Foot Problems Flashcards
(30 cards)
What is the medical term for bunions?
Hallux Vargus
What are the risk factors for hallux valgus?
Genetics
Shoe type and wearing
Female
What are the symptoms of hallux valgus?
Pressure symptoms from shoe wear
Pain from crossing over of toes
Metatarsalgia
What is the pathogenesis of hallux valgus?
Lateral angulation of great toe.
Tendons pull realigned to lateral of centre of rotation of toe worsening deformity
Vicious cycle of increased pull creating increased deformity
Sesamoid bones sublux – less weight goes through great toe
As deformity progresses abnormalities of lesser toes occur
What is the management of hallux valgus?
Shoe wear modification (wide +/- high toe box)
Orthotics to offload pressure/correct deformity
Activity modification
Analgesia
Release lateral soft tissues
Osteotomy 1st metatarsal +/- proximal phalanx
Generally good outcome but recurrence inevitable
What is Hallux Rigidus?
Osteoarthritis of first MTP joint
Typical shape of metatarsal head is slightly pointed rather than rounded
What are the symptoms of hallux rigidus?
Many asymptomatic
Pain – often at extreme of dorsiflexion
Limitation of range of movement-dorsiflexion
What is the management of hallux rigidus?
Activity modification Shoe wear with rigid sole Analgesia Cheilectomy-remove dorsal impingement Arthrodesis Arthroplasty
What are the risk factors for lesser toe deformities?
Imbalance between flexors/extensors Shoe wear Neurological Rheumatoid arthritis Idiopathic
What are the symptoms of lesser toe deformities?
Deformity
Pain from dorsum
Pain from plantar side (metatarsalgia)
What is the management of lesser toe deformities?
Activity modification Shoe wear – flat shoes with high toe box to accommodate deformity Orthotic insoles – metatarsal bar/dome support Operative Flexor to extensor transfer Fusion of interphalangeal joint Release metatarsophalangeal joint Shortening osteotomy of metatarsal
What are the risk factors for interdigital neuralgia/Morton’s neuroma?
Mechanically induced degenerative neuropathy
Tends to affect females aged 40-60
Frequently associated with wearing high healed shoes
Common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear
What are the symptoms of Morton’s neuroma?
Typically affects 3rd followed by 2nd webspace/toes
Neuralgic burning pain into toes
Intermittent
Altered sensation in webspace
How is Morton’s neuroma diagnosed?
MRI
US
Clinical diagnosis
Mulder’s click
What is the management of Morton’s neuroma?
Injection for small lesions
Surgery – excision of lesion including a section of normal nerve
What is plantar fibromatosis?
Ledderhose disease
“Dupuytren’s of the foot”
Progressive
Usually asymptomatic unless very large or on weightbearing area
Treatment
Non-operative – avoid pressure – shoe wear/orthotics
Operative – excision (up to 80% risk of recurrence)
Radiotherapy (similar recurrence as operative)
Combination radiotherapy/surgery (low risk recurrence/high risk complications)
What is Achilles tendinosis?
Degenerative / overuse condition with little inflammation
What are types of Achilles tendinopathy?
Insertional tendinopathy within 2cm of insertion Non-insertional / mid-substance tendinopathy 2-7cm of insertion Bursitis Retrocalcaneal Superficial calcaneal Para tendinopathy is a true inflammatory problem showing Para tendonitis histologically
What are the risk factors for both tendinopathy and tendinopathy of the Achilles tendon?
Paratendonopathy Commonest in athletic populations Age group 30-40 Male:Female = 2:1 Tendonopathy Commonest in non-athletic populations Aged over 40 Obesity Steroids Diabetes
What are the symptoms for Achilles tendinopathy?
Pain during exercise Pain following exercise Recurrent episodes Difficulty fitting shoes (insertional) RUPTURE
What imaging should be done for Achilles tendinopathy?
US
MRI
What clinical tests can be done to check for an Achilles tendon rupture?
Calf squeeze-the soleus muscle is gently squeezed and this should move the foot, if it doesn’t then the Achilles tendon is fully ruptured between the soleus muscle and the heel
“Angle of the dangle”
Matles
What is the management of Achilles tendinopathy?
Activity modification Weight loss Shoe wear modification – slight heel Physiotherapy – Eccentric stretching Extra-corporeal shockwave treatment Immobilisation (in below knee cast) Gastrocnemius recession Release and debridement of tendon
What is plantar fasciitis?
Actually fasciosis- Chronic degenerative change, fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels and collagen, avascularity of the plantar fascia
