Foot problems Flashcards by Michael Gray

What are some possible causes of hallux valgus (bunions)?

Genetic
Foot wear
Significant female preponderance

How well did you know this?

Not at all

Perfectly

What are some symptoms of hallux valgus?

Pressure symptoms from shoe wear
Pain from crossing over of toes
Metatarsalgia

How well did you know this?

Not at all

Perfectly

What causes hallux valgus?

Lateral angulation of toe
Tendons pull realigned to lateral of centre
Increased pull creates increased deformity

How well did you know this?

Not at all

Perfectly

How is hallux valgus diagnosed?

Clinical

X-ray

How well did you know this?

Not at all

Perfectly

What is x-ray used for in hallux valgus?

Assess severity of bone deformity

Exclude associated degenerative change

How well did you know this?

Not at all

Perfectly

What are some non-operative treatment options for hallux valgus?

Shoe wear modification
Orthotics to offload pressure/correct deformity
Activity modification
Analgesia

How well did you know this?

Not at all

Perfectly

What are some operative treatment options for hallux valgus?

Release lateral soft tissues
Osteotomy 1st metatarsal +/- proximal phalanx
Generally good outcome but recurrence inevitable

How well did you know this?

Not at all

Perfectly

What is hallux rigidus?

Stiff big toe

Osteoarthritis of 1st MTP joint

How well did you know this?

Not at all

Perfectly

How does hallux rigidus present?

Limited range of movement
Pain mostly on dorsiflexion
Many asymptomatic

How well did you know this?

Not at all

Perfectly

What are some non-operative treatment options for hallux rigidus?

Activity modification
Shoe wear with rigid sole
Analgesia

How well did you know this?

Not at all

Perfectly

What are the operative treatment options for hallux rigidus?

Cheilectomy
Arthrodesis
Arthroplasty
1st MTPJ fusion (gold standard)

How well did you know this?

Not at all

Perfectly

What is cheilectomy?

Remove dorsal impingement

How well did you know this?

Not at all

Perfectly

What are some lesser toe deformities?

Claw toes
Hammer toes
Mallet toes

How well did you know this?

Not at all

Perfectly

What are some causes of lesser toe deformities?

Imbalance between flexors/extensors
Shoe wear 
Neurological
Rheumatoid arthritis
Idiopathic

How well did you know this?

Not at all

Perfectly

What are some symptoms of lesser toe deformities?

Deformity
Pain on dorsum of foot
Pain from plantar side

How well did you know this?

Not at all

Perfectly

What are some operative treatment options for lesser toe deformities?

Flexor to extensor transfer
Fusion of interphalangeal joint
Release metatarsophalangeal joint
Shortening osteotomy of metatarsal

How well did you know this?

Not at all

Perfectly

What are some non-operative treatment options for lesser toe deformities?

Activity modification
Shoe wear – flat shoes with high toe box to accommodate deformity
Orthotic insoles to support metatarsal bar/dome

How well did you know this?

Not at all

Perfectly

What is interdigital neuroma?

Morton’s neuroma

Common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear

How well did you know this?

Not at all

Perfectly

What are some possible causes of Morton’s neuroma?

Mechanically induced degenerative neuropathy
Tends to affect females aged 40-60
Frequently associated with wearing high healed shoes

How well did you know this?

Not at all

Perfectly

How does Morton’s neuroma present?

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

How well did you know this?

Not at all

Perfectly

How is Morton’s neuroma diagnosed?

Clinical
Mulder’s click
USS best test
MRI

How well did you know this?

Not at all

Perfectly

How are Morton’s neuromas managed?

Injection for small lesions

Excision of lesion including section of normal nerve

How well did you know this?

Not at all

Perfectly

What are some possible causes of metatarsalgia?

Study These Flashcards

Synovitis
Bursitis
Arthritis
Neuralgia
Neuromata
Freiberg's disease
Tight gastrocnemius

What are some non-operative treatment options for rheumatoid forefoot?

Study These Flashcards

Shoewear
Orthotics
Activity modification

What are some operative treatment options for rheumatoid forefoot?

1st MTJP arthrodesis | 2-5th tow excision arthroplasty

Where do dorsal foot ganglia come from?

Joint or tendon sheath

What causes dorsal foot ganglia?

Idiopathic Underlying arthritis Underlying tendon pathology

What are some symptoms of dorsal foot ganglia?

Pain from pressure from shoe wear | Pain from underlying problem

How are dorsal foot ganglia treated?

Immobilisation to stop growth Aspiration Excision

What is ledderhose disease?

Plantar fibromatosis | "Dupuytrens of the foot"

How does plantar fibromatosis present?

Usually asymptomatic unless very large or over weightbearing area Progressive

How is plantar fibromatosis treated?

Orthotics Excision Radiotherapy

What is the difference between paratendonopathy and tendonopathy?

Tendonopathy more common in non-athletic populations rather than athletic Tendonopathy also often associated with obesity, steroids, diabetes

How does achilles tendonopathy present?

Pain during exercise Pain following exercise Recurrent episodes Difficulty fitting shoes

Can achilles tendonopathy cause rupture?

Yes

How is achilles tednonopathy diagnosed?

Tenderness Test for rupture USS MRI

What are some tests used to check for achilles rupture?

Simmonds test | Matles ("angle of the dangle")

What are some non-operative treatment options for achilles tendonopathy?

``` Activity modification Weight loss Shoe wear modification – slight heel Physiotherapy – Eccentric stretching Extra-corporeal shockwave treatment Immobilisation ```

What are the operative treatment options for achilles tendonopathy?

Gastrocnemius recession | Release and debridement of tendon

What is plantar fasciitis?

Chronic degenerative change Fibroblast hypertrophy Disorganised and dysfunctional blood vessels and collagen

What are some possible causes of plantar fasciitis?

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

How does plantar fasciitis present?

Pain first thing in the morning | Pain on weight bearing after rest

What are some possible differential diagnoses with plantar fasciitis?

Nerve entrapment syndrome Arthritis Calcaneal pathology

How is plantar fasciitis diagnosed?

Mainly clinical | Sometimes x-rays, USS, MRI

How can plantar fasciitis be treated?

``` Rest Stretching Ice NSAIDs Orthoses Physio Weight loss Corticosteroid injections Night splinting ```

What is tibialis posterior tendon dysfunction?

Acquired adult flat foot planovalgus

Where does pain occur in tibialis posterior tendon dysfunction?

Medial or lateral

How is tibialis posterior tendon dysfunction managed?

Orthoses or surgery

How is tibialis posterior tendon dysfunction diagnosed?

Largely clinical diagnoses | Single and double heel raise (heels should normally swing from varus to valgus)

How does surgery resolve diabetic foot ulcers?

Improve Vascular Supply Debride ulcers and get deep samples for microbiology Correct any deformity to offload area Amputation

What is neurovascular charcot neuropathy?

Abnormal autonomic nervous system results in increased vascular supply and bone resorption

What is neurotraumatic charcot neuropathy?

Lack of proprioception and protective pain sensation

When should charcot neuropathy be considered?

High index of suspicion Consider in any diabetic with acutely swollen erythematous foot especially with neuropathy Greater than 3 degree difference between limbs Frequently not painful

Which tests are used for charcot neuropathy?

Radiographs | MRI

How is charcot neuropathy managed?

Prevention Immobilisation Correct deformity causing neuropathy

Foot problems Flashcards

(55 cards)