Flashcards in Foot and Ankle Deck (58):
function of medial foot?
function of lateral foot?
functions of plantar fascia?
supports arch of foot
attaches skin to underlying structures, so skin doesn't move away from foot when foot in contact with ground, which would make walking impossible.
factors to consider in ptnt presenting with pain in foot?
exact site- ask ptnt to point, is it over a bony prominence or joint?- probably a local disorder e.g. shoe pressure upon a local deformity, arthritis, tendinitis, or apophysitis in younger ptnt= inflammation over point where tendon inserts. Lateral= subtalar joint?
precipitants?- metatarsal stress fractures occur in ballet dancers and soldiers on route marches.
factors to consider in deformity presentation in ankle, foot or toes?
is this old/new?
has it progressed?
why is it important to ask about previous trauma in ptnt presenting with ankle pain?
ankle arthritis usually preceded by trauma
what are corns and callosities, and why do they occur?
thinkened, often tender, plaques of skin on toes or soles of feet, usually produced by localised pressure and friction e.g. from ill-fitting shoes.
why might a ptnt feel their ankle is 'giving way'?
result of pain, or instability at ankle or subtalar joint
if swelling of foot over medial side of 1st metatarsal head, why might FH be considered?
likely to be a bunion (hallux valgus), which often run in families.
normal position of heels on standing and on tiptoes?
on standing= slight valgus
on tiptoes= inverted, should invert equally
what do inverted heels indicate when ptnt is standing on their tiptoes?
that subtalar joints are mobile, and tibialis posterior muscles are functioning.
name for a high-arched foot?
what deformities may be noted on observation of ptnt's foot when standing?
where are corns common?
over the proximal toe joints
4 stages of walking cycle?
name for flat feet?
or planovalgus foot= heel is valgus
collapsed longitudinal arch and medial border of foot in contact with ground
midtarsal joints tested in ankle and foot examination?
F+E, A+A, rotations
slight DF and PF, and pronation and supination?
what is hammer toe?
a fixed flexion deformity of proximal IP joint of 1 of lesser toes
what is the too many toes/Johnson sign?
when viewing foot from behind, can see > 1 and a half to 2 toes.
indicates tibialis posterior tendon dysfunction, as occurs in flat-feet (pes planovalgus).
what is arthrodesis?
artificial induction of joint ossification between 2 bones via surgery, so joint is basically removed and stiffening occurs.
4 features of OA on an X-ray?
reduced joint space
1st metatarsal posture in hallux valgus?
components of the hindfoot?
components of midfoot?
navicular, cuboid, cuneiforms
components of forefoot?
metatarsals and phalanges
what ligament stabilises the mid-forefoot junction (tarsometatarsal joints)?
the Lisfranc ligament
injury indicated by loss of alignment of 2nd metatarsal with intermediate cuneiform on radiograph
how can abduction and adduction of forefoot occur?
mainly in midtarsal joint
some in tarsometatarsal joints and in ankle
what makes sure the rest of the foot also moves when the heel moves?
the calcaneo-cuboid joint (part of the midtarsal joint connecting the hindfoot with the midfoot.)
what are valgus heels assoc. with?
flat foot (planovalgus or pes planus)
depressed medial longitudinal arch*
what are varus heels assoc. with?
pes cavus= high arch
commonest major congenital abnormality of the foot?
talipes equinovarus (club foot)
characteristics of clubfoot?
heel varus deformity, forefoot adduction
some degree of plantarflexion and supination
tment of clubfoot?
manipulative stretching of tightened structures, and apply cast from toes to groin
repeated every 5-7 days
abduction foot orthosis to be worn full time for 12 wks once full correction obtained
what is talipes calcaneus?
congenital foot abnormality in which dorsum of foot lies against shin
treat with stretching and splintage
what residual deformity may be seen in clubfoot?
skewfoot- metatarsals are adducted, and there is a valgus deformity of hindfoot
what in intoeing usually the result of?
postural deformity of hips (IR) or excessive anteversion of femoral neck
how does pes cavus arise?
muscle imbalance, which disturbs forces controlling formation and maintenance of arches
appearance of foot in more severe cases of pes cavus?
toe clawing with foot intrinsic muscle wkness
excessive callus formation under metatarsal heads and heel
what specifically is a bunion?
a protective bursa
forms in hallux valgus, and is often assoc. with recurrent episodes of inflammation
what is hallux rigidus?
primary OA of MTPJ of great toe
joint pain and stiffness
commoner in males
toe may be held in flexed position, and proximal phalanx and metatarsal head are thickened following joint narrowing and circumferential exostosis formation
tment= fusion or Keller's arthroplasty-excision of deformities
what is splay foot?
widening of foot at level of metatarsal heads
what is Freiberg's disease?
osteochondritis of 2nd metatarsal head, assoc with palpable deformity and pain
present. complaint in plantar fasciitis?
what is mallet toe?
fixed flexion deformity of distal IPJ of toe
what is claw toe?
both IP joint flexed, and MTPJ extended
all 3 joints flexed in curly toe
where does gout classically affect in the feet?
the MTPJ of the great toe
how is tarsal tunnel syndrome relieved?
division of flexor retinaculum
why is the ankle more unstable in plantarflexion?
talus is wider anteriorly, so in PF, talus gripped less firmly between malleoli as narrower portion being gripped
components of the lateral ligament of the ankle?
anterior and posterior talo-fibular ligaments
tment of functional instability of ankle?
what movement do the inferior tibiofibular ligaments restrict?
lateral and proximal movement of distal end of fibula when foot dorsiflexed
normal range of plantarflexion?
normal range of dorsiflexion?
if dorsiflexion restricted, but normal range restored on knee flexion, what does this indicate?
tight Achilles tendon
what deformities may be seen on radiograph of foot in RA?
MTPJ dislocation, and associated lateral displacement of sesamoid bones
toe valgus deformities
bony erosion, OP apperance
what is a Morton's neuroma?
a compressive neuorpathy of the interdigital nerve, most commonly involving the 2nd and 3rd interdigital nerve between the metatarsal heads.
what imaging usually identifies a Morton's neuroma?
ultrasound- oval hypoechoic mass oriented parallel to metatarsal bones