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MUSCULOSKELETAL > FOOT > Flashcards

FOOT Flashcards

1
Q

What are the 3 groups of bones in the feet?

A

Tarsals
Metatarsals
Phalanges

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2
Q

What are the tarsal bones?

A

Proximal - talus, calcaneus
Intermediate - navicular
Distal - cuboid, medial lateral and intermediate cuneiform

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3
Q

What are the metatarsals?

A

The forefront bones 1-5 before the phalanges

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4
Q

What are the 2 groups of muscles acting on the foot?

A

Extrinsic muscles = arise from the leg and responsible for eversion, inversion, plantar and dorsiflexion
Intrinsic muscles - located within he foot and responsible for fine motor actions of the foot

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5
Q

What are the 2 intrinsic muscles within the dorsum of the foot?

A

The extensor digitorum brevis and extensor hallucis brevis

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6
Q

Action of the extensor digitorum brevis?

A

Extension of the lateral 4 toes

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7
Q

Function of extensor hallucis brevis?

A

Extension of the great toe

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8
Q

What are the 10 intrinsic muscles located in the plantar aspect of the foot?

A

First layer - abductor hallucis, flexor digitorum brevis, abductor digiti minimi
Second layer - quadratus plantae and lumbricals
Third layer - flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis
Fourth layer - plantar interossei and dorsal interossei

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9
Q

Function of abductor hallucis?

A

Abduction and flexion of the big toe

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10
Q

Function of flexor digitorum brevis?

A

Flexion of the lateral 4 toes at the the proximal interphalangeal joints

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11
Q

Function of abductor digiti minimi?

A

Abduction and flexion of the little toe

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12
Q

Function of quadratus plantae?

A

Assists flexor digitorum longus in flexion of the lateral 4 toes

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13
Q

Function of the lumbricals?

A

Flexion at metatarsophalngeal joints and extension at interphalangeal joints

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14
Q

Function of flexor hallucis brevis?

A

Flexion of great toe at MTP joint

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15
Q

Function of adductor hallucis?

A

Adduction of great toe

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16
Q

Function of flexor digiti minimi brevis?

A

Flexion of little toe at MTP joint

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17
Q

Function of plantar interossei?

A

Adduction of lateral 3 digits and flexion at MTP joints

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18
Q

Function of dorsal interossei?

A

Abduction of lateral 4 digits and flexion at MTP joints

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19
Q

Symptoms of medial plantar nerve entrapment?

A

Paraesthesia of medial sole of foot and plantar aspect of 1st and second toes
Pain of medial plantar arch and heel

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20
Q

What causes medial plantar nerve entrapment?

A

“Joggers foot”
Repetitive foot eversion e.g. running, space occupying lesions of the foot, tenosynovitis of flexor hallucis longus or flexor digitorum long jaw tendons etc

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21
Q

What is Hallux valgus?

A

A bunion
Valgus deformity of the big toe

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22
Q

What causes bunions?

A

Wearing overly tight shoes, high heeled shoes, FHx, RA

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23
Q

Presentation of bunions?

A

Slow development of….
Obvious valgus deformity of the foot and a bony enlargement of the first metatarsal head
Gait deviations
Irritation of skin around the bunion and blisters may form
Difficulties finding properly fitting footwear

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24
Q

Treatment of bunions?

A

Change in footwear
Use of orthotics
Rest, ice, analgesia

If the discomfort persist then surgery may be done

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25
Q

What is hallux rigidus?

A

OA of the MTP joint of the big toe

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26
Q

What can be precipitating factors for hallux rigidus?

A

Normal wear and tear
Traumatic injury of big toe in the past
Poor foot alignment - pes planus or bunion

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27
Q

Presentation of hallux rigidus?

A

Pain in MTPJ of big toe at top of joint during activity
Swelling
Redness
Stiffness

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28
Q

Management of hallux rigidus?

