Foot Problems

Question 1

Forefoot problems

Answer 1

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

Question 2

What is hallux valgus

Answer 2

“Bunions”

Question 3

Hallux valgus aetiology

Answer 3

Genetic
Foot wear
Female > male

Question 4

Hallux valgus symptoms

Answer 4

Pressure symptoms from footwear
Pain from crossing over of toes
Metatarsalgia

Question 5

Hallux valgus management

Answer 5

Non-operative =>
-Shoe wear modification
-Orthotics to offload pressure/correct deformity
-Activity modification
-Analgesia
Operative (if non-operative failed or unacceptable to patient) =>
-Release lateral soft tissues
-Osteotomy 1st metatarsal +/- proximal phalynx
-Generally good outcome but recurrence inevitable

Question 6

Hallux rigidus

Answer 6

Pain and stiffness at joint of big toe

No joint space

Question 7

Hallux rigidus management

Answer 7

Non-operative =>
   -Activity modification
   -Shoe wear with rigid sole
   -Analgesia
Surgery =>
   -Cheilectomy
   -Arthrodesis
   -Arthroplasty

Question 8

Lesser toe deformities

Answer 8

Claw toes
Hammer toes - flexion at pip joint
Mallet toes

Question 9

What is Morton’s neuroma?

Answer 9

Mechanically induced degenerative neuropathy
Frequently associated with wearing high healed shoes
Common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear

Question 10

Symptoms of Morton’s neuroma

Answer 10

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

Question 11

Management of Morton’s neuroma

Answer 11

Injections for small lesions

Surgery - excision of lesion

Question 12

Rheumatoid forefoot treatment

Answer 12

Footwear

Surgery

Question 13

Midfoot problems

Answer 13

Ganglia
OA
Plantar fibromatosis

Question 14

Where do dorsal foot ganglia arise?

Answer 14

From joint or tendon sheath

Question 15

Ganglia treatment

Answer 15

Aspiration

Excision

Question 16

Midfoot arthritis

Answer 16

Post-traumatic arthritis
Osteoarthitis
Rheumatoid arthritis

Question 17

Plantar fibromatosis

Answer 17

“Dupuytren’s of the foot”

Usually asymptomatic unless very large or on weightbearing area

Question 18

Plantar fibromatosis treatment

Answer 18

Footwear
Avoid pressure
Excision
Radiotherapy

Question 19

Hindfoot problems

Answer 19

Achilles tendonitis/tendinosis
Plantar fasciitis
Ankle osteoarthitis
Tibialis posterior dysfunction
Cavovarus foot

Question 20

Achilles tendonitis/tendonosis

Answer 20

Degenerative/overuse condition with little inflammation

Question 21

Plantar fasciitis

Answer 21

Running with poorly padded shoes or hard surfaces
Obesity
Occupations involving prolonged standing
Foot/lower limb rotational deformities

Question 22

Plantar fasciitis symptoms

Answer 22

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

Question 23

Plantar fasciitis differential diagnosis

Answer 23

Nerve entrapment syndrome
Arthritis
Calcaneal pathology

Question 24

Other foot problems

Answer 24

Diabetic foot =>

• Ulceration
• Charcot foot

Question 25

Causes of lesser toe deformities

Answer 25

``` Imbalance between flexors/extensors Shoe wear Neurological Rheumatoid arthritis Idiopathic ```

Question 26

Symptoms of lesser toe deformities

Answer 26

Deformity Pain from dorsum Pain from plantar side (metatarsalgia)

Question 27

Achilles tendonopathy symptoms

Answer 27

``` Pain during exercise Pain following exercise Recurrent episodes Difficuly fitting shoes (insertional) Rupture ```