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MSK Diseases > Foot & Ankle > Flashcards

Foot & Ankle Flashcards

(88 cards)

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1
Q

What is hallux valgus?

A

bunion- Medial deviation of 1st metatarsal

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2
Q

What are the risk factors for hallux valgus?

A

Genes
Ligamentous laxity
RA
Cerebral palsy
Flat feet
2nd toe amputation
High heeled narrow toed shoes

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3
Q

How does hallux valgus present?

A

Often bilaterally,

It’s kind of obvious just look at the toe lol

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4
Q

Management for hallux valgus

A

Analgesia
Splints and spacers
Better fitting shoes

Surgical correction if all else fails

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5
Q

What is hallux rigidus?

A

OA of 1st metatarsophalangeal joint

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6
Q

Primary vs secondary hallux rigidus

A

Primary- degenerative
Secondary- result of injury

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7
Q

What can cause hallux rigidus?

A

Unknown distinct cause but trauma may predispose

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8
Q

How does hallux rigidus present?

A

Joint pain and motion loss
Transfer Metatalgia- referred pain to other part of foot due to increased strain
Dorso-medial paraesthesia (weird sensation in feet)

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9
Q

How is hallux rigidus investigated?

A

X-ray

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10
Q

How is hallux rigidus managed?

A

NSAIDs
injections- corticosteroids
orthotics
activity modifications

Worst case scenario can either chop off affected bone or just replace the whole toe

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11
Q

What is Morton’s neuroma?

A

Benign fibrotic thickening of plantar digital nerve due to irritation

Most common in third joint space

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12
Q

What causes Morton’s neuroma?

A

Repeat trauma of plantar interdigital nerves overlying intermetatarsal ligaments -> neuroma

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13
Q

What are the risk factors for Mortons neuroma?

A

Age
obesity
Generally more common in females -> high heel shoe use

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14
Q

How does Morton’s neuroma present?

A

Squeezing toes together produces a click
Shoes exacerbate pain
Burning and tingling sensation in affected toes

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15
Q

How is Morton’s neuroma investigated?

A

Ultrasound to find the swollen nerve

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16
Q

How is Morton’s neuroma managed?

A

Conservative options such as orthotics and analgesia
Steroid injections as a second line

Surgical excision of affected nerve as a last resort

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17
Q

What is a lesser toe deformity?

A

Deformity of the 4 smaller toes, leaving them in a curved position/overlapping

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18
Q

What causes a lesser toe deformity?

A

Imbalance between flexor and extensor tendon

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19
Q

What is a claw toe?

A

Extended MTP, flexed DIP and PIP

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20
Q

What is a hammer toe?

A

Neutral MTP with flexed PIP and extended DIP

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21
Q

How do lesser toe deformities present?

A

Pain in footwear
Rubbing
Usually curved

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22
Q

How are lesser toe deformities managed?

A

Toe sleeves to prevent skin issues secondary to rubbing, wide toe shoes

Surgical correction/amputation is possible

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23
Q

What is pes cavus?

A

High arched feet

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24
Q

What causes pes cavus?

