinsic, extrinsic

62
Q

ganglion cyst
tendinopathy
tenosynovitis
lipoma/tumor
perineural fibrosis
Osteophytes

A

Intrinsic impingement

63
Q

shoes
trauma
anatomic deformity (tarsal coalition, valgus hindfoot)
post-surgical scarring
systemic inflammatory disease
edema of the lower extremity

A

Extrinsic impingement

64
Q

Pain with prolonged standing or walking

often vague and misleading medial foot pain

sharp, burning pains in the foot

A

Symptpms of TTS

65
Q

intermittent paresthesias and numbness in the plantar foot

tingling/burning sensation

A

Numbness of TTS

66
Q

posterior tibial tendon deficiency (adult-acquired flatfoot), plantar fasciitis, tarsal tunnel syndrome

believed to be due to loss of static and dynamic stabilizers of the medial arch and subsequent traction neuropathy on the tibial nerve

A

heel pain triad

67
Q

medications
-anti-inflammatory medications
-SSRIs have been used

bracing
-orthosis or foot wear changes to address alignment of hindfoot
-can try a period of short-leg cast

A

conservative treatment of TTS

68
Q

surgical release of tarsal tunnel

A

Operative treatment for TTS

69
Q

after 3-6 months of failed conservative management and compressive mass (ganglion cyst) identified

positive EMG

reproducible physical findings

A

Indications for TTS surgery

ms 1 - 2nd shift (13 decks)

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