Foot and ankle

Question 1

most common ligaments for spraining the ankle

Answer 1

ATFL

CFL (less common)

Question 2

Structures of the medial hind foot

Answer 2

Tom Dick and Harry

Tibias posterior
flexor digitorium longus
HFL nerve

Question 3

features of the medial and hind foot

Answer 3

medial malleolus 
anteromedial tibiotalar joint 
deltoid ligament 
PTT, FDL, FHL 
posterior tibial artery

Question 4

structures in the posterior ankle and hind foot

Answer 4

achilles tendon 
calcaneal insertion 
retrocalcaneal space 
perineal tendons 
FHL

Question 5

anterior ankle structures

Answer 5

anterior ankle joint 
superficial perineal N 
EHL
EDL 
Saphernous N (just over medial malleolus)

Question 6

structures in the plantar surface of the foot

Answer 6

heel pad 
5th MT base 
plantar fascia 
metatarsal heads 
tib post insertion

Question 7

Foot and ankle examination LOOK

Answer 7

look

patient age
obvious rheumatoid disease 
walking aids 
shoes, raises, insoles, never wear 
skin changes 
atrophy, skin, hair 
gait

Question 8

3 rockers of gait

Answer 8

1- heal strike to flat floor
2- mid stance
3-heel rise

Question 9

Foot and ankle examination MOVE

Answer 9

ankle joint 
subtler joint 
talonavicular and CC joints 
Lis Franc 
MTPJs 
PJs 
hindfoot/forefoot relationship

Question 10

what happens when achilles tendon is ruptured

Answer 10

in Thomson’s test there is no relation between leg and foot

Question 11

when do children develop arches

Answer 11

around 6 or 7

Question 12

what can cause adult acquired flat foot

Answer 12

tibias posterior dysfunction
seen in up to 10% of elderly women
can’t push off properly, tiring to walk

Question 13

who gets tibias posterior dysfunction

Answer 13

obese middle aged women 
increases with age 
flat foot 
hypertension 
diabetes
steroid injection 
seronegative arthropathies 
idiopathic tendonitis

Question 14

symptoms of tibias posterior dysfunction

Answer 14

pain and/or swelling posterior to medial malleolus 
change in foot shape 
diminished walking ability/balance 
dislike of uneven surfaces 
more noticeable hallux valgus 
lateral wall 'impingement' pain 
mid foot and ankle pain

Question 15

Treatment for tibias posterior dysfunction

Answer 15

physio 
insole support for medial arch 
NO steroid injections
orthotics 
bespoke footwear 
surgery

Question 16

what causes pes cavus

Answer 16

idiopathic

v high arches suggest underlying pathology most commonly HSNM, club foot, polio, CP)

Question 17

what is pes cavus

Answer 17

v high arch?

Question 18

what is plantar fasciitis

Answer 18

start up pain after rest
can be worse after exercise
fullness or swelling of plantar medial aspect of feel
tender over plantar aspect of heel

Question 19

treatment for plantar fasciitis

Answer 19

NSAIDS 
night splints 
taping 
heel cups or medial arch supports 
physio 
steroid injection 

self-limiting over 18-24 months

Question 20

causes of plantar fasciitis

Answer 20

physical overload - excessive exercise or weight 
seronegative arthropathy 
diabetes 
abnormal foot shape 
improper footwear

Question 21

what are bunions (hallux valgus)

Answer 21

deformity at first MTP joint

Question 22

4 causes for bunion pain

Answer 22

1. medial nerve
2. from the bursa
3. intrinsic joint pain
4. transfer of load through other toes

Question 23

who gets hallux valgus

Answer 23

females:males 2:1
increases with age
usually bilateral
adolescent subgroup

Question 24

how do you treat hallux valgus

Answer 24

non-operative (shoe modifications, padding)

operative

Question 25

what surgery can you do for hallux valgus

Answer 25

scarf/akin break the bone an move the head laterally

Question 26

what is hallux rigidus

Answer 26

osteoarthritis of the 1st MTP joint

Question 27

how do you manage hallux rigidus

Answer 27

non-operative joint replacement fusion

Question 28

what operation do you do for rheumatoid arthritis in the feet

Answer 28

same as for hallux rigidus | joint fusion

Question 29

what is the pathogenesis of RA in the feet

Answer 29

synovitis proteinases and collagenases impaired integrity of joint capsules destruction of the hyaline cartilage

Question 30

what is the main reason foot problems arise in diabetes

Answer 30

peripheral neuropathy - cant feel when they've hurt they're feet - poor wound heeling

Question 31

what is charcots foot

Answer 31

weakness in the bones of the foot due to nerve damage with continued walking the bones become deformed 30-50% chance of ulceration which can lead to osteomyelitis

Question 32

how do you treat charcots foot

Answer 32

conservative | failed conservative measures - surgery

Question 33

things to consider before operating on charcots foot

Answer 33

``` normal pulses nutrition optimisation of HbA1C soft tissue envelope-ideally closed location of deformity presence of infection or osteomyelitis ```

Question 34

what type of surgery is done for charcots

Answer 34

``` fixed surgery primary internal, primary external or a combination of both external fixation (external metal work on patient) ```

Question 35

what is Morton's neuroma

Answer 35

degenerative fibrosis of digital nerve near its bifurcation | causes forfeit pain, burning and tingling in toes

Question 36

who gets Morton's neuroma

Answer 36

45-50 y/o F>M

Question 37

how is Mortons's neuroma managed

Answer 37

non-op (insoles and injections) | operative (excise)

Question 38

tendon-achiles tendinosis

Answer 38

repetitive micro trauma, failure of collagen repair with loss of fibre alignment/structure