A

Analgesia, ice, activity modification
Footwear - stiff-soled shoes or a standard shoe with a Morton’s extension insert
Corticosteroid injections

If not effective surgical options include…
Cheilectomy - removal of bony spurs
Arthrodesis - fusion of bones together
Arthroplasty - joint replacement

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29
Q

What is Morton’s neuroma?

A

A benign tumour of the interdigital nerve in the forefoot due to entrapment e.g. wearing tight shoes, running, other foot problems

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30
Q

How does Morton’s neuroma present?

A

Persistent burning or sharp pain in the ball of the foot which radiates into the toes, especially during weight bearing activities - most commonly between base of 3rd and 4th toes but it can occur between the 2nd and 3rd toes
Sensation of having a pebble/marble under their foot as they walk
Tight shoes such as high heels exacerbate this
Some may feel numbness q

31
Q

What test can you do to clinically diagnose a Morton’s neuroma?

A

Mulder’s click - with 1 hand clasp the metatarsal heads and then place the thumb of the other hand on the plantar surface of the foot in the intermetatarsal space at the site of suspected neuroma. Squeeze the metatarsal heads together ans then exert pressure on the interdigital space. You may feel a mass displace towards the plantar surface of the foot - palpable click and pain

32
Q

Diagnosis of Morton’s neuroma?

A

USS

33
Q

Treatment of Morton’s neuroma?

A

Rest, ice, analgesia, wide shoes, insoles, lose weight, avoid high impact activity
Steroid injections
Radiofrequency ablation
Surgery - neurectomy

34
Q

What is plantar fasciitis?

A

Inflammation of the plantar fascia which is a thick connective tissue attaching to the calcaneus of the heel and traveling along the sole of the foot before branching out and connecting to flexor tendons of the toes
Caused by micro tears of the plantar fascia usually as a result of overuse

35
Q

How does plantar fasciitis present?

A

Gradual onset of pain on the plantar aspect of the heel which is worse with pressure, particuarly when walking.standing for prolonged periods. Also worse first thing in morning
Difficult to raise toes off the floor
Tenderness to palpation

36
Q

Management of plantar fasciitis?

A

Rest, ice, analgesia
Orthotics
PT
Steroid injections

Specialist management is rarely needed: extracorporeal shockwave therapy or surgery

37
Q

Causes of plantar fasciitis?

A

Recently stared exercising on hard surfaces
Exercise with a tight calf or heel
Overstretching sole of foot during exercise
Recently started doing a lot more walking/running/standing
Wearing shoes with poor support
Very overweight

38
Q

What is fat pad atrophy?

A

When the fat pad under the calcaneus which usually protects the heel from impact atrophies
This can occur with age or inflammation from repetitive impacts
Local steroid injections in the foot can also cause it

39
Q

Presentation of fat pad atrophy?

A

Pain and tenderness over the plantar aspect of the heel
Symptoms worse with activities, particularly when barefoot on hard surfaces

40
Q

How is fat pad atrophy diagnosed?

A

USS to measure the thickness of the fat pad

41
Q

Management of fat pad atrophy?

A

Comfortable shoes with custom insoles
Adaptive activities e.g avoiding high heels
Weight loss

42
Q

What is a hammer toe?

A

When the toe is bent at the proximal interphalangeal joint

43
Q

What causes hammer toes?

A

Muscle imbalance that puts pressure on the toe tendons and joints
Wearing shoes that dont fit properly e.g. Shoes that narrow toward the toe or high heels
Also caused by hallux valgus or high feet arches

44
Q

Presentation of hammer toe?

A

Swelling or redness
Inability to straighten the toe
Difficulty walking
A corn or callus on the top of the middle joint of the toe or on the tip of the toe

45
Q

Treatment of hammer toe?

A

Change foot wear
Exercises to help strength and stretch the muscles
Surgery can be done also if severe e.g. Arthrodesis

46
Q

What is claw toe?

A

Dorsiflexion of proximal phalanx on MTP joint and concurrent flexion of PIP and DIP joints

47
Q

What is mallet toe?

A

Flexion at the distal interphalangeak joint of the toe

48
Q

Causes of mallet toe?

