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From Flashcardlet > -O05 Emily Station 4 > Flashcards

-O05 Emily Station 4 Flashcards

0
Q

Presentation of ctev

A 
Foot
-plantarflexion at tcj
-inversion at stj
-adduction at mmtj
-cavus foot posture
Achilles tendon, lateral muscles and ligments
-tend to tighten
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1
Q

Congenital talipes equinovarus (clubfoot)

A

Congenital deformity
Estimated 50% are bilateral, tends to be idiopathic
Effects approx 1 in 1000 live births

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2
Q

Treatment of ctev

A

Ponsetti method

Post-ponsetti method

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3
Q

Ponsetti method

A

Around 90% success rate
Programme of serial casting
Carried out in first 18months of life and lasts around 10weeks, with the casts being changed every 5-7 days
-approx 6-10 casts needed
Cavus and adduction firstly controlled to reduce forefoot supination
Inversion at the hindfoot is then controlled
Achilles tendon assessed before tcj dorsiflexion

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4
Q

Post-ponsetti method

A 
Denis brown bar splint
-boots and bar
Foot abduction brace
-can involve using a reverse last
Worn for 23 hours/day for around 3 months
Worn only at night until around age 4
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5
Q

Other orthotic treatment for ctev

A 
Depending on degree of deformity
Heel cups/ucbl
Smo
Afo
Footwear
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6
Q

Paediatric flat foot

A

Decrease of medial longitudinal arch with either a partial or total loss of arch
-symptomatic (pain, falls etc)
-asymptomatic
Arch tends to develop age 2-6

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7
Q

Types of pediatric flat foot

A

Flexible flat foot

Rigid flat foot

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8
Q

Flexible paediatric flat foot

A

Recreation of arch during windlass

Inversion of calcaneus

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9
Q

Rigid paediatric flat foot

A

No recreation of arch during gait

Tend to present with calcaneal eversion and midfoot pronation

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10
Q

Orthotic treatment for paediatric flat foot

A

Ffos
Heel cups/ucbl
Smo
Footwear

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11
Q

Skewfoot

A

Uncommon disorder characterised by severe pronation of the rearfoot and an adductovarus forefoot

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12
Q

Pes cavus types

A

Simple pes cavus
Pes cavo-varus
Calcaneo-cavus
Pes equino-cavus

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13
Q

Simple pes cavus

A

High arch

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14
Q

Pes cavovarus

A 
Most common
Normally seen in neuromuscular disorders
Presentation
-inversion of calcaneus
-plantarflexed 1st metatarsal
-claw-toe deformity
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15
Q

Pes calcaneocavus

A

Primarily from paralysis of triceps surae eg from polio
Tcj dorsiflexed
Forefoot plantarflexed

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16
Q

Triceps surae

A

Inserts into calcaneus
Made of gastroc, soleus and deep profundis
Supplied by tibial nerve (l5-s2)

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17
Q

Assessment of pes cavus

A 
Size of apex
Metatarsal callosities
Age
Toe deformity
Test for hindfoot flexibility
Type
Muscle strength
Position of hindfoot
Fixed/flexible deformity
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18
Q

Orthotic treatment for pes cavus

A

Tcis

Ffos

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19
Q

Surgical treatment for pes cavus

A

Plantarfasiotomy (steindler)
Transfer long toe extensors to mt necks (jones procedure)
Transfer tibialis anterior to 1st mt base
Tarsal/metatarsal osteotomies
Triple arthrodesis
Dwyer valgus calcaneal osteotomy
Posterior calcaneal displacement osteotomy

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20
Q

Tarsal coalition

A

1-fibrous -syndesmosis
2-cartilage -syndchondrosis
3-bony -synotosis
Cause of rigid flat foot and limited rom at stj
Medial pain poorly localised and lateral pain more localised
Hindfoot usually valgus
Peroneal muscles may be contracted causing spastic flatfoot

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21
Q

Treatment for tarsal coalition

A 
Cast for acute symptoms
Surgery
Activity modification 
Shoe inserts
Nsaids
Walking in cast
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22
Q

Plantar fascia

A

Thick ligament band on the plantar aspect of the foot, which supports the longitudinal arch
Originates at the calcaneal tuberosity
Inserts into the plantar aspect of met heads

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23
Q

Plantar Fasciitis

A

Inflammation of the plantar fascia at its origin
Presents as heel pain, which is most severe in the morning at the medial calcaneus
Associated with short achilles tendon
Common in pes planus foot
Affects approx 1 in 10 people
Also associated with strenuous activity, obesity and standing for long periods of time
Possibility of heel spurs (following direction of pf)
Tends to have a unilateral presentation

