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Year 2 MSK > Foot and Ankle > Flashcards

Foot and Ankle Flashcards

(59 cards)

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1
Q

Hallux Valgus

A

Big toe deformity.

Medial deviation of 1st metatarsal and lateral movement of the toe.

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2
Q

Who is most affected by hallux Valgus?

A

Women 4:1 with some familial tendency.

Seems to be more common in show wearing countries.

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3
Q

What conditions are associated with hallux Valgus?

A

Rheumatoid arthritis
Inflammatory arthropathies
Multiple sclerosis
Cerebral Palsy

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4
Q

What is main complaint of patients with hallux Valgus?

A

Pain

Cosmetic appearance

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5
Q

What causes the pain in hallux valgus?

A

Widened forefoot causes rubbing resulting in an inflamed bursae (bunion) and frequent ulceration.
1st and 2nd toe rub together resulting in skin breakdown.

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6
Q

What is used in the non surgical treatment of hallux Valgus?

A

Wearing wider accommodating shoes.

Spacer between 1st and 2nd toe to prevent ulcers.

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7
Q

What is the main reason for surgical treatment of hallux Valgus ?

A

generally for cosmetic reasons, however 30% are dissatisfied with the result due to pain.

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8
Q

What is hallux rigidus?

A

Osteoarthritis of the 1st Metatarsophalangeal joint

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9
Q

Two types of hallux rigidus

A

Primary (degenerative)

Secondary (osteochondral injury etc)

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10
Q

What is the conservative treatment of hallux rigidus?

A

Use of stiff soled shoes to limit movement.

Removal of dorsal osteophytes which can impinge movement.

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11
Q

What is the removal of osteophytes called?

A

Cheilectomy

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12
Q

What is the gold standard surgical treatment of hallux rigidus?

A

Arthrodesis, fusion of MTPJ joint.

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13
Q

Benefits of arthrodesis of the MTPJ joint?

A

Alleviate all pain
MTPJ is a stiff joint anyway no real sacrifice in movement.
More successful than joint replacement.

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14
Q

Drawback of arthrodesis in hallux rigidus?

A

Unable to wear heals

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15
Q

Mortons neuroma

A

Irritated and swollen digital nerve leads to degenerative fibroma.

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16
Q

Clinical signs of Mortons neuroma

A

Burning and tingling pin radiating from affected toes.

Loss if sensation in web space.

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17
Q

What is the Mulder’s click test?

A

Mortons neuroma

Mediolateral compression of metatarsal ellicits a click

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18
Q

What imaging is used for diagnosis of Mortons neuroma?

A

Ultrasound

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19
Q

What is the conservative management used in Mortons neuroma?

A

Injections of local anaesthetic and steroids.

Insoles

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20
Q

What us the surgical management of a Mortons neuroma?

A

Excision- some patients complain of continued pain.

Small risk of recurrence.

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21
Q

What are some common stories for metatarsal stress fractures?

A

Runners, soldiers on long marches, dancers, of poorly conditioned people walking long distances.

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22
Q

Which are the most common metatarsals to present with stress fractures?

A

2nd and 3rd

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23
Q

What is the treatment for a metatarsal stress fracture?

A

Prolonged rest in rigid soled boot.

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24
Q

On X-ray when are the metatarsal fractures most visible?

Study These Flashcards
A

3 weeks post injury as resorption of the fracture causes gap to open up or callus forms.

