Feet problems

Question 1

What bones make up the tarsals? (superior -> inferior, medial -> lateral)

Answer 1

Talus
Calcaneus
Navicular 
Cuneiforms 
Cuboid

Question 2

What bones form the ankle joint?

Answer 2

Tibia, fibula and talus

Question 3

What type of joint is the ankle joint?

Answer 3

hinge

Question 4

What is the function of the medial ligament?

Answer 4

resists over eversion of the foot

Question 5

What is the function of the lateral ligament?

Answer 5

resists over inversion

Question 6

What ligaments does the lateral ligament consist of?

Answer 6

i. anterior talofibular
ii. posterior talofibular
iii. calcaneofibular

Question 7

what ligament is commonly strained and by what mechanism? what are the signs of this?

Answer 7

anterior talofibular of lateral ligament by twisting inversion
stiffness, tenderness over lateral ligament
pain on inversion

Question 8

What is the Rx of ankle ligament strain

Answer 8

RICE
Rest 
Ice 
Compression
Elevation 
Rule out fracture - XR or signs (tenderness at malleolus or inability to walk)

Question 9

What is a maissoneuve fracture?

Answer 9

proximal fibular fracture and syndesmosis rupture, medial malleolus fracture or deltoid ligament rupture

Question 10

What is the syndesmosis?

Answer 10

slightly moveable fibrous joint joined together by connective tissue

Question 11

What rules can be used to rule out the need for an XR in case of a clinically significant ankle fracture?explain them

Answer 11

Ottawa ankle rules
Pain in malleolar zone and:
1. unable to weight bear for 4 steps
2. tenderness over distal tibia
3. bone tenderness over fibula

Question 12

What is the Weber classification?

Answer 12

classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint.

Question 13

What are the symptoms of achilles tendinopathy?

Answer 13

gradual onset
posterior heel pain
morning pain and stiffness

Question 14

What is the treatment for achilles tendinopathy

Answer 14

analgesia

stop activities that cause it

Question 15

What are the clinical features of an achilles tendon rupture?

Answer 15

1. pop in ankle
2. sudden significant pain in calf or ankle or inability to walk
3. occurs during running or sport

Question 16

How can you diagnose an achilles tendon rupture?

Answer 16

Simmonds triad:
- pt lies face down, feet hanging off the bed
+ve if there is no plantar flexion (pushing foot down) on squeezing the calf
can also feel gap in the tendon

Question 17

what is the management of achilles tendon rupture?

Answer 17

refer acutely to orthopaedic specialist

Question 18

What are the RFs for achilles tendon disorderS?

Answer 18

quinolone e.g. ciprofloxacin

hypercholesterolaemia

Question 19

What is the management of ankle fractures in young and elderly ppl?

Answer 19

young - surgical repair (often compression plate)

elderly - conservative as the thin bone doesn’t hold metal work well

Question 20

What is hallux valgus?

Answer 20

bunion

the big toe deviates laterally at the metatarsophalangeal j

Question 21

What is hallux valgus associated w?

Answer 21

genetics
f>m
age
footwear
BMI
commonly secondary to arthritis

Question 22

What is the rx of hallux valgus

Answer 22

• bunion pads
• wedges between toes
• surgery if severe
• metatarsal osteotomy

Question 23

What is pes planus? why does it occur?

Answer 23

flat foot

dysfunction of the posterior tibias tendon

Question 24

How does pes planus present?

Answer 24

mostly asymptomatic 
w progression: 
- pain
- forefoot abduction 
- hindfoot valgus deformity

Question 25

What is pes cavus?

Answer 25

elevated arch of the foot

Question 26

What are the associations of pes cavus?

Answer 26

usually idiopathic spina bifida Cerebral palsy Polio

Question 27

What is plantar fasciitis?

Answer 27

inflammation of the aponeurosis (flat sheet of tendon material) at its origin on the calcaneus

Question 28

What is the plantar fascia?

Answer 28

connective tissue connecting the calcaneus (heel bone) to the toes and creates the arch of the foot

Question 29

What is the presentation of plantar fasciitis?

Answer 29

pain worse around medial calcineal tuberosity

Question 30

What is the treatment of plantar fasciitis?

Answer 30

rest feet shoes w good arch support and cushioned heels insoles + heel pads can be helpful

Question 31

What are the RFs for plantar fasciitis?

Answer 31

``` excessive running high arches standing on hard surfaces for long periods leg length inequality flat feet ```

Question 32

What is the treatment of ingrowing toenails?

Answer 32

tuck cotton wool soaked in surgical spirit under proudflesh abx? nail avulsion + chemical matrixectomy (phenol, sodium bicarbonate)