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24
Q

Treatment of plantar fasciitis

A 
Heel wedges
Ffos
Stretching 
Nsaids
Steroid injections (max 3 injections)
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25
Q

Freibergs disease

A

Known as feibergs infarction
-incomplete in the dorsal aspect of foot
Tends to present unilateral in 2nd metatarsal however may occur in 3rd metatarsal
Can cause partial collapse of 2nd met head due to avascular necrosis
Osteophytes may form causing stiffness and enlargement of the joint

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26
Q

Stages of freibergs disease

A 
0-subchondral fracture with normal xray appearance
1- osteonecrosis without deformation
2- deformation of the osteonecrotic segment
-bone collapse
3-cartilaginous tearing
-gradual detachment of abnormal bone
4-arthosis
-fusion
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27
Q

Orthotic intervention for freibergs disease

A

Insole/ffo with met dome/bar to offload affected area

Combined with rest

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28
Q

Tibialis posterior dysfunction

A

Most common cause of acquired flat foot (normally adults)

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29
Q

Function of tibialis posterior

A 
Invertor and plantarflexor
Elevation of medial longitudinal arch
Locking of midtarsal bones
-makes rearfoot and midfoot rigid 
Inserts into navicular
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30
Q

Symptoms of tibialis posterior dysfunction

A 
Often misdiagnosed
Pain and swelling of medial hindfoot
Flattening of longitudinal arch
Valgus hindfoot
Pain on walking
Can progress to arthritis
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31
Q

Visual appearance of tibialis posterior dysfunction

A

Flattened medial longitudinal arch
Eversion at stj
Forefoot abduction
Internal tibial rotation

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32
Q

Stage I tibialis posterior dysfunction

A

Inflammation of tib post tendon
Medial pain
Mobile rearfoot
Windlass reveals mild weakness

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33
Q

Stage II tibialis posterior dysfunction

A 
Elongation of tib post tendon
Mobile valgus rearfoot
Medial pain
Positive too many toes sign 
Weakness on windlass
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34
Q

Stage III tibialis posterior dysfunction

A 
Degeneration of tib post tendon
Rearfoot becomes fixed
Valgus hindfoot in stance
Medial and lateral pain
-lateral due to impingement
Positive too many toes sign
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35
Q

Stage IV tibialis posterior dysfunction

A

Valgus calcaneus

Early degeneration of ankle joint

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36
Q

Tests for tibialis posterior dysfunction

A

Windlass

Functional hallux limitus

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37
Q

Mortons neuroma

A

Most commonly found in inter-metatarsal space between 3rd and 4th metatarsals
Thickening of plantar common digital nerve
-trauma
-irritation
-excessive pressure
-compression to the nerve
Pain and tenderness that radiates into toes
-may cause numbness
Positive mulders click test
-palpating plantar aspect of foot and compressing transverse arch

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38
Q

Treatment of mortons neuroma

A

Non-narrow footwear
Insoles with inclusion of met dome or morton’s pad
-opens up joint space and decreases pressure on neuroma

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39
Q

Metatarsalgia

A

Pain in the met head region of the foot (ball of foot) mainly at met heads 2-4
Described as walking on pebbles
Can occur from
-pes cavus, claw toes, distal migration of fatty pad
Obesity, high impact sports and other medical conditions can contribute

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40
Q

Treatment of metatarsalgia

A

Painkillers
Rest
Nsaids

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41
Q

Orthotic intervention for metatarsalgia

A 
Insoles
-cushioning
-met dome/bar to offload
Footwear advice
-deep toe box
-rocker sole
-not high heel
-rubber sole
-secure fastening
Footwear if appropriate
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42
Q

Metatarsus adductus

A 
Most common congenital foot deformity
Adduction at tarsal-metatarsal joint
Hindfoot normal
Associated with hip dysplasia
Surgery to release adductor hallux
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43
Q

Osteochronditis

A

Vascular abnormalities
-caused by vascular disturbanies
-kohlers disease affects navicular and presents as pain on dorsum of foot
-Freibergs disease
Damage to apophyses
-muscles attached to apophysis can lift/tear away from bone during adolescent growth
-severs disease occurs at calcaneus giving heel pain

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44
Q

Hypermobility

A

Increased joint rom without pain

45
Q

Hypermobility syndrome

A

Increased joint rom with pain over 3 months

Can be associated with ehlers danlos syndrome -tissue flexibility sue to decreased collagen

46
Q

Symptoms of hypermobility syndrome

A

Pain
Soft tissue injuries
Joint dislocation
Can cause pes planus

47
Q

Brighton criteria

A

Major

Minor

48
Q

Major brighton criteria

A

Beighton score of greater than or equal to 4

Joint pain for more than 3 months (past or present) in 4 or more joints

49
Q

Minor beighton criteria

A

Beighton score of one-3 or 0-3 if age >50
Joint pain for >3 months in 0-3 joints
Back pain >3 months
-spondylosis or spondylolithesis
Dislocating/partially dislocating more than one joint or the same joint more than once
Three or more soft tissue injuries