A

Restrictive shoes
Arthritis
Trauma

49
Q

Claw toe causes?

A

Shoes that dont fit properly
Diabetes or alcoholism - neuropathy weakness muscle in foot

50
Q

What is metatarsalgia?

A

A common injury
A term used to refer to any painful foot condition affecting the metatarsal region of the foot e.g. bunions, fat pad atrophy, high arched feet, arthritis, gout, pes cavus

51
Q

What is a sprain?

A

A stretching, partial or complete tear of a ligament

52
Q

What are the 2 types of ankle sprains?

A

High ankle sprains - involving the syndesmosis bindings the distal tibia and fibula together
Low ankle sprains - involving the lateral collateral ligaments

53
Q

What most commonly causes low ankle sprains?

A

> 90% are inversion injuries causing damage to the anterior talofibular ligament

54
Q

Presentation of low ankle sprains?

A

Pain, swelling, tenderness over affected ligaments
Sometimes bruising
Usually able to weight bear unless severe

55
Q

Grading of a low ankle sprains?

A

Grade 1 - stretch/micro tear - minimal bruising and swelling
Grade 2 - partial tear - moderate bruising and swelling with minimal pain on weight bearing
Grade 3 - complete tear - severe bruising, swelling and pain on weight bearing

56
Q

Why should radiographs for ?ankle sprains be done according to the Ottawa ankle rules?

A

As 15% of sprains are associated with a fracture

57
Q

Management of a low ankle sprains?

A

Rest, ice, compression, elevation
Orthosis, cast, crutches may be required short term

If symptoms fail to settle or there is significant joint instability then an MRI and surgical intervention may be contemplated, but this is rare.

58
Q

What causes a high ankle sprain?

A

These are very rare!!
External rotation of the foot causes the talus to push the fibula laterally

59
Q

Presentation of a high ankle sprain?

A

Pain, swelling, bruising
Weight bearing very painful

60
Q

What is the Hopkins squeeze test?

A

Squeeze the tibia and fibula together starting just below the knee and work down to the malleolus
Sign of a high ankle sprain - the more proximal pain is felt, the more sevee the injury!

61
Q

Investigation for ?high ankle sprain?

A

XR - widening of tibiofibular joint or ankle mortise
MRI if high suspicion but normal XR

62
Q

Tx of high ankle sprains?

A

If no diastasis then non-weight-bearing orthosis or cast until pain subsides.
If diastasis or failed non-operative management then operative fixation is usually warranted.

63
Q

What is a Charcot joint?

A

A joint that has become badly disrupted and damages secondary to a loss of sensation
Most commonly seen in diabetics

64
Q

Features of a Charcot joint?

A

Typically a lot less painful than expected due to sensory neuropathy - most report some pain
Swollen, red, warm joint

65
Q

What is talipes eqinovarus?

A

Club foot
Inverted and plantar flexed foot

66
Q

Most common associations for club foot?

A

Most commonly idiopathic

Spina bifida
Cerebral palsy
Edward’s syndrome
Oligohydramnios
Arthrogryposis

67
Q

What is osteomyelitis?

A

Infection of the bone

68
Q

What are the 2 subclassifications of osteomyelitis?

A

Haematogenous osteomyelitis - from bacteraemia
Non-haematogenous osteomyelitis - from contiguous spread of infection from adjacent soft tissues to the bone OR from direct injury to the bone

69
Q

Risk factors for haematogenous osteomyelitis?

A

Sickle cell anaemia
IVDU
Immunosuppression - meds, HIV
Infective endocarditis

70
Q

Risk factors for non-haematogenous osteomyelitis?

A

Diabetic foot ulcers
Pressure sores
DM
PAD

71
Q

What is the most common microorganism that causes osteomyelitis?

A

Staph aureus

72
Q

What is the most common microorganism that causes osteomyelitis in sickle cell patients?

A

Salmonella species

73
Q

Investigation for osteomyelitis?

A

MRI

MUSCULOSKELETAL (13 decks)

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