Foot/ankle conditions Flashcards

Question

Age groups affected by hallux valgus

Answer 1

30-50 More prevalent in females due to type of shoes

Answer 2

P + deformity of first MTP Jt Increasingly large bump over first MTP Jt Complaints of how shoe fits More symptomatic throughout day

Answer 3

Conservative- accommodate deformity, alleviate symptoms, shoe wear modification Night splints, custom orthotic inserts, bunion pads, and spacers may be useful Surgical options post conservative

Answer 4

History of gradual, chronic, onset rather than acute, traumatic presentation P usually occurs from prolonged weightbearing activities such as walking, standing and running

Answer 5

Excess weight Shoes Morton’s neuroma Foot deformities

Answer 6

P on ball of foot Onset is gradual Tenderness to palpation at dorsal, central +/or plantar aspect of affected lesser MTPJ Are of thickened skin/callus at affected JT Assess ROM of MTPJ

Answer 7

Alleviate P by decreasing weight bearing Advised to modify shoe wear + avoid narrow toe box + high heels Use metatarsal pad to shift pressure

Answer 8

Progressive deformity that fails surgical treatment, Pt with recalcitrant P that fails nonsurgical treatment

Answer 9

Band of fibrous tissue extending from plantar calcaneal tuberosity to flexor tendon expansion in forefoot Supports longitudinal arch of foot

Answer 10

Obesity Work related weight bearing Decreased ankle dorsiflexion Runners/athletes more prone, repetitive microtrauma to fascia

Answer 11

Heel P Start up P is classic complaint with worse symptoms upon getting out of bed Usually non-radiating, abates with rest Stance may reveal foot deformity such as pes planus/cavus P often exacerbated when toes are passively dorsiflexed (stretches fascia) Neurological exam necessary to rule out neuropathy from diabetes, radiculopathy or nerve root compression

Answer 12

Nonsurgical Benefits from 3-4 weeks of immobilisation in short leg cast Well-padded shoes, inserts, night splints, stretching gastroc + plantar fascia Length of treatment varies

Answer 13

Calcaneal stress #

Answer 14

Refers to symptoms caused by painful branches of common digital nerves most often in second or third web spoces of foot

Answer 15

Traction of metatarsal ligament compresses nerve during normal gait, leaving it susceptible to irritation or direct trauma

Answer 16

Middle aged women- history of wearing shoes with narrow toe box or high heels

Answer 17

Pin point burning P in second/third web space, worsened by shoe wear Symptoms often alleviated by removing shoes + massaging toes May report decreased sensations P with palpation of plantar surface or lesser metatarsal head + of skin Reproducible P with palpation of second/third interspace

Answer 18

Goal of treatment is to alleviate pressure on nerve Shoe modification- wide toe box, smaller heel Orthotic or insole with metatarsal pads placed directly behind interspace allows separation of metatarsal heads, thereby protecting nerve from pressure during walking NSAIDs will provide some benefits

Answer 19

Cause unknown Evidence of chromosomal defect, arrested development in utero, or an embryonic event such as vascular injury

Answer 20

Incidence of 1-3 per 1000 births Boys 2x more likely than girls

Answer 21

Family history increases risk by 20-30 times Boy Spina bifida

Answer 22

Foot curved downwards and inwards, ankle in equinus, heel in varus, forefoot adducted, flexed and supinated Skin and soft tissue of calf and medial boarder of lateral foot are short + underdeveloped Deformity obvious at birth Heel small and high Assess for associated disorders- hip dislocation, spina bifida

Answer 23

Treatment should be early, preferably within few hours of birth Repeated manipulation and adhesive strapping Once corrected, splintage in de-rotation boot is followed until child is 3

Answer 24

Varies form slightly curved forefoot to something resembling mild club foot Deformity across tarsometatarsal Jt

Answer 25

90% improving spontaneously or can be managed non-operatively using corrective cast

Answer 26

Apex of longitudinal arch has collapsed and medial border of foot is in contact with ground Heel becomes valgus and pronates the foot

Answer 27

Bones may not have grown properly in womb As a result of injury

Answer 28

Arch not formed until 4-6 years About 15% of population have supple symptomatic flat-feet Mobile/flexible flat foot- occurs in toddlers as normal stage of development Stiff/rigid- teenagers

Answer 29

Appearance can be normal and without P Some can be stiff + P If heels invert and medial arches form when on their toes- likely to be flexible/mobile Teenagers sometimes present with painful, rigid flat foot

Answer 30

Ask if they've always had flat feet or if its recent onset More recent deformities may be due to underlying disorders, e.g., RA, or general muscle weakness

Answer 31

Mobile- often disappears after a few years when medial arch development is complete Rigid- cannot be corrected passively, can be improved by surgery

Answer 32

Can be past history of spinal disorders Hereditary

Answer 33

Often noticeable by age 8-10, before there are any symptoms

Answer 34

Highly arched foot, toes drawn into claw position At first position is mobile and deformity cna be corrected passively by pressure under metatarsal heads; as forefoot lifts, toes flatten automatically Later deformity becomesfixed with toes hyperextended at MTP Jt and flexed at IP Jt Walking tolerance usually reduced