50
Q

The beighton test

A

1 Touch floor with hands whilst keeping knees straight
2 hyperextend elbows
2 hyperextend knees
2 touch anterior surface of forearm with thumb
2 5th finger extends >90degrees

51
Q

Treatment of hypermobility syndrome

A 
Painkillers/nsaids
Physio
Occupational therapy
Joint support
Ffos
52
Q

Hallux valgus

A

1st ray abducts from midline of the body
Prominent 1st mtpj
-bursas may form over this for protection
Associated with oa
Treatment will not change structure of joint

53
Q

Treatment of hallux valgus

A

Tcis to support mla and decrease pressure
Appropriate footwear
Surgery

54
Q

Hallux rigidus and limitus

A

Rom required at hallux for gait is 30-65degrees dorsiflexion at 1st mtpj
-allows rigid lever and rollover at terminal stance

55
Q

Hallux rigidus

A

No rom/rom between 0-30degrees at 1st mtpj

Loss of 3rd rocker at terminal stance

56
Q

Hallux limitus

A 
Rom limited to <65degrees
Can be functional or structural 
Functional
-observed weight bearing
-restriction of hallux dorsiflexion
Structural
-observed non weight bearing
57
Q

Treatment of hallux rigidus/limitus

A

Ffos with adaptations to maintain some rom at 1st mtpj or to block 1st mtpj movement
Footwear advice-stiffened sole unit and rocker sole

58
Q

Toe deformities

A

Curly toe
Mallet toe
Hammer toe
Claw toe

59
Q

Curly toe

A

Rotation of toes with flexion of mtpj and ipj

Could be contracture of flexor digitorum longus/brevis

60
Q

Mallet toe

A

Commonly 2nd toe

Flexion of dipj

61
Q

Hammer toe

A

Usually middle 3 toes
2nd toe commonly affected by impact/pressure from hallux valgus
Extension of mtp and dip joints
Secondary pipj flexion

62
Q

Claw toe

A

Abnormal position of all three joints of the toe
Normally middle three toes
Extension contracture with dorsal subluxation of mtpj
Flexion of pipj and dipj
Caused by flexor digitorum brevis contracture

63
Q

Vertical talus

A 
Rare foot deformity diagnosed at time of birth
Causes pes planus
Can be unilateral or bilateral
Head of talus found medially in sole
Forefoot abducted and dorsiflexed
64
Q

Appearance of vertical talus

A

Pes planus
Valgus hindfoot
Equinus calcaneus
May present as rocker bottom foot

65
Q

Sesamoiditis

A

Inflammation of sesamoid bones (x2)
Found on plantar aspect of foot behind 1st MTPJ
Knee cap is also a sesamoid bone
-a bone with a tendon

66
Q

Metatarsus varus

A

Common birth deformity
Milder, yet similar to ctev and torticolis
Lateral border of foot convex with increased separation of 1st and 2nd toes
Forefoot supination
-heel never varus or fixed equinus
Deformity is flexinle in mild case
Can be corrected via stretching
Can be serial cast in less flexible cases

67
Q

Tibial torsion

A

Assessed by palpating med and lat malleoli with pt seated with knees 90degrees flexed
Compare transmalleolar axis with knee joint axis
Measured via staheli measurement external
5degrees tibial torsion normal in 1st year
10degrees ext tibial torsion normal mid-childhood
14degrees ext tibial torsion normal in teens/adults
Internal tibial torsion seldom requires treatment under 18months
In a child over 18months under 3 years with internal tibial torsion, external rotation splints may be used
-splint modifies sleeping postures, which delay normal process of spontaneous correction

68
Q

Haglunds deformity

A

Bony enlargement on posterior aspect of calcaneus
Often leads to a painful bursitis
Soft tissue near achilles tendon becomes irritated when bony enlargement rubs against shoes

69
Q

Symptoms of haglunds deformity

A

Visible bump on back of heel
Pain in area where ta attaches to heel
Swelling in the back of the heel
Redness near inflammed tissue

70
Q

Causes of haglunds deformity

A

Pes cavus foot as ta attaches to posterior calcaneus. Those with high arches tend to be more tilted back
Due to constant irritation bursa forms
Tight achilles tendon-causes compression
Supination of foot - grinds ta over calcaneus

