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Musculoskeletal System > Common Foot and Ankle Problems > Flashcards

Common Foot and Ankle Problems Flashcards

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1
Q

What is the other term commonly used for Hallux Valgus

A

Bunions

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2
Q

What are the risk factors for Hallux Valgus

A

Genetics, specific footwear, significant female preponderance

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3
Q

Symptoms of Hallux Valgus

A

Pressure symptoms from shoe wear, pain from crossing over of toes, metatarsalgia

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4
Q

Pathogenesis of Hallux Valgus

A

Occurs from lateral angulation of the great toe, the tendons then pull to lateral of centre of rotation of toes which then worsens the deformity. The sesamoid bones then sublux and less weight goes through the great toe.

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5
Q

Diagnosis of Hallux Valgus

A

Clinical, Xrays

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6
Q

Management of Hallux Valgus (non operative)

A

Foot wear modification, orthotics to offload the pressure and correct the deformity, activity modification, analgesia

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7
Q

Management of Hallux Valgus (non-operative)

A

Release lateral soft tissues

Osteotomy 1st metatarsal and the proximal phalanx

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8
Q

What is Hallux Rigidus

A

A stiff big toe, osteoarthritis of the 1st MTP joint, bimodal distribution of age

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9
Q

Aetiology of Hallux Rigidus

A

Possibly genetic, possibly multiple microtrauma

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10
Q

Symptoms of Hallux Rigidus

A

Pain at extreme dorsiflexion, limitation of range of movement

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11
Q

Diagnosis of Hallux Rigidus

A

Clinical or Xray

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12
Q

Hallux Rigidus Xray

A

complete loss of joint space bilaterally or dorsal osteophyte

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13
Q

Non operative management of hallux rigidus

A

Activity modification, shoe wear with rigid sole, analgesia

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14
Q

Surgery Hallux Rigidus

A

Cheilectomy, arthrodesis, arthroplasty

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15
Q

Cheilectomy

A

Removal of the dorsal impingement

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16
Q

Gold standard treatment of Hallux Rigidus

A

1st MTPJ fusion

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17
Q

Aetiology of Lesser Toe Deformities

A 
Imbalance between flexors/extensors
Shoe wear 
Neurological
Rheumatoid arthritis
Idiopathic
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18
Q

Symptoms of lesser toe deformities

A

Deformity, pain from the dorsum, pain from the plantar side

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19
Q

Different lesser toes deformities

A

Hammer Toe, Claw Toe, Mallet Toe

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20
Q

Non-operative management of lesser toe deformities

A

Activity modification
Shoe wear – flat shoes with high toe box to accommodate deformity
Orthotic insoles – metatarsal bar/dome support

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21
Q

Operative Treatment of lesser toe deformities

A

Flexor to extensor transfer
Fusion of interphalangeal joint
Release of metatarsophalangeal joint
Shortening osteotomy of metatarsal

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22
Q

What is Mortons Neuroma

A

Thickening of the tissue around the nerves at the base of the toes (usually the 3rd and 4th)

