How many bones, joints, ligaments and muscles are there in the foot?
Bones: 28 + accessory
What are common accessory bones?
- Os trigonum & accessory navicular are most troublesome
- Also os peroneum commonly
What are the common tarsal coalitions?
- 45% talocalcaneal
- 45% calcaneonavicular
- 10% other
What are the symptoms of tarsal coalitions?
Symptoms tend to occur in the same location, regardless of the location of coalition: on the lateral foot, just anterior and below the lateral malleolus. This area is called the sinus tarsi
The onset of symptoms related to a tarsal coalition usually occurs at about nine to seventeen years of age, with a peak incidence occurring at ten to fourteen years of age. Symptoms may start suddenly one day and persist, and can include pain (may be quite severe), lack of endurance for activity, fatigue, muscle spasms and cramps, an inability to rotate the foot, or antalgic gait.
What are the two likely causations of ankle arthritis?
Consider haemochromatosis if no known trauma and under 50 years.
Which starts earlier, hip or ankle arthritis?
Ankle - mean age of diagnosis of ankle arthritis is 46 years
Mean age of onset of hip arthritis is 51 years
What are the sirgical procedures for ankle arthritis?
Plate and screws - fusing bones together
Ankle replacement is great if done well – but bad is done badly
- Fusion is preferential to bad ankle replacement
What are the two tendons that form the achilles tendon?
- Formed by 2 tendons
What are the tests possible for assessing if the an=chilles tendon is ruptured?
Simmonds triad of tests
Calf squeeze and no plantarflexion
Altered angle of dangle (the foot adopts a more dorsiflexed position)
Visible gap in the achilles tendon
What does cavovarus foot look like?
The arch is very high and the heel slants inward. Both feet are often affected and the misalignment gradually worsens over time.
If caused by charcot-marie-tooth then it is bilateral
What happens as a result of cavovarus foot deformity?
Pain, calluses, ankle sprains and stress fractures are all common results of cavovarus foot deformity.
What might cavovarus foot indicate?
The condition may be a sign of a neurological disorder or Charcot-Marie Tooth disease, both of which can affect the nerves and weaken the muscles of the feet.
What do the words cavus and varus mean?
Cavus means high arched
Varus means the heal has turned inward
A feature of cavovarus foot is equinus, what does this mean?
Insufficicent ankle dorsiflexion for normal gait
Here is the pathogenesis of deformity
- Weakness of intrinsic muscles - clawing of toes
- ‘Plunger-effect’ by proximal phalanges - plantarflexion of MT’s – also ‘overaction’ of peroneus longus
- Weakness of peroneus brevis - hindfoot varus
- Weakness of tibialis anterior - equinus
- Overpull of tibialis posterior - adduction of forefoot
What are the clinical manifestations of the following deformities?
Clawing of toes and plantarflexion of metatarsals
Weakness of peroneus brevis
Weakness of tibialis anterior
Overpull of tibialis posterior
- Clawing of toes & plantarflexion of metatarsals - plantar callosities and shoe problems
- Weakness of peroneus brevis - hindfoot varus - ankle instability
- Weakness of tibialis anterior – equinus - altered gait
- Overpull of tibialis posterior - adduction of forefoot - stress fractures of lateral metatarsals
What is the presentation of cavovarus foot?
Lateral foot pain (5th metatarsal stress fractures)
Plantar calluses on the 5th and the 1st metatarsal heads
What is the physical test for cavovarus foot?
Coleman block test
What does the coleman block test assess?
place 1” block under the lateral foot
eliminates contribution of the plantarflexed 1st ray and forefoot pronation to the hindfoot deformity
flexible hindfoot will correct to neutral or valgus when block placed under lateral aspect of foot (if the hindfoot varus corrects, it shows hind foot flexibility)
rigid hindfoot will not correct to neutral
Differentiates between forefoot driven hindfoot varus and hindfoot driven varus.