25
Where on the achilles tendon does tendonitis or rupture originate from?
Hypovascular region 2-6 cm from the origin.
26
Pathology of achilles tendonitis
Repetitive microtrauma and collagen repair dysfunction resulting in misalignment.
27
Predisposing factors for achilles tendontitis
``` Quinolone antibiotics (ciprofloxacin) Over training Rheumatoid arthritis Gout Inflammatory athropathies Steroids CTD ```
28
In achilles tendonitis where can the pain occur?
Within the tendon | On its insertion on the calcaneous.
29
Treatment for achilles tendonitis?
Activity modification (heel raising) NSAIDs Physiotherapy
30
What treatment is last line for achilles tendonitis?
Surgical decompression, wound healing and scars are often problematic.
31
What treatment is never used in achilles tendonitis?
Steroid injections
32
Method of injury in achilles rupture?
Sudden deceleration with calf contraction. | Lunging in badminton
33
What do patients often say with an achilles rupture?
Feel like they'd been kicked in the back of the leg.
34
What is clinical appearance of an achilles rupture?
Unable to bear weight. Weak plantar flexion Palpable painful gap
35
Predisposing factors for an achilles tendon rupture
``` Old age (degenerative) Existing tendonitis Steroid injections ```
36
Surgical repair of achilles tendon rupture.
Suture damaged tendon to restore tension. | Cast for 8 weeks
37
Non surgical repair of achilles tendon rupture.
Serial casts with ankle plantar flexed. | Early weightbearing whilst preventing dorsiflexio
38
Benefits of serial casting over surgery for achilles rupture repair?
Serial casting avoids common wound problems and has as good functional output.
39
Plantar Facsiits
Self limiting Repetitive stress/ degenerative condition. Pain whilst walking
40
Where is the pain in plantar fasciitis.
Heel of the foot | Origin of plantar aponeurosis on distal plantar aspect of calcaneal tuberosity.
41
What are some predisposing factors for plantar fasciitis?
Diabetes Obesity Frequent walking on hard floor or poorly cushioned shoes.
42
Treatment for plantar fasciitis
``` Rest Physiotherapy NSAIDs Steroid injection Night splints Heel cups in shoes. ```
43
Is surgery used in plantar faciitis?
Surgical release is used however 50% success rate and risk of damaging plantar nerves.
44
Tibialis Posterior route and insertion in the foot.
Passes posterior to the medial malleolus. | Inserts onto medial aspect of the navicular , and plantar aspect of medial and middle cuneiform.
45
What is the function of the tibias posterior?
Raises and stabilises the posterior arch. | Invertor and plantar flexor.
46
Predisposing factors for developing tibialis posterior dysfunction.
``` Rheumatoid arthitis Hypertension Diabetes Obesity Seronegative arthropathies ```
47
Treatment for tibialis posterior tendonitis
Splinting with medial arch support. NO steroid injection Surgical decompression if symptoms unresolving
48
How does tibias posterior dysfunction present?
Pain posterior to medial malleolus Diminished balance dislikes uneven surfaces Flat Feet Valgus of the heel
49
What is likely to occur if tibias posterior ruptures?
Osteoarthritis of hind and mid foot.
50
Surgery if no OA present in tibalis posterior rupture?
Tendon transfer and calcaneal osteotomy
51
Surgery if OA is present in tibialis posterior rupture?
Arthrodesis
52
Pes Cavus
Abnormally high arched foot | Often with clawed toes
53
What is pes cavus often associated with?
Polio unilateral Cerebral palsy Hererditary sensory and motor neuropathy Spina Bifida occulta
54
What is treatment if pain is present?
``` Surgical Soft tissue release Tendon transfer Calcaneal osteotomy Arthrodesis (severe) ```
55
What is the dysfunction in claw toes?
Hyperextension at MTPJ | Hyperflexion at PIP and DIP
56
What is the dysfunction in hammer toes?
Hyperextension and MTPJ and DIP | Hyperflexion at PIPJ
57
Issues with claw and hammer toes?
Painful and often rub against shoes and or each other resulting in ulceration and skin breakdown.
58
What are the non surgical options in claw or hammer toes?
Toe sleeves and corn plasters can prevent skin issues
59
Surgical options for claw or hammer toes.
Tenotomy (devotion of overactive tendon) Tendon transfer Arthrodesis or amputation in severe cases.

Year 2 MSK (19 decks)

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