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23
Q

Causes of Mortons Neuroma

A

Mechanically induced degenerative neuropathy

Tends to affect females aged 40-60

Frequently associated with wearing high healed shoes

Common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear

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24
Q

Symptoms of Mortons Neuroma

A

Neuralgic burning pain into the toes and altered sensation in webspace

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25
What webspace does Mortons Neuroma commonly effect
3rd followed by 2nd
26
Diagnosis of Mortons Neuroma
Clinical, Mulders Click, Ultrasound/MRI
27
Treatment of small Mortons Neuroma
Steroid Injection
28
Treatment of larger Mortons Neuroma
Excision of lesion including a section of normal nerve
29
Common effects of surgery of mortons neuroms
Numbness, recurrence, 30% have pain 1 year post surgery
30
Metatarsalgia
Pain and inflammation on the base and balls of the foot
31
Causes of Metatarsalgia
Synovitis, bursitits, arthritis, neuralgia, neuromata, Freiberg's disease
32
Non operative treatment of rheumatoid forefoot
Shoewear, orthotics, activity modification
33
Operative management of rheumatoid forefoot
1st MTPJ arthrodesis and 2-5th toe excision arthroplasty
34
Ganglia
These tend to occur from arthritis of underlying tendon pathology
35
Symptoms of ganglia
Pain from pressure
36
Treatment of ganglia
Aspiration or excision (high rate of return (50%))
37
Plantar Fibromatosis
Ledderhose disease, thickening of the foots deep connective tissue
38
Symptoms of plantar fibromatosis
Usually asymptomatic unless very large on weightbearing area
39
Non-operative management of plantar fibromatosis
Avoid pressure by changing foot wear or adding orthotics
40
Other treatments of plantar fibromatosis
Operative excision, radiotherapy, combination radiotherapy/surgery
41
Achilles Tendinosis
Degenerative overuse condition with little inflammation
42
Insertional Achilles Tendinopathy
Within 2cm of insertion
43
Non-insertional/ Mid-substance tendinopathy
2-7cm
44
Bursitis achilles tendinopathy
Retrocalcaneal or superficial calcaneal
45
Paratendinopathy
True inflammatroy problem showing paratendonitis histologically
46
Aetiology of paratendonopathy
Common in athletic populations aged around 30-40 and occurs in males more than females (2:1)
47
Aetiology of tendonopathy
Common in non-athletic populations, usually aged over 40
48
Risk factors for tendonopathy
Obesity, steroids and diabetes
49
Symptoms of Achilles Tendinopathy
Pain during exercise Pain following exercise Recurrent episodes Difficulty fitting shoes
50
How is achilles tendinopathy usually diagnosed
Tenderness, tests for rupture, ultrasound scan or MRI
51
Simmonds Test
If the calf squeeze does not move the foot then the achilles tendon is ruptured
52
Non-operative treatment of achilles tendinopathy
``` Activity modification Weight loss Shoe wear modification Physiotherapy - eccentric stretching Extra-corporeal shockwave treatment Immobilisation in below the knee cast ```
53
Operative treatment of achilles tendinopathy
Gastrocnemius recession | Release and debridement of tendon
54
Plantar Fasciitis/Fasciosis
Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen and avasularity
55
Causes of Plantar Fasciitis
Athletes associated with high intensity or marked increase in training Running with poorly padded shoes Obesity Occupations involving long periods of standing Foot/lower limb rotational deformities Tight gastro-soleus compex
56
Symptoms of plantar fasciitis
Pain first think in the morning, pain on weight bearing after rest (post-static dyskinesia), pain located at the origin of plantar fascia, frequently long lasting - 2 years or more
57
Differential diagnosis plantar fasciitis
Nerve entrapment syndrome Arthritis Calcaneal Pathology
58
Diagnosis of Plantar Fasciits
Mainly clinical, can use X-rays, Ultrasounds and MRI
59
Treatments of plantar fasciitis
``` Rest Stretching Ice NSAIDs Orthoses Physiotherapy Weight loss Corticosteroid injections Night spinting ```
60
Newer treatments of plantar fasciitis
``` Extracorporeal Shockwave therapy Topaz Plasma Coblation Nitric Oxide Platelet Rich Plasma Endoscopic / Open Surgery ```
61
Ankle Arthritis mean age of presentation
46
62
Symptoms of Ankle arthritis
Pain and stiffness in the ankle joint
63
Diagnosis of Ankle Arthritis
Clinical, X-ray, CT scan - exclude adjacent joint arthritis
64
Non-operative management of Ankle Arthritis
Weight loss, activity modification, analgesia, physiotherapy, steroid injections
65
Operative Managment of Ankle Arthritis (exclusively anterior symptoms)
Arthroscopic anterior debridement
66
Operative management of ankle arthritis
Arthrodesis, joint replacement
67
Gold standard treatment for ankle arthritis
Arthrodesis
68
Tibialis posterior tendon dysfunction
Acquired adult flat foot planovalgus
69
Diagnosis of tibialis posterior tendon dysfunction
Double and single heel raise test (valgus to varus)
70
Symptoms of tibialis posterior tendon dysfunction
Medial or lateral pain
71
Treatment of tibialis posterior tendon dysfunction
Orthoses (medial arch support) or surgery (reconstruction of tendon or triple fusion of subtalar, talnoavicular and calcaneocuboid)
72
Aetiology of diabetic foot ulcer
Occurs due to diabetic neuropathy resulting in the patient being unaware of the trauma occuring to their foot. There is also autonomic neuropathy resulting in a alack of sweating and normal sebum production, therefore there is dry cracked skin and it is more sensitive to trauma Poor vascular supply
73
Treatment of diabetic foot ulcer (modification the main detriments to healing)
``` Diabetic control Smoking Vascular supply External pressure (splints/shoes/weight bearing) Internal pressure (deformity) Infection Nutrition ```
74
Surgical treatment of diabetic foot ulcer
Improvement of vascular supply Debridement of ulcers and get deep samples for microbiology Amputation
75
Percentage of diabetic patients who get foot ulcers
15%
76
Percentage of patients with diabetic foot ulcers that go on to have amputation
25%
77
5 year mortality of diabetic foot ulcers
50%
78
Aetiology of Charcot Neuroarthropathy
Any cause of neuropathy to the foot, mostly diabetic neuropathy
79
Neurotraumatic theory of the pathophysiology of Charcot Neuroarthropathy
Lack of proprioception and protective pain sensation
80
Neurovascular pathophysiology of Charcot
Abnormal autonomic nervous system results in increased vascular supply and bone resorption
81
3 stages of bone destruction in Charcot
Fragmentation Coalescence Remodelling
82
Diagnosis of Charcot
Consider in any diabetic with acutely swollen erythematous foot X-ray MRI scan
83
Management of Charcot
Prevention Immobilisation Correction of the deformity

Musculoskeletal System (34 decks)

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