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Foot and Ankle Problems Flashcards

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1
Q

Non-operative management of foot and ankle problems

A 
Analgesia
Shoe wear modification 
Activity modification 
weight loss
physio 
orthotics including insoles and bracing
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2
Q

Only indication for operative management in foot and ankle problems

A

Failure of non-operative management

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3
Q

Definition of achilles tendonitis/tedinosis

A

Degeneration/overuse condition of the achilles tendon with little inflammation

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4
Q

Definition of paratendinopathy

A

True inflammatory problem showing paratendoitis histologically

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5
Q

What is tendinopathy?

A

A term used to describe symptoms

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6
Q

Who gets paratendinopathy in achilles tendonitis?

A

Athletic populations
30-40 y/os
M > F

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7
Q

Who gets tendinopathy in achilles tendonitis?

A 
Non-athletic populations
> 40 y/os
Obesity
Steriods
Diabetes
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8
Q

Symptoms of achilles tendonitis

A 
Pain during exercise
Pain following exercise
Recurrent episodes
Difficulty fitting shoes (insertional)
RUPTURE
tenderness
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9
Q

Investigations for achilles tendonitis

A 
tenderness
Simmonds test 
angle of dangle and matles 
USS
MRI
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10
Q

Tests for rupture of achilles tendon

A

Simmonds test

Angle of dangle and matles

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11
Q

how does Simmonds test work?

A

Feet hanging off the bed lying face down
calf is squeexed
IF MOVES FOOT - then tendon not fully ruptured between the soleus mucle and heel bone
IF DOESNT MOVE FOOT - then full rupture of the tendon

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12
Q

Treatment of achilles tendonitis

A 
activity modification 
weight loss
shoe wear modification - > slight heel 
Extracorpeal shockwave treatment
Physio-eccentric stretching 
Immbolilisation (below knee cast)
operative
- gastrocnemius resection 
- release and debridement of tendon
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13
Q

Definition of plantar fasciitis

A

inflammation of the plantar fascia that runs along the bottom of the foot and connects the heel bone to the toes

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14
Q

Pathology of plantar fasciitis

A 
Chronic degenerative change
fibroblast hypertrophy 
absence of inflammatory cells
disorganised and dysfunctional vessels and collagen 
avascularity
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15
Q

Who is plantar fasciitis seen in?

A

Athletes with high intensity or rapid increase in training
Running in poorly padded shoes or on hard surfaces
Obesity
occupations with prolonged standing
foot/lower limb rotational deformities
tight gastro-soleus complex

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16
Q

Symptoms of plantar fasciitis

A

Pain first thing in the morning
Pain on weight bearing after rest - post static dyskinesia
Pain located at origin of plantar fascia
Frequently long lasting > 2 + years

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17
Q

Differential diagnosis of plantar fasciitis

A

nerve entrapement syndrome
arthritis
calcaneal pathology

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18
Q

Investigations of plantar fasciitis

A

Mainly clinical
Xrays
USS
MRI

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19
Q

Treatment of plantar fasciitis

A 
Rest, change training 
Stretching = achilles +/- direct stretching
Ice
NSAIDs
Arthoses - heel pads
physio 
weight loss
injections - corticosteriods
extracorpoel shockwave therapy 
nitric oxide
endoplasmic/open surgery 
platlet rich plasma 
topaz plasma coblation
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20
Q

What is hallux valgus?

A

Bunions

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21
Q

Which gender is hallux valgus most seen in?

A

Females

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22
Q

Causes of hallux valgus

A

Genetic

footwear

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23
Q

Symptoms of hallux valgus

A

deformed foot shape pressure
pressure symptoms from shoewear
pain from crossing over toes
metatarsalgia

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24
Q

What is metatarsalgia?