A

Related to neuromuscular conditions, like cerebral palsy, spina bifida, etc

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25
How does pes cavus present?
Pain in arch of foot and a visible larger curvature
26
What does pes cavus often present in conjunction with?
Claw doe deformity
27
How is pes cavus investigated?
X-ray MRI to further investigate a suspected neurological cause
28
How is pes cavus managed?
Orthotics, braces, special shoes More severe cases can get surgery eg soft tissue release, tendon transfers, arthrodesis
29
What is pes planus?
Flat feet
30
What is the most common cause of pes planus?
Tibialis posterior dysfunction Common in women
31
How does the arch of our feet normally develop?
Starts out flat and develops as we learn to walk- sometimes this doesn’t happen
32
How can development of the arch in our feet variate?
Familial tendency, ligamentous laxity Tibialis posterior dysfunction/rupture RA Diabetes -> Charcot foot
33
What are the types of flat feet?
**Mobile**- only present when patient is on tip toes- (familial/ligamentous laxity) **Rigid**- flatness persistent regardless- sign of underlying bone issue or inflammation
34
How does pes planus present?
Pain and swelling posterior to medial malleolus (specific) Change in foot shape Mid foot and ankle pain Change in walking ability, especially on uneven surfaces Poor balance Lateral wall impingement sensation (Sometimes)
35
How is pes planus investigated?
Observation Imaging Testing for TPD
36
How is pes planus managed?
If it causes no pain it doesn’t need treating If painful- Physio Bespoke footwear Orthotics Surgery
37
Name a complication of flat feet
Higher risk of Tibialis posterior tendonitis
38
What is plantar fasciitis?
Inflammation of plantar aponeurosis (at origin of calcaneus)
39
What causes plantar fasciitis?
Repeat stress/degeneration
40
What are the risk factors for plantar fasciitis?
Physical overload obesity diabetes age (atrophy of cushion pad) improper footwear
41
How does plantar fasciitis present?
Well localised pain, exacerbated by walking Likely swollen and tender Positive tinels test for Baxter’s nerve (the nerve that runs inside the heel)
42
How is plantar fasciitis diagnosed?
Via clinical diagnosis
43
How is plantar fasciitis managed?
Rest NSAIDs Night splints Heel support Physio Steroid injections
44
What causes Achilles tendon rupture?
Age related degeneration Or a specific event, e.g. injury
45
What are the risk factors for an Achilles tendon rupture?
Age steroids ciprofloxacin use RA diabetes
46
Clinical presentation of Achilles tendon rupture
**can’t weight bear** Palpable gap Weak plantar flexion Patient may hear audible rip sound at time of injury
47
Investigations for Achilles tendon rupture
US + MRI to distinguish between partial/complete tears
48
Treatment for an Achilles tendon rupture
Surgical repair OR Casting with foot plantarflexed to close tendon gap
49
What is Achilles tendonosis?
Inflammation of the Achilles tendon
50
What causes Achilles tendonosis?
Sport induced overuse -> Repeat strain peritendonitis (Micro tears + degeneration)
51
What are the risk factors for Achilles tendonosis?
Overtraining Ciprofloxacin use RA (or other inflammatory arthritis)
52
What is the basic pathophysiology of an Achilles tendonosis?
Repeat micro tears combined with failed collagen repair
53
How does Achilles tendonosis present?
Localised pain Morning stiffness that eases with walking
54
How is Achilles tendonosis diagnosed?
Clinical but can use scans to confirm
55
How is Achilles tendonosis managed?
Activity modification Analgesia NSAIDs Shockwave therapy Orthotics Physio
56
What causes a calcaneus fracture?
Most commonly a fall from height causing axial compression
57
How does a calcaneus fracture present?
Pain and difficulty weight bearing, Swelling, Other associated injuries from a fall
58
How is a calcaneus fracture investigated?
X-ray, CT scan, Bohlers angle assessment
59
How is a calcaneus fracture managed?
Casting Surgery is a bit shit so its not routine
60
Name complications of a calcaneus fracture
Risk of compartment syndrome, post injury arthritis, and permanent stiffness
61
What causes an ankle fracture?
Forceful inversion injury
62
What are the types of ankle fracture?
Can affect one or more part- medial malleolar, lateral malleolar, posterior malleolar Stable- a break without impacting alignment, so ankle stays stable Unstable- often bimalleolar or trimalleolar leading to misalignment of the joint (less common)
63
In terms of the ankle, what is meant by the syndesmosis?
The joint between the distal tibia and fibula
64
Explain the assessment criteria used for ankle fractures
**Weber classification** A- below syndesmosis, stable, non surgical management B- at syndesmosis level, negligible stability, may require surgery C- above syndesmosis, unstable, needs surgery
65
How is an ankle fracture investigated?
X-ray AP and Lat Check for soft tissue swelling and bony alignment CT to clarify anatomy in most complex cases
66
How is an ankle fracture managed?
Determined by Weber class Can be casting, moon boot, or ORIF
67
What causes an ankle sprain?
Twisting
68
How are ankle sprains graded?
1- stretch/microtears 2- partial ligament tear 3- complete rupture of ligament 4- chronic- recurrent sprains within 6 months
69
How do ankle sprains present?
Tenderness, swelling, bruising, Loss in function
70
How are ankle sprains managed?
PRICE: Protection Rest Ice Compression Elevation
71
What causes a talus fracture?
Forced dorsiflexion/rapid deceleration High energy impact
72
Name another type of talus related fracture
Talar dome margin fracture- Piece of bone fragment breaks off the superior talar surface
73
What are the risks that come with a talar fracture?
post traumatic arthritis Avascular necrosis or malunion
74
How is a talar fracture managed?
Either cast immobilisation or surgery depending on severity
75
What is a lisfranc fracture?
Broken bones or ligaments of the midfoot
76
What causes lisfranc fractures?
High energy impact
77
How does a lisfranc fracture present?
Severe midfoot pain when weight bearing
78
How are lisfranc fractures investigated?
X-ray AP and oblique (Other angles helpful as fracture may be subtle) CT due to multi-joint involvement, and possible ligamentous avulsion injury
79
How are lisfranc fractures managed?
ORIF
80
What are some complications of a lisfranc fracture?
Post traumatic OA
81
What causes a 5th metatarsal injury?
Inversion
82
What are the 3 types of digit and metatarsal injury
Avulsion Jones Proximal shaft
83
avulsion metatarsal fracture
Twisting injury -> avulsion via peroneus brevis tendon Treated with moon boot
84
Jones metatarsal fracture
Repeat trauma -> metaphyseal-diaphyseal junction fracture Often needs surgery because of malunion risk
85
Proximal shaft (stress) metatarsal fractures
Repeat stress or overuse (eg jumping athletes) -> mid shaft fracture Heals well with rest and immobilisation
86
How are metatarsal fractures investigated?
Lateral X-ray Can be confused with lateral malleolar fractures
87
How does a 5th metatarsal fracture present?
Pain over lateral foot border, issues weight bearing
88
What is a pilon injury
High impact causes talus to smash into distal tibia MDT managed due to severity and common soft tissue involvement

MSK Diseases (18 decks)

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