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2 - MSK > Foot and Ankle Conditions > Flashcards

Foot and Ankle Conditions Flashcards

1
Q

List common foot and ankle conditions

A
  • Bunions
  • Hallux rigidus
  • Osteoarthritis of ankle
  • Achilles tendonitis
  • Achilles tendon rupture
  • Ankle fracture
  • Sprained ankle
  • Flat foot
  • Claw toe
  • Hammer toe and mallet toe
  • Diabetes mellitus affecting the foot
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2
Q

Describe the presentation of bunions

A
  • Hallux valgus
  • Medial deviation of the first metatarsal
  • Lateral deviation and/or rotation of the hallux
  • Prominence of the first metatarsal head, with or without an overlying callus
  • Cosmetic, pain, difficulty with shoes
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3
Q

Describe the causes and risk factors of bunions

A
  • Risk factors - females (high heels), middle aged
  • Cause may be due to trauma, gout, rheumatoid arthritis, connective tissue disorder
  • High heeled shoes do not cause bunions, but exaggerate it
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4
Q

Describe hallux rigidus and its presentation

A
  • Osteoarthritis of the 1st metatarsophalangeal joint
    • Joint is under lots of stress when walking
  • Presentation - pain in metatarsal phalangeal joint, lump over joint, stiffness, pain on movement
    • May compensate by walking on the outside of their foot
      • Range of dorsiflexion of big toe reduced
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5
Q

Describe presentation and risk factors of osteoarthritis of ankle joint

A
  • Usually occurs in a joint that has previously suffered trauma - post traumatic arthritis
  • Some occur due medical condition (gout, RA) or no identifiable cause
  • Risk factors - joint stress (ballet dancer, footballer), age, obesity, family history of OA
  • Presentation - pain, stiffness especially in morning
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6
Q

Describe achilles tendonitis and its cause

A
  • Inflammation of the Achilles tendon
    • Can occur within the tendon itself or at the point of insertion into the calcaneus
  • Commonly occur due to years of overuse - sprinters, runners
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7
Q

Describe symptoms and signs of achilles tendonitis

A
  • Pain and stiffness along the Achilles tendon in the morning
  • Pain in the tendon that worsens with activity
  • Severe pain 24 hours after exercising
  • Thickening of the tendon
  • Swelling that is present all the time but worsens with activity
  • Palpable bone spur
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8
Q

Describe typical cause of achilles tendon rupture and location

A
  • Rupture most commonly occurs in middle aged male during recreational sports
    • Forceful push-off with an extended knee (during jumping)
    • Fall with the foot outstretched in front and the ankle dorsiflexed
    • Falling from a height
  • Usual site of complete tear is the vascular watershed area
    • Hypovascular space 6cm above calcaneus insertion which lacks blood supply and therefore weak and susceptible to rupture
  • Plantaris running beside can still provide some movement
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9
Q

Describe the signs and symptoms of achilles tendon rupture

A
  • Sudden and severe pain at the back of ankle or in calf
  • Sound of a loud pop or snap
  • Palpable gap or depression in the tendon
  • Initial pain and swelling followed by bruising
  • Inability to stand on tip toe or push off whilst walking
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10
Q

Describe how to test for Achilles tendon rupture

A
  • Thompson’s test / Simmond’s test

- Kneel on chair, squeeze calf and foot should move if normal

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11
Q

Describe how ankle fractures occur

A
  • Fracture causing internal/external rotation or inversion/eversion can push the medial or lateral malleolus, thus causing a fracture at the site
  • Can also rupture the medial or lateral ligaments on the opposite side
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12
Q

Differentiate between stable and unstable ankle fracture

A
  • If the fracture is below the tibiofibular joint, the ankle will be relatively stable
  • If the fracture is above the tibiofibular joint, the ankle is unstable and requires surgical fixation
  • Talar shift - talar move out of mortise - equal space within ankle joint
    - Means unstable fracture
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13
Q

Describe ankle sprain including cause and consequence to 5th metatarsal

A
  • Ankle sprain refers to partial or complete tear of one or more ligaments of the ankle joint
  • Most common mechanism is an inversion injury affecting a plantarflexed and weightbearing foot
  • Commonly in ankle fractures, the 5th metatarsal is fractured as the fibularis brevis tendon is attached to the tuberosity of the 5th metatarsal
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14
Q

Describe the risk factors of sprained ankle

A
  • Weak muscle/tendons
  • Weak or lax ankle ligaments - hereditary or due to overstretching of ligaments due to repetitive sprains
  • Inadequate joint proprioception
  • Slow neuromuscular response to an off balance position
  • Running on uneven surfaces
  • Shoes with inadequate heel support
  • Wearing high heeled shoes
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15
Q

Describe flat foot

A
  • (Pes Planus)
  • Loss of medial longitudinal arch
  • Most children appear flat footed as their arches have not fully developed
    • Only a problem if it persists during or after adolescence
  • Results from excessive stretching of plantar calcaneonavicular ligament and plantar aponeurosis
  • Presents with pain behind medial malleolus, change of shape
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16
Q

Describe claw toe

A
  • Commonly affects all 4 of the small toes at the same time
    • Often hyperextended at the MTPJ and flexed at the PIP joint (and sometimes DIP joint)
  • Due to muscle imbalance causing ligaments and tendons to become unnaturally tight
    • Commonly secondary to neurological damage including cerebral palsy, stroke, diabetes, alcohol
17
Q

Describe hammer toe and mallet toe

A
  • Hammer toe is when the toe is flexed at the PIPJ whereas a mallet toe is flexed at the DIPJ
    • Can affect any toe but most common in second toe
  • Causes include ill-fitting pointed shoes and pressure on the second toe from adjacent hallux valgus
  • A tight shoe can cause muscles to contract and shorten - thus difficult to straighten
18
Q

Describe how diabetes causes foot problems

A
  • Infection, ulceration or destruction of the tissues of the foot
  • Peripheral neuropathy, ischaemia due to peripheral arterial disease or combination may lead to foot ulcers
  • Affects nerves and desensitisation - cannot detect injury
  • Immunosuppressed and thus injury causes infection
  • Rockerbottom foot may develop as middle of foot has all weight bearing
19
Q

Describe Charcot arthropathy

A
  • Progressive destruction of the bones, joints and soft tissues most commonly in ankle or foot
  • Over stress joint and hit foot against objects
  • Leads to bone deformity and bone loss - loss of weight bearing ability
  • Loss of bone stock, soft bone due to inflammation, lack of pain as a reminder
  • Patients often obese, cognitive problems, immunocompromised, self neglect

2 - MSK (19 decks)

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