Foot Problems

Question 1

What are some of the general non operative treatment options for foot problems?

Answer 1

Analgesia 
Physiotherapy 
Weight loss 
Shoe wear modification 
Activity modification 
Orthotics

Question 2

What are some common forefoot problems?

Answer 2

Hallux valgus 
Hallux rigidus
Lesser toe deformities
Morton’s neuroma
Metatarsalgia
Rheumatoid Forefoot

Question 3

What are the symptoms of hallux valgus?

Answer 3

Pressure symtoms from shoe wear
Pain form crossing over of toes
Metatarsalgia

Question 4

What is the pathogenesis of hallux valgus?

Answer 4

Lateral angulation of great toe
Tendons pull realigned to lateral of centre of rotation of toe worsening deformity
Sesamoid bones sublux
As deformity progresses abnormalities of lesser toes occur

Question 5

How is a diagnosis of hallux valgus made?

Answer 5

Clinical examination

Xray

Question 6

What are the management options for hallux valgus?

Answer 6

Shoe wear modification 
Orthotics 
Activity modification 
Analgesia 
Release lateral soft tissues 
Osteotomy 1st metatarsal +/- proximal phalanx

Question 7

What is hallux rigidus?

Answer 7

Osteoarthritis of 1st MCP

Question 8

What are the symptoms of hallux rigidus?

Answer 8

Pain often at extreme of dorsiflexion

Limitation of range of movement

Question 9

What are the management options for hallux rigidus?

Answer 9

Activity modification 
Shoe wear with rigid sole 
Analgesia 
Cheilectomy 
Arthrodesis 
Arthroplasty

Question 10

What is the aetiology of lesser toe deformity?

Answer 10

Imbalance of flexors/extensors
Shoe wear 
Neurological 
Rheumatoid arthritis 
Idiopathic

Question 11

What are the general symptoms of lesser toe deformities?

Answer 11

Pain from dorsum

Pain from plantar side

Question 12

What are the treatment options for lesser toe deformities?

Answer 12

Activity modification 
Shoe wear (flat shoes with high toe box) 
Orthotic insoles 
Flexor to extensor transfer 
Fusion of interphalangeal joint 
Release metatarsophalangeal joint 
Shortening osteotomy of metatarsal

Question 13

What is the aetiology of Morton’s neuroma?

Answer 13

High healed shoes

Question 14

What are the symptoms of Morton’s neuroma?

Answer 14

Typically affects 3rd flowed by 2nd webspace/toes
Neuralgic burning pain into toes
Intermittent
Altered sensation in webspace

Question 15

How is a diagnosis of Morton’s neuroma made?

Answer 15

USS/MRI

Mulder’s click

Question 16

What is the management for Morton’s neuroma?

Answer 16

Injection for small lesions

Excision of lesion including a action of normal nerve

Question 17

What is the treatment for rheumatoid forefoot?

Answer 17

Shoe/orthotics/activity modification
1st MTPJ arthrodesis
2-5th oe excision arthroplasty

Question 18

What are the symptoms of dorsal foot ganglia?

Answer 18

Pain from pressure of shoewear

Pain from underlying problem

Question 19

What is the treatment for dorsal foot ganglia?

Answer 19

Aspiration

Excision

Question 20

What are the treatment options for mid foot arthritis?

Answer 20

Activity/shoewear/orthotics
Xray guided injections
Fusion operation

Question 21

What are the treatment options for plantar fibromatosis?

Answer 21

Avoid pressure
Shoe wear/orthotics
Excision
Radiotherapy

Question 22

What is an insertional tedinopathy?

Answer 22

With 2cm of insertion

Question 23

What is a non-insertional/id-substance tendinopathy?

Answer 23

2-7cm of insertion

Question 24

What is achilles tendinopathy associated with?

Answer 24

Non-athletic population 
>40 
Obesity 
Steroids 
Diabetes

Question 25

What are the symptoms of an achilles tendinopathy?

Answer 25

``` Pain during exercise Pain following exercise Recurrent episodes Difficulty fitting shoes Rupture ```

Question 26

How is a diagnosis of an achilles tendinopathy made?

Answer 26

Tenderness Tests for rupture (Simmonds, Matles) USS MRI

Question 27

What are the treatment options for achilles tendinopathy?

Answer 27

``` Activity modification Weight loss Shoe wear modification Physio Extra-corporeal shockwave treatment Immobilisation Gastrocnemius recession Release and debridement of tendon ```

Question 28

What is fasciosis?

Answer 28

Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen, asvascularity

Question 29

What is the aetiology of plantar fasciitis?

Answer 29

High intensity or rapid increase in training Running with poorly padded shoes or hard surfaces Obesity Occupations involving prolonged standing Foot/lower limb rotational deformities Tight gastro-soleus complex

Question 30

What are the symptoms of plantar fasciitis?

Answer 30

``` Pain first thing in morning Pain on weight bearing after rest Post-static dyskinesia Pain located at origin of plantar fascia Frequently long lasting – 2 years or more ```

Question 31

What is the differential diagnosis of plantar fasciitis?

Answer 31

Nerve entrapment syndrome Arthritis Calcaneal pathology

Question 32

How is the diagnosis of plantar fasciitis made?

Answer 32

Mainly clinical | Occasionally x-rays, ultrasound and MRI

Question 33

What are the treatment options for plantar fasciitis?

Answer 33

``` Rest, change training Stretching – Achilles +/- direct stretching Ice NSAIDs Orthoses – Heel pads Physiotherapy Weight loss Injections – corticosteroid (good in short term but may make condition worse long term) Night Splinting ```

Question 34

What are the symptoms of ankle arthritis?

Answer 34

Pain | Stiffness

Question 35

How is a diagnosis of ankle arthritis made?

Answer 35

Clinical Xrays CT

Question 36

What are the management options for ankle arthritis?

Answer 36

Weight loss, activity modification, analgesia, physiotherapy, steroid injections Arthroscopic anterior debridement Arthrodesis Joint replacement

Question 37

What are the management options for tibialis posterior tendon dysfunction?

Answer 37

Orthotics Reconstruction of tendon Triple fusion

Question 38

What is the treatment for diabetic foot ulcer?

Answer 38

``` Prevention Improve diabetic control Smoking Vascular supply External pressure (splints/shoes/weight bearing) Internal pressure (deformity) Infection Nutrition Debride ulcers and get deep samples for microbiology Correct any deformity to offload area Amputation ```

Question 39

What is the pathophysiology of Charcot's neuroarthropathy?

Answer 39

Lack of proprioception and protective pain sensation | Abnormal autonomic nervous system results in increased vascular supply and bone resorption

Question 40

What are the 3 stages of Charcot's neuroarthropathy?

Answer 40

Fragmentation Coalescence Remodelling

Question 41

What are the management options for Charcot's neuroarthropathy?

Answer 41

Prevention Immobilisation Correct deformity