Answer 35

Often no treatment required Pt with significant discomfort may benefit from fitting custom made shoes with moulded supports If symptoms persist, tendon rebalancing operation may be required

Answer 36

Hereditary Loss of muscle tone in elders Common with RA

Answer 37

Women 50-70 Appears during late adolescents

Answer 38

Type of shoe

Answer 39

Slightly fan shaped appearance P pressure may be due to- shoe pressure on bunion, splaying of forefoot + muscle P, associated deformities to lesser toe

Answer 40

Encourage wear of shoes with deep toe-box, soft uppers and low heels Surgical treatment readily offered to older Pt

Answer 41

Rigidity of MTP Jt

Answer 42

Local trauma Osteochondritis dissecans of first metatarsal head Older people- long standing Jt disorders, e.g., gout, pseudogout, OA

Answer 43

P on walking, especially on slopes or rough ground Hallux is straight, MTPJ feels knobbly Tender osteophyte on dorsum on MTPJ Restricted + painful extension

Answer 44

Rocker-soled shoe may abolish P by allowing foot to roll without necessity for dorsiflexion at MTPJ If walking is painful despite of shoe adjustment, operation advised Removal of osteopahyte

Answer 45

Isolated flexion deformity of proximal IPJ of lesser toes 2/3 Shoe pressure may produce painful corn Operative treatment offered if P and difficulty with shoes

Answer 46

Deformity of all toes MTPJ hyperextended and IPJ flexed Suggests intrinsic muscle weakness NO cause found May indicate pes cavus P in forefoot + under metatarsal head Bilateral, walking may be impaired Painful corns + calluses may develop Metatarsal support to relieves P Operation

Answer 47

Distal IPJ flexed Toenail or tip of toe presses into shoe, resulting in painful callosity If conservative treatment doesn't work, operations is indicated

Answer 48

Often seen when a markedly valgus big toe forces adjacent second toe to find room by sitting on top of hallux Overlapping toe may fall back into position once hallux is corrected, but sometimes surgery is needed Overlapping fifth toe is congenital anomaly, if bothersome toe may be straightened by dorsal plasty

Answer 49

Early on- synovitis in joints, sheathed tendons Progression- joint erosion and tendon dysfunction, increasingly severe deformities

Answer 50

P and swelling of MTPJ Tenderness first localised to MTPJ, later entire foot is painful on pressing or squeezing Increase weakness of intrinsic muscles and/or Jt destruction Deformities- flattened arch, hallux valgus, claw toes + prominence of metatarsal heads in sole (Pt may say its like walking on pebbles) Corns, calluses common Once deformity is advanced, treatment is surgery

Answer 51

Earliest symptoms are P + swelling around ankle Walking becomes increasingly difficult + later deformities appear Swelling + tenderness localised to back of medial malleolus Restricted ROM Synovitis- splintage helpful to allow inflammation to subside Injections 2-3 times may reduce inflammation

Answer 52

Almost always secondary to- malunited fracture, recurrent instability, osteochondritis dissecans of talus, avascular necrosis or repeated bleeding with haemophilia

Answer 53

P + stiffness localised to ankle, particularly when first standing from rest Ankle usually swollen, palpable ant osteophyte + tenderness along Jt line Dorsi/plantar flexion restricted Gait often antalgic Foot may be turned outwards in stance phase to compensate for loss of ankle movement

Answer 54

Painful exacerbation can be managed by analgesics or anti-inflammatory drugs Offloading the Jt can be achieved with use of walking stick, weight loss might be appropriate

Answer 55

Obesity High blood pressure Diabetes Kidney problems

Answer 56

More likely in men 30-50

Answer 57

Swelling, redness, heat and tenderness of MTPJ of big toe Ankle Jt or one of lesser toe may be affected, especially following minor injury May resemble septic arthritis

Answer 58

Ant-inflammatory drugs Until pain subsides foot should be rested + protected from injury

Answer 59

Begins as synovitis or as osteomyelitis because walking is painful Swollen ankle Calf markedly wasted Skin feels warm Limited ROM

Answer 60

In addition to general treatment a removeable splint used the foot in neutral If diseases arrested early, Pt allowed up non-weightbearing in a calliper, gradually taking more and more weight and then discard calliper

Answer 61

1. Predisposition to peripheral vascular disease 2. Damage to peripheral nerves 3. Reduced resistance of infection 4. Osteoporosis

Answer 62

Complications of long standing diabetes mellitus appear in foot, causing chronic disability

Answer 63

May be ulceration or gangrene in foot Peripheral neuroplasty early on, P may complain of symmetrical numbness and paraesthesia Motor loss may lead to claw-toes with high arches, may predispose to ulceration

Answer 64

With regular attendance to diabetic clinic, full compliance with medication, taking advice of foot wear, high level of skin hygiene, etc will ease complications

Answer 65

Athletes, joggers and hikers often develop pain and swelling around achilles, due to local irritation Function inhibited because of P Condition may come on gradually or rapidly following change of activity Tendon feels thickened + tender around 4cm above insertion RICE, NSAIDs initially When symptoms improve, stretching exercises + muscle strengthening introduced

