Foot and ankle

Question 1

tests to see if pes planus is flexible

Answer 1

form arch on tiptoe

Jack’s test ( form arch when extend big toes)

Question 2

tibialis posterior courses immediately posterior to __
attachments =
function =

Answer 2

medial malleolus
navicular tuberosity + plantar aspect of medial and middle cuneiforms
elevates arch, invertor and plantar-flexor

Question 3

most common cause of acquired pes planus =

Answer 3

tibialis posterior dysfunction

Question 4

tibialis posterior dysfunction is common in which group of patients

Answer 4

obese middle age women and increasing incidence with age

hbp and diabetes

Question 5

causes of tibialis posterior dysfunction =

Answer 5

steroid injection
sero-ve arthropathies
idiopathic tendinosis (most common)

Question 6

sign of pes planus on observation

Answer 6

from back can see too many toes (poke out laterally)

Question 7

Type 1 pes planus

Answer 7

swelling tender and slightly weak power

Question 8

type 2 pes planus =

Answer 8

planovalgus
midfoot abduction
passively correctable

Question 9

type 3 pes planus =

Answer 9

fixity and mortise signs

Question 10

Rx of pes planus

Answer 10

physio
insole
steroid injection only if florid synovitis
Sx - fuse if stage 4 (FDL replaces tib post tendon)

Question 11

pes cavus causes

Answer 11

commonest - idiopathic

neuro - HSMN, CP, polio, spina bifida, club foot

Question 12

plantar fasciitis:
worst = ___ and eases off, worse with ___
__ pain
++_ at plantarmedial heel

Answer 12

first step in the morning
activity
stabbing
fullness, swelling and tender

Question 13

plantar fasciitis: ___ test +ve for Baxter’s nerve

Answer 13

Tinnel’s test

Question 14

heel spurs are present in __ of population

=

Answer 14

1/4

calcification of insertion at calcaneus

Question 15

causes of plantar fasciitis

Answer 15

excessive exercise / wt
sero -ve arthropathy
diabetes
planovalgus / cavovarus
footwear
hypothyroid

Question 16

Rx of plantar fasciitis

Answer 16

NSAIDs
night splints (v painful, in dorsiflexion)
tape
physio
steroid injection
usually self-limiting 18-24mnths

Question 17

Hallux valgus
usually uni/bilateral
M:F
causes =

Answer 17

bilateral
F3:1M
familial (laxity/alignment)
shoes
CT disease
rheumatoid
splayed forefoot ass with loss of muscle tone and age

Question 18

possible sequelae of hallux valgus

Answer 18

transfer metatarsalgia (as 2nd MTP takes over wt bearing)
lesser toe impingement (usually PIPJ)
bunion
neuralgia
shoe difficulties

Question 19

Rx of hallux valgus

Answer 19

shoe modifications
padding
Sx if not managed / deformities = osteotomies to realign

Question 20

OA of 1st MTPJ =

Rx (3) =

Answer 20

Hallux rigidus
non op
joint replace
arthrodesis

Question 21

feet features of RA

Answer 21

subluxed MTPJ
hallux valgus
clawed toes
painful plantar calluses

Question 22

Morton’s neuroma =

s+s =

Answer 22

degenerative fibrosis (maybe due to traction/bursitis) of digital nerve near bifurcation
metatarsalgia, burning and tingling in toes

Question 23

mortons neuroma
age
F:M

Answer 23

45-50yo

F>M

Question 24

management of mortons neuroma

Answer 24

examine and US

insoles injections / exercise

Question 25

achilles tendonitis is due to repetitive microtrauma at ___ | eg of causes =

Answer 25

``` hypovascular region 2-6cm proximal to insertion overtrain ciprofloxacin steroids CT diseases ```

Question 26

Ix for achilles tendonitis

Answer 26

examine US MRI

Question 27

treatment of achilles tendonitis

Answer 27

``` activity modification NSAIDs orthotics physio Sx ```

Question 28

Achilles rupture: mechanism = age = s+s =

Answer 28

``` sudden deceleration with resisted calf contraction >40yo cant wt bear weak plantarflex painful gap +ve calf squueze (Simmond's) test ```

Question 29

acquired imbalances between flexors and extensors in toes => (4)

Answer 29

claw mallet hammer toes

Question 30

mechanism of ankle sprain

Answer 30

inversion on planted foot

Question 31

typical ligaments that are sprained in a sprained ankle

Answer 31

ATFL and CFL

Question 32

management of ankle sprain =

Answer 32

RICE and physio | Sx - Brostrum Gould - direct repair

Question 33

Weber A ankle # = | Rx =

Answer 33

below syndesmoses - stable and no ligament rupture | moon boot

Question 34

Weber B ankle # = | Rx =

Answer 34

at syndesmoses - can be stable/unstable | if talar shift needs fixed to prevent OA

Question 35

Wever C ankle # =

Answer 35

unstable

Question 36

Pilon # =

Answer 36

distal tibial # | high E and causes sig soft tissue problems

Question 37

5th MT common # mechanism =

Answer 37

inversion injury

Question 38

3 types of MT #

Answer 38

``` avulsion by peroneus brevis tendon Jones # prox shaft (stress #) ```

Question 39

tarsoMT dislocation # = high/low E can sometimes dislocate __ from __

Answer 39

Lisfranc high hindfoot from forefoot

Question 40

calcaneal fracture => __+__ foot

Answer 40

broad and flat (bone explodes outwards)

Question 41

talus fracture mechanism = __/___ | has a __ blood supply and so may lead to __

Answer 41

dorsiflexion/rapid deceleration reversed AVN