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MSK > Forefoot Problems > Flashcards

Forefoot Problems Flashcards

1
Q

6 forefoot problems

A
  • Hallux Valgus (bunion)
  • Hallux Rigidus
  • Lesser toe deformities
  • Morton’s neuroma
  • Metatarsalgia (symptom not a diagnosis)
  • Rheumatoid forefoot
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2
Q

Aetiology of hallux valgus

A
  • Footwear
  • Women more likely
  • Genetic
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3
Q

Symptoms of hallux valgus

A
  • Pressure symptoms of from shoe wear
  • Pain from crossing over of toes
  • Metatarsalgia
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4
Q

Pathogenesis of hallux valgus

A
  • Lateral angulation of big toe
  • Tendons pull realigned to
  • Vicious cycle of increased pull creating increased deformity
  • Sesamoid bones sublux, less weight goes through big toe
  • As deformity progresses abnormalities of lesser toes occur
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5
Q

How to diagnose hallux valgus

A

-Clinical
-X-ray
Determines the severity of underlying bony deformation
Excludes associated degenerative change

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6
Q

Non-surgical Rx of hallux valgus

A
  • Shoe modification (wide +/- high toe box)
  • Orthotics to offload pressure/correct deformity
  • Activity modification
  • Analgesia
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7
Q

Surgical Rx of hallux valgus

A

Only if non-surgical Rx fails
-Release lateral soft tissues
-Osteotomy 1st metatarsal +/- proximal phalanx
Generally good outcome but recurrence inevitable

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8
Q

What is hallux rigidus

A
  • Latin = Stiff big toe

- Osteoarthritis of 1st MTP joint

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9
Q

Aetiology of hallux rigidus

A
  • Unknown

- Maybe genetic or multiple micro-traumas

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10
Q

Symptoms of hallux rigidus

A
  • Many asymptomatic
  • Pain (often at extreme of dorsiflexion)
  • Limitation of ROM
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11
Q

How to diagnose hallux rigidus

A
  • Clinical

- Radiographs

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12
Q

Non-surgical Rx of hallux rigidus

A
  • Activity modification
  • Shoe wear with a rigid sole
  • Analgesia
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13
Q

Surgical Rx of hallux rigidus

A
  • Cheilectomy (removal of bone spurs from base of big toe)
  • Arthrodesis
  • Arthroplasty
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14
Q

3 lesser toe deformities

A
  • Claw toes
  • Hammer toes
  • Mallet toes
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15
Q

Aetiology of lesser toe deformities

A
  • Shoe wear
  • Rheumatoid arthritis
  • Neurological
  • Imbalance between flexors/extensors
  • Idiopathic
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16
Q

Symptoms of lesser toe deformities

A
  • Deformity
  • Pain from dorsum
  • Pain from plantar side (metatarsalgia)
17
Q

Non-surgical Rx of lesser toe deformities

A
  • Activity modification
  • Flat shoes with a high toe box to accommodate deformity
  • Orthotic insoles (metatarsal bar/dome support)
18
Q

Surgical Rx of lesser toe deformities

A
  • Fusion of IPJ
  • Release of metatarsophalangeal joint
  • Shortening osteotomy of metatarsal
19
Q

Aetiology of Morton’s neuroma

A
  • Mechanically induced degenerative neuropathy
  • Associated with wearing high heels
  • Common digital nerve relatively tethered to one metatarsal + movement in adjacent metatarsal causing mechanical shear
20
Q

what group is Morton’s neuroma most commonly seen

A

Women aged 40-60

21
Q

Symptoms of Morton’s neuroma

A
  • Neuralgic burning pain into toes
  • Intermittent
  • Altered sensation in webspaces
  • Typically affect 3rd followed by 2nd webspaces/toes
22
Q

How to diagnose Morton’s neuroma

A
  • Clinical
  • Mulder’s click
  • US (gold standard)
  • MRI (good but not best)
23
Q

Rx of Morton’s neuroma

A
  • Injection for small lesions (?steroids?)

- Surgical excision of lesion + a section of normal nerve

24
Q

Problems with surgical Rx of Morton’s neuroma

A
  • Numbness
  • Recurrence
  • 30% have pain 1 year post-op
25
Q

What is metatarsalgia

A
  • Common overuse injury

- Describes + and inflammation in the ball of the foot

26
Q

Causes of metatarsalgia

A
  • Synovitis
  • Bursitis
  • Arthritis
  • Neuralgia
  • Neuromata
  • Freiberg’s disease

etc…

27
Q

If there’s no obvious cause of metatarsalgia what should you consider

A

Tight gastrocnemius

28
Q

Non-surgical Rx for rheumatoid foot

A
  • Shoewear
  • Orthotics
  • Activity modification
29
Q

Surgical Rx for rheumatoid foot

A
  • 1st MTPJ arthrodesis
  • 2-5th toe excision arthroplasty

Both are current gold standard

MSK (28 decks)

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