Answer 66

Rupture probably occurs if tendon is degenerate Most Pt over 40 While pushing off, gastroc contracts, body contraction is resisted by body weight --> rupture Unable to rise on tip toes Soon after, gap can be seen + felt about 5cm above insertion Simmonds test

Answer 67

Except after trauma or in RA, persistent P around ankle usually originates in one periarticular structures or in talus rather than Jt itself

Answer 68

Tenderness + swelling localised to affected tendon P aggravated by active movement- inversion or eversion, against resistance Local corticosteroid injection usually helps

Answer 69

P starts suddenly, may be history of snapping tendon Heel in valgus during weightbearing area around medial malleolus is tender + active inversion of ankle is painful + weak operative treatment available

Answer 70

Unexplained P + slight limitation of movement of ankle in a young person May be due to small osteochondral fracture pf dome of talus X-ray will show fragment MRI identifies lesion If fragment is removed, treatment is successful

Answer 71

Talus- preferred site of idiopathic necrosis If P is marked, arthrodesis of ankle may be needed

Answer 72

Ligament laxity

Answer 73

P felt predominately in heel, mid foot ot forefoot Common causes: - mechanical pressure- likely from foot deformity - joint inflamm/stiffness - localised bone lesion - muscle strain

Answer 74

Usually occurs in young boys Mild traction injury P + tenderness localsied to achilles insertion

Answer 75

X-ray shows increased density/irregularities of apophysis Heel of shoe should be raised a little + strenuous activity restricted for a few weeks

Answer 76

Older girls + younger women often complain of painful bumps on back of their heels Shoe friction causes bursitis Treatment should focus on footwear, open back shoes, padding of heel If symptoms warrant, removal of calcaneal prominence may help

Answer 77

P under ball of heel Mainly men, aged 30-60 Worse on weightbearing X-ray shows bony spurs Sometimes encountered in Pt with inflamm disorders (e.g., gout, ankylosing spondylitis) Treatment is conservative- NSAIDs, local steroid injections, pad under heel Can take 18-36 months to heal

Answer 78

Calcaneal lesions such as infection, tumours, and Paget's disease can give rise to unremitting pain in heel Diagnosis usually obvious in x-ray

Answer 79

In children, P in midtarsal region is unusual Possible cause- Kohler's disease or bony coalition across midtarsal Jt Kohler's- may resolve spontaneously Bony coalition- not all need removing

Answer 80

P + tenderness directly under 1st metatarsal head, typically aggravated by walking or passive dorsiflexion of greater toe Symptoms usually arise from irritation or inflammation of peritendinous tissues around sesamoids Treatment- reduced weightbearing, pressure pad on shoe

Answer 81

P over MTPJ + bony lump, palpable and tender X-ray shows head to be flattened + wide, neck thick + Jt space increased Walking plaster or moulded sandal will help reduce pressure on metatarsal head Persistent symptoms- synovectomy, debridement + trimming of metatarsal heads

Answer 82

Of 2/3 metatarsal bones seen in young adults after activity Affected metatarsal shaft feels thick + tender

Answer 83

Usually seen in women around 50 P in forefoot, as if walking on pebble, with radiation to all toes Tenderness localised to one intermetatarsal spaces- usaully 3rd + pressure just proximal to interdigital web may elicit both P + tingling sensation Secondary thickening of nerve creates impression of 'neuroma' Treatment- protective padding, wearing wider shoes, steroid injection may relieve injection may relieve symptoms Operative options if that doesnt work

Answer 84

Nail burrows into nail groove; this ulcerates + its wall grows over the nail (embedded toenail) Cut nail in square shape If preventative measures don't work, part of nail responsible for 'ingrown' should be ablated, rare to ablate whole toenail

Answer 85

Nail gradually lifts from bed by an 'exostosis' growing on dorsum of terminal phalanx X-ray shows bony tuberance 'Exostosis' should be removed, but reoccurrence is not uncommon

Answer 86

Hx- insidious onset of P, better with rest, overuse injury SSx- tender to palpation

Answer 87

Most common stress # Usually involves dominant leg Repetitive trauma Less common mid shaft where the 'dreaded black line' (where more serious injury occurs)

Answer 88

Commonly involves 2/3 Secondary to repetitive stress Tenderness with metatarsals/Mortons squeeze test No numbness or tingling

Answer 89

Secondary to repetitive trauma Heel P may mimic plantar fasciitis or retrocalcaneal bursitis/achilles tendonitis Tenderness with calacaneal side squeeze + percussion May be P on heel strike Often has altered gait (soft heel strike)

Answer 90

Medial or plantar foot P or parasthesis

Answer 91

Tenderness around tarsal tunnel +ve tinels

Answer 92

Lumbar radiculopathy

Answer 93

Burning P between metatarsals

Answer 94

Local tenderness +ve Mortons neuroma

Answer 95

Lumbar radiculopathy Metatarsal stress #

Foot/ankle conditions Flashcards

(119 cards)