Foot and Ankle problems

Question 1

what causes ankle OA

Answer 1

may be idiopathic/primary or as a consequence of a previous injury

Question 2

2 surgical options for ankle OA

Answer 2

arthrodesis and ankle replacement

Question 3

pros/cons arthrodesis

Answer 3

perhaps more reliable than replacement

re-operation rates much lower

Question 4

pros/cons ankle replacement

Answer 4

better functional outcome
high rates of early loosening, component sinkage and failure
should be reserved for elderly patients

Question 5

what is hallux valgus

Answer 5

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

Question 6

risk factors for hallux valgus

Answer 6

female
RA
other inflammatory arthropathies
neuromuscular disease

Question 7

what is a bunion

Answer 7

inflamed bursa over the medial 1st metatarsal

Question 8

what is hallux rigidus

Answer 8

1st metatarsophalangeal joint OA

Question 9

what causes hallux rigidus

Answer 9

can be primary (degenerative) or secondary to osteochondral injury

Question 10

treatment of hallux rigidus

Answer 10

wearing of a stiff-soled shoe to limit motion of a joint
removal of osteophytes
gold standard surgical treatment is arthrodesis

Question 11

what is Morton’s neuroma

Answer 11

when plantar interdigital nerves overlying the intermetatarsal ligaments become swollen and inflamed due to repeated trauma

Question 12

complaint in mortons neuroma

Answer 12

burning pain and tingling sensation radiating to the affected toes

Question 13

what is mulders click test

Answer 13

squeezing forefoot reproduces symptoms or produces characteristic click on Mortons neuroma

Question 14

diagnosis in mortons neuroma

Answer 14

USS - shows swollen nerve

Question 15

management of Mortons neuroma

Answer 15

metatarsal pad or offloading insole
steroid/local anaesthetic injection
neuromas can be excised

Question 16

most common place for metatarsal stress fracture

Answer 16

2nd met followed by 3rd

Question 17

how long before a fracture may occur on X-ray and what will be seen

Answer 17

3 weeks

resorption at fracture ends or callus appears

Question 18

treatment for stress fracture

Answer 18

prolonged rest 6-12wks in rigid soled boot

Question 19

predisposing factors to tendonitis

Answer 19

quinolone antibiotic use, RA, other inflammatory arthropathies and gout

Question 20

why should steroid injections not be administered around the Achilles tendon

Answer 20

risk of rupture

Question 21

presentation of plantar fasciitis

Answer 21

pain with walking felt on instep of foot, with localised tenderness on palpation of this site

Question 22

what is pes planus

Answer 22

flat foot

Question 23

in what percentage of the population is pes planus a normal variant

Answer 23

20%

Question 24

why does pes planus occur in some individuals

Answer 24

medial arch fails to develop in childhood

Question 25

what are flat footed people at higher risk of

Answer 25

tendonitis of tibialis posterior tendon

Question 26

what causes acquired flat foot

Answer 26

tibialis posterior stretch or rupture, RA or diabetes with Charcot foot

Question 27

what does the tibialis posterior tendon do

Answer 27

support the medial arch of the foot

Question 28

what is pes cavus

Answer 28

abnormally high arch of the foot

Question 29

what often causes pes cavus

Answer 29

neuromuscular conditions

Question 30

what often accompanies pes cavus

Answer 30

claw toes

Question 31

treatment for pain from pes cavus

Answer 31

soft tissue release and tendon transfer or calcaneal osteotomy severe cases may require arthrodesis

Question 32

why do claw and hammer toe occur

Answer 32

acquired imbalance between flexor and extensor tendons

Question 33

features of claw toe

Answer 33

hyperextension at MTPJ with hyperflexion at PIPJ and DIPJ

Question 34

features of hammer toe

Answer 34

hyperextension at MTPJ with hyperflexion at PIPJ and hyperextension at DIPJ

Question 35

surgical solutions for claw and hammer toe

Answer 35

tenotomy, tendon transfer, arthrodesis or toe amputation