Foot and Ankle Disorders

Question 1

What is the role of tibias posterior?

Answer 1

Support the medial arch of the foot

Question 2

What are the risk factors for tibialis posterior dysfunction?

Answer 2

• obesity
• age
• flat foot
• hypertension
• diabetes
• steroid injection
• seronegative arthropathies
• idiopathic tendonitis

Question 3

How will tibialis posterior dysfunction present?

Answer 3

Pain/swelling posterior to medial malleolus
Change in foot shape
Diminished walking ability/balance
Dislike of uneven surfaces - hallux valgus

Question 4

Describe the 4 types of tibialis posterior dysfunction

Answer 4

I - swelling, tenderness, weak muscle power
II - planovalgus mid foot abduction
III/IV - fixity and mortise signs

Question 5

How is tibialis posterior dysfunction treated?

Answer 5

Physio 
No steroids 
Insoles 
Orthoses 
Special footwear 
Surgery

Question 6

What causes pes cavus?

Answer 6

Usually idiopathic but can be secondary to HSMN, CP, polio, spina bifida, club foot

Question 7

How is pes cavus treated?

Answer 7

Surgery may be required - soft tissue releases, tendon transfers, calcaneal osteotomy, arthrodesis

Question 8

How does plantar fasciitis present?

Answer 8

Start up pain after rest, worse after exercise, fullness/swelling of plantar medial aspect of heel

Question 9

What causes plantar fasciitis?

Answer 9

• physical overload
• seronegative arthropathie
• diabetes
• abnormal foot shape

Question 10

How is plantar fasciitis treated?

Answer 10

NSAIDS, night splints, taping/support, physio, steroids, surgery
Self limiting

Question 11

Define Hallux Valgus

Answer 11

Deformity of the great toe due to medial deviation of the 1st metatarsal and lateral deviation of the toe

Question 12

How is affected by hallux valgus?

Answer 12

Older women with joint laxity

Rheumatoid arthrits

Question 13

What is hallux rigidus?

Answer 13

Osteoarthritis of the 1st MTP joint
Primary
Secondary to osteochondral injury

Question 14

Describe Morton’s Neuroma

Answer 14

Degenerative fibrosis of digital nerve near its bifurcation

Question 15

How will a patient with morton’s neuroma present?

Answer 15

Burning and tingling in toes

Question 16

Describe the examination findings in mortons neuroma

Answer 16

Loss of sensation
Mulder’s click - compression will reproduce symptoms
Ultrasound will show swollen nerve

Question 17

How is Morton’s neuroma diagnosed?

Answer 17

Modify footwear
Steroids
Anaesthetic injections

Question 18

Name the risks of achilles tendonitis

Answer 18

Ciprofloxacin
Steroids
Rhematoid arthritis

Question 19

How does achilles tendonitis present?

Answer 19

Pain, morning stiffness eased by heat/walking

Question 20

How is achilles tendonitis diagnosed?

Answer 20

Examination
Ultrasound
MR

Question 21

How is achilles tendonitis managed?

Answer 21

Physio 
Splint/boot
NSAIDs 
Surgery 
Analgesia

Question 22

What is the mechanism of injury for achilles tendonitis ?

Answer 22

Sudden deceleration with resisted calf contraction leads to pain and difficulty weight bearing

Question 23

What test can be done in achilles rupture?

Answer 23

Simmonds - no plantar flexion of foot when squeezing calf

Question 24

What are the risk factors for achilles rupture?

Answer 24

Rheumatoid
Arthritis
Steroids

Question 25

How is achilles rupture managed?

Answer 25

Surgery

Cast in equinous position

Question 26

How are sprains and strains treated?

Answer 26

Rest
Ice
Compression
Elevation

Question 27

Describe the weber system for ankle fractures

Answer 27

A - below syndesmosis
B - at level of syndesmosis
C - above syndesmosis

Question 28

What criteria is used to assess need for ankle x-ray?

Answer 28

Ottowa

Question 29

How is an ankle fracture treated?

Answer 29

Boot, cast, surgery if unstable