A

Pain and inflammation in the ball of the foot

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25
Pathology of hallux valgus
Lateral angulation of great toe Tendon pull realigned to centre of rotation of worsening deformity Viscous cycle of increased pull creating increased deformity Sesamoid bones sublex - less weight goes through the great toe As deformity progresses, abnormality of the lesser toes occur
26
Investigations of hallux valgus
clinical x-ray - severity of deformity - exclude associated degenerative change
27
Treatment of hallux valgus
shoe wear modification (wide +/- high toe box) orthotics to offload pressure/correct deformity activity modification analgesia operative - release lateral soft tissues - osteotomy 1st metatarsal +/- proximal phalanx
28
What is hallux rigidus?
Osteoarthritis of 1st MTP joint - stiff big toe
29
Causes of hallux rigidus
unknown genetic multiple microtrauma
30
Symptoms of hallux rigidus
mainly asymptomatic extreme pain on dorsiflexion limited ROM
31
Investigations of hallux rigidus
clinical | radiographs
32
Treatment of hallux rigidus
``` activity modification shoe wear with rigid sole (limited bending of toe) analgesia Surgery - cheilectomy - arthrodesis - arthroplasty - 1st MTPJ fusion - GOLD STANDARD - 1st MTPJ hemiarthropalsty ```
33
Pathology of claw toes
MTP hyperextended | Distal and proximal ITP flexed
34
Pathology of hammer toe
MTP can be extended but sometimes not | Distal ITP is straight or hyperextended
35
Causes of mallet toe
``` Imbalance between flexors/extensors Shoe wear (long 2nd toe being pushed down in shoe) neurological RA idiopathic ```
36
Symptoms of mallet toe
``` Deformity Pain from dorsum - from joint - from where toe sticks up rubbing on shoe Pain from plantar side - metatarsalgia ```
37
Treatment of mallet toe
``` activity modification shoe wear - flat shoes with high toe box to accommodate deformity orthotic insoles operative - flexor to extensor transfer - fusion of interphalangeal joint - release of metatarsophalangeal joint - shortening of osteotomy of metatarsal ```
38
What is mortons neuroma?
common digital nerve branches become individual nerves in between the metatarsal heads - interdigital neuralgia
39
symptoms of Mortons neuroma
``` Typically affects 3rd and 2nd webspaces pain - neuralgic burning pain - pain in between metatarsal heads - pain on the plantar side Inflammation and swelling severe numbness intermittent - especially if barefooted altered sensation in webspace ```
40
Who does mortons neuropathy tend to affect?
females aged 40-60
41
What is mortons neuroma frequently associated with?
Wearing high heeled shoes
42
investigations of mortons neuroma
clinical mulders click USS - BEST CHOICE MRI
43
What is mulder's click?
squeeze the metatarsal heads together and you will feel a CLICK
44
Treatment of mortons neuroma
injections for small lesions exicision of lesion including a section of normal nerve - ALWAYS leads to NUMBNESS
45
Mean presentation of ankle arthritis
46 y/o
46
Causes of ankle arthritis
Commonly post traumatic | idiopathic
47
Symptoms of ankle arthritis
Pain | stiffness
48
Diagnosis of ankle arthritis
clinical radiographs CT scan - to exclude other adjacent joint arthritis
49
treatment of ankle arthritis
``` weight loss activity modification analgesia physio steroid injections arthrodesis - GOLD STANDARD joint replacement ```
50
What is posterior tibial tendon dysfunction?
Acquired adult flat foot planovalgus
51
Diagnosis of posterior tibial tendon dysfunction?
``` Clinical = double or single heel rise MRI = to assess tendon ```
52
Presentation of posterior tibial dysfunction
flat foot planovalgus | medial or lateral pain
53
In double/single heel rise, what should happen to the heels?
Should swing from valgus to varus as heal rises
54
Treatment of posterior tibial tendon dysfunction
orthotics - medial arch support reconstruction of tendon triple fusion - subtalar, talonavicular, calcaneouboid
55
Treatment of rheumatoid forefoot
``` shoewear orthotics activity modification gold standard - MTPJ arthrodesis - 2-5th toe excision arthroplasty ```
56
Where do dorsal foot ganglion arise from?
Joint | tendon sheath
57
Causes of dorsal foot ganglia
Idiopathic underlying arthritis underlying tendon pathology
58
Symptoms of dorsal foot ganglia
condition itself doesn't present with pain but can get pain from - pressure of shoewear - underlying problem
59
Treatment of dorsal foot ganglia
Aspiration | operative excision
60
Recurrence rate of dorsal foot ganglia
high - 50%
61
What is plantar fibromatosis also known as?
Ledderhose disease and | Dupytrens of the foot
62
Pathology of plantar fibromatosis
progressive thickening if the foots deep connective tissue (fascia)
63
Presentation of plantar fibromatosis
Usually asymptomatic unless - very large - weight bearing area
64
Treatment of plantar fibromatosis
Avoid pressure - shoewear/orthotics Operative excision radiotherapy
65
Recurrence rate of plantar fibromatosis
very high - up to 80%
66
Causes of diabetic foot ulcer
``` diabetic neuropathy (unaware of trauma) diabetic autonomic neuropathy - lack of sweating/normal sebum production leading to dry cracked skin and skin being more sensitive to minor trauma poor vascular supply lack of patient education ```
67
Treatment of diabetic foot ulcer
``` prevention modify detriments to healing - diabetic control - smoking - vascular supply - external pressure (splints/shoe/weight bearing) - internal pressure (deformity) - infection - nutrition surgery - improve vascular supply - debride ulcers - correct any deformity to offload area - amputation ```
68
How many diabetic patients will develop ulceration?
15%
69
How many diabetic patients with ulcers will go onto amputation?
25%
70
5 year mortality of diabetic patients with ulcers
50%
71
Pathology of charcot's neuroathropathy
Neurotraumatic - lack of proprioception and protective pain sensation Neurovascular - abnormal autonomic nervous system results in increased vascular supply and bone resorption Rapid bone destruction occurring in 3 stages 1. fragmentation 2. coalescence 3. remodelling
72
Causes of charcot's neuroarthropathy
any cause of neuropathy diabetes syphillius
73
Presentation of charcots neuroarhropathy
``` not painful swelling erythematous foot neuropathy fractures/dislocations from minimal or no known trauma ```
74
Diagnosis of charcots neuroarthropathy
clinical radiographs MRI
75
Treatment of charcot's neuroarthropathy
prevention immobilisation/non weight bearing until acute fragmentation resolved correct deformity
76
What is used to look for evidence of achilles tendon rupture?
Simmonds triad 1. Palpation 2. Examining the angle of declination at rest 3. Calf squeeze test
77
What drug can have S/Es of new onset achilles tendon disorders?
Ciprofloxacin

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