Foot/Ankle problems Flashcards

(46 cards)

1
Q

What is Pes Planus? What causes it?

A

flat floot

failure of the medial arch development in childhood - normally aged 7

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2
Q

What can Pes Planus be due to when it is acquired and not congenital?

A

due to tibialis posterior tendon stretch or rupture, rheumatoid arthritis or charcot foot

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3
Q

What is the biggest risk factor for Pes Planus?

A

increased ligamentous laxity

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4
Q

What does the tibialis posterior tendon do?

A

support the medial arch of the foot

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5
Q

When does tibialis posterior tendon dysfunction occur?

A

when the tendon is under repeated stress, degeneration can develop tendonitis and it can rupture

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6
Q

What is tibialis posterior tendonitis treated with?

A

a splint

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7
Q

What are the risk factors for tibialis posterior tendonitis?

A
older women
obese
diabetes
hypertension
rheumatoid arthritis
steroid injections into tendon
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8
Q

What is the common presentation of tibialis posterior tendon dysfunction?

A

pain/swelling posterior to the medial malleolus
change in foot shape
noticable hallux valgus
more toes on the affected side when look at foot from behind

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9
Q

What are the types 1-4 of tibialis posterior tendon dysfunction?

A

1 - swelling, tenderness, slightly reduced muscle power
2 - planovalgus, midfoot abduction
3 & 4 - fixity and mortise signs

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10
Q

What is the treatment for tibialis posterior tendon dysfunction?

A

physiotherapy - special footwear
insoles
surgery

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11
Q

What is Pes Cavus?

A

high arched foot

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12
Q

When is Pes Cavus pathological?

A

if only one foot is involved

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13
Q

What are the pathological causes of Pes Cavus?

A

hereditary sensory and motor neuropathy
cerebral palsy
spina bifida

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14
Q

What is the presentation of Pes Cavus?

A

clawing of toes

high arch

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15
Q

What is the treatment of Pes Cavus?

A

soft tissue release
tendon transfer
calcaenal osteotomy
arthrodesis

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16
Q

What is plantar fascitis?

A

pain when walking is felt on the instep of the foot with localised tenderness

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17
Q

What are the causes of plantar fascitis?

A

diabetes
obesity
frequent walking on hard floors

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18
Q

What is the test to test for plantar fascitis?

A

Baxters nerve

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19
Q

What is the treatment for plantar fascitis?

A
usually heals over 18-24 months
rest
achillis and plantar fascia stretching
NSAID injections
electrocarpal shocks
20
Q

What are hallux valgus?

A

“bunions” - inflammed base over the medial 1st metatarsal head

21
Q

What is the cause of hallux valgus?

A

some are hereditary

some due to increased laxity - females>males

22
Q

What are the problems that occur with hallux valgus?

A
lesser toe impingement
transfer metatarsalgia
pain
deformity
shoe problems
23
Q

What is the management of hallux valgus?

A

non surgical shoe modifications - padding

surgical - osteotomies to realign bone and to tighten slack tissue and release tight tissue

24
Q

What is hallux rigidus?

A

osteoarthritis of the 1st metatarsalphalangeal (MTP) joint

25
What can cause hallux rigidus?
could be degenerative or | secondary to oesteochondral injury
26
What is the treatment for hallux rigidus?
gold: arthodesis (fusion) | stiff soled shoes and removal of osteophytes
27
What is mortons neuroma?
irritated plantar interdigital nerves can become inflamed and swollen forming a neuroma
28
What is the presentation of a mortons neuroma?
burning pain and tingling radiating to affected toes
29
What is the main risk of mortons neuroma?
women > men due to high heel wearing
30
How is mortons neuroma diagnosed?
ultrasound - shows a swollen nerve | Mulders click test
31
What is the treatment of mortons neuroma?
conservative - metatarsal pad/offloading insole steroid/anaesthetic injections excise the neuroma
32
What metatarsals are more prone to stress fractures?
2nd then 3rd
33
Who do stress fractures commonly occur in?
runners | distance walkers
34
What are the investigations for stress fractures?
1st: bone scan | Xray show it 3 weeks later
35
What is the treatment for stress fractures?
rest and 6-12 weeks in a rigid sole boot
36
What is Achillies tendonitis due to?
repetitive strain Quinolone antibiotics rheumatoid arthritis gout
37
What is the treatment of Achillies tendonitis?
rest use of splint/boot if unresponsive: tendon decompression and resection of paratendon
38
What may Achillies tendonitis lead to?
RUPTURE
39
Who is most prone to Achillies tendonitis rupture?
middle aged/older age groups - due to degenerative changes
40
What leads to a Achillies tendonitis rupture?
sudden deceleration with calf muscle contraction
41
What is the presentation of an Achillies tendonitis rupture?
pain down back of the calf inability to weight bear weakness of plantar flexion palpable gap in tendon
42
What is the investigation for Achillies tendonitis rupture? What is the treatment?
Thompsons test | some surgeons would repair the tendon, some would not
43
Why do claw and hammer toes develop?
due to an imbalance between the flexor and extensor tendon
44
What are claw toes?
hyperextended MTP joint | hyperflexed PIP and DIP joint
45
What are hammer toes?
hyperextended MTP and DIP | hyperflexion at PIP
46
What is the treatment of claw toes and hammer toes?
tenotomy - devision of overactive tendon tendon transfer arthrodesis toe amputation