Foot/Ankle problems

Question 1

What is Pes Planus? What causes it?

Answer 1

flat floot

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

Question 2

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

Answer 2

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

Question 3

What is the biggest risk factor for Pes Planus?

Answer 3

increased ligamentous laxity

Question 4

What does the tibialis posterior tendon do?

Answer 4

support the medial arch of the foot

Question 5

When does tibialis posterior tendon dysfunction occur?

Answer 5

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

Question 6

What is tibialis posterior tendonitis treated with?

Answer 6

a splint

Question 7

What are the risk factors for tibialis posterior tendonitis?

Answer 7

older women
obese
diabetes
hypertension
rheumatoid arthritis
steroid injections into tendon

Question 8

What is the common presentation of tibialis posterior tendon dysfunction?

Answer 8

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

Question 9

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

Answer 9

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

Question 10

What is the treatment for tibialis posterior tendon dysfunction?

Answer 10

physiotherapy - special footwear
insoles
surgery

Question 11

What is Pes Cavus?

Answer 11

high arched foot

Question 12

When is Pes Cavus pathological?

Answer 12

if only one foot is involved

Question 13

What are the pathological causes of Pes Cavus?

Answer 13

hereditary sensory and motor neuropathy
cerebral palsy
spina bifida

Question 14

What is the presentation of Pes Cavus?

Answer 14

clawing of toes

high arch

Question 15

What is the treatment of Pes Cavus?

Answer 15

soft tissue release
tendon transfer
calcaenal osteotomy
arthrodesis

Question 16

What is plantar fascitis?

Answer 16

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

Question 17

What are the causes of plantar fascitis?

Answer 17

diabetes
obesity
frequent walking on hard floors

Question 18

What is the test to test for plantar fascitis?

Answer 18

Baxters nerve

Question 19

What is the treatment for plantar fascitis?

Answer 19

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

Question 20

What are hallux valgus?

Answer 20

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

Question 21

What is the cause of hallux valgus?

Answer 21

some are hereditary

some due to increased laxity - females>males

Question 22

What are the problems that occur with hallux valgus?

Answer 22

lesser toe impingement
transfer metatarsalgia
pain
deformity
shoe problems

Question 23

What is the management of hallux valgus?

Answer 23

non surgical shoe modifications - padding

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

Question 24

What is hallux rigidus?

Answer 24

osteoarthritis of the 1st metatarsalphalangeal (MTP) joint

Question 25

What can cause hallux rigidus?

Answer 25

could be degenerative or | secondary to oesteochondral injury

Question 26

What is the treatment for hallux rigidus?

Answer 26

gold: arthodesis (fusion) | stiff soled shoes and removal of osteophytes

Question 27

What is mortons neuroma?

Answer 27

irritated plantar interdigital nerves can become inflamed and swollen forming a neuroma

Question 28

What is the presentation of a mortons neuroma?

Answer 28

burning pain and tingling radiating to affected toes

Question 29

What is the main risk of mortons neuroma?

Answer 29

women > men due to high heel wearing

Question 30

How is mortons neuroma diagnosed?

Answer 30

ultrasound - shows a swollen nerve | Mulders click test

Question 31

What is the treatment of mortons neuroma?

Answer 31

conservative - metatarsal pad/offloading insole steroid/anaesthetic injections excise the neuroma

Question 32

What metatarsals are more prone to stress fractures?

Answer 32

2nd then 3rd

Question 33

Who do stress fractures commonly occur in?

Answer 33

runners | distance walkers

Question 34

What are the investigations for stress fractures?

Answer 34

1st: bone scan | Xray show it 3 weeks later

Question 35

What is the treatment for stress fractures?

Answer 35

rest and 6-12 weeks in a rigid sole boot

Question 36

What is Achillies tendonitis due to?

Answer 36

repetitive strain Quinolone antibiotics rheumatoid arthritis gout

Question 37

What is the treatment of Achillies tendonitis?

Answer 37

rest use of splint/boot if unresponsive: tendon decompression and resection of paratendon

Question 38

What may Achillies tendonitis lead to?

Answer 38

RUPTURE

Question 39

Who is most prone to Achillies tendonitis rupture?

Answer 39

middle aged/older age groups - due to degenerative changes

Question 40

What leads to a Achillies tendonitis rupture?

Answer 40

sudden deceleration with calf muscle contraction

Question 41

What is the presentation of an Achillies tendonitis rupture?

Answer 41

pain down back of the calf inability to weight bear weakness of plantar flexion palpable gap in tendon

Question 42

What is the investigation for Achillies tendonitis rupture? What is the treatment?

Answer 42

Thompsons test | some surgeons would repair the tendon, some would not

Question 43

Why do claw and hammer toes develop?

Answer 43

due to an imbalance between the flexor and extensor tendon

Question 44

What are claw toes?

Answer 44

hyperextended MTP joint | hyperflexed PIP and DIP joint

Question 45

What are hammer toes?

Answer 45

hyperextended MTP and DIP | hyperflexion at PIP

Question 46

What is the treatment of claw toes and hammer toes?

Answer 46

tenotomy - devision of overactive tendon tendon transfer arthrodesis toe amputation