71
Q

Treatment of haglunds deformity

A 
Nsaids
Ice
Stretching of ta
Heel elevators decrease stretch on ta
Proper shoes
Physio (ultrasound) 
Ffo
Immobilisation
Surgery
Avoid running up hill/on hard surface
72
Q

Plantarflexed 1st ray (flexible)

A

1st metatarsal bone is below the level of 2nd-5th metatarsals
Can be realigned with plantar pressure
Viewed non weight bearing
Can hide other problems eg subtalar varus and forefoot varus

73
Q

Plantarflexed 1st ray with no forefoot deformity

A

Compensate by dorsiflexing 1st ray and pronation of stj

74
Q

Plantarflexed 1st ray with forefoot varus

A

Compensate by stj pronation, mtj supination and dorsiflex 1st ray

75
Q

Clinical observations of plantarflexed 1st ray (with subtalar inversion)

A

Dorsal-dorso-medial bunion, hammer toes
Plantar-callousing under 2nd-4th met heads
Posterior-haglunds deformity

76
Q

Symptoms of plantarflexed 1st ray

A

Leg fatigue and night cramp
Low back pain/fatigue
Lateral ankle sprains

77
Q

Clinical observations of plantarflexed first ray (with forefoot varus)

A

Dorsal hallux valgus/limitus/rigidus, overlapping toes (esp 2nd)
Plantar plantar callous under 2nd to 4th met heads
Frontal-genu valgum
Xray- calcaneal sput

78
Q

Symptoms of plantarflexed first ray

A 
Hallux bursitis 
Plantar fasciitis 
Inferior calc bursiitis
Sciatica
Chronic low back pain
Metatarsalgia
Severe fatigue
79
Q

Treatment of plantarflexed first ray

A

Control foot in neutral position and stabilise first ray against ground
Cast in neutral and post rearfoot to neutral
Mortons pad to drop first ray

80
Q

Why is pf 1st ray difficult to recognise?

A

Movement of 1st ray dorsally will mask common abnormal foot types (varus deformity)

81
Q

Why is it important to know difference of arch shape weight bearing and non-weight bearing for pf 1st ray?

A

First ray will dorsiflex on wb if flexible

-results in flattening of mla. Rigid maintains same arch shape throughout

82
Q

Diabetes mellitus

A

Est 2.9 million in uk diagnosed with disorder
A metabolic disorder causing either:
Hyperglycaemia-increase of glucose in bloodstream
Hypoglycaemia-decrease of glucose in bloodstream

83
Q

Insulin

A

Hormone produced by beta cells in pancreas
Triggers muscle, fat and liver cells to absorb glucose into the bloodstream
Liver and muscle cells store this as glycogen and fat converts it to triglycerides for energy storage
Failure of insulin secretion results in diabetes

84
Q

Type 1 diabetes

A

Least common around 10%
Develops earlier in life eg children and young adults
Auto-immune dysfunction when body attacks beta cells in pancreas
Decrease of glucose in bloodstream

85
Q

Type 2 diabetes

A

Widespread condition across uk
Tends to develop in those >40
Body either resists function of insulin or pancreas fails to produce enough insulin
Blood sugar levels increase

86
Q

Contributing factors to type 2 diabetes

A 
Excessive body weight
High cholesterol 
Family history
Poor diet
Low activity level
High blood pressure
87
Q

Symptoms of diabetes

A 
Polyuria 
Sweating 
Lethargia
Weight loss
Feeling thirsty 
Blurred vision
88
Q

Side effects of diabetes

A

Retinopathy
Renal failure
Cardiovascular problems
Peripheral neuropathy

89
Q

Types of peripheral neuropathy

A

Motor neuropathy
Autonomic neuropathy
Sensory neuropathy

90
Q

Motor neuropathy

A

Effects muscle function, causing weakness to the foot ankle and leg
Can cause muscle imbalance
Can cause fatty pad migration exposing met heads and causing high pressure

91
Q

Autonomic neuropathy

A

Loss of sweating and moisture
Dry cracked skin
If left untreated, fissures can occur therefore ulceration

92
Q

Sensory neuropathy

A

Inability to detect temperature changes or if the foot is touched
Dangerous if foreign objects enter the shoe

93
Q

Treatment of diabetes

A

Diet and activity control
Tablets (type 2 to lower blood glucose levels)
Insulin (mainly for type 1)
Monitor blood glucose
4-7mmol/l
Hba1c indicates levels for previous 2-3months by measuring glucose in red blood cells
-below 48mmol/l

94
Q

The diabetic foot

A 
Altered sensation
Toe deformities
Distal migration of fatty pad
Prominent met heads
Ulceration
95
Q

Neuropathic foot

A

Dry skin (autonomic neuropathy)
Palpable pulses
Warm

96
Q

Diabetic neuropathic ulcers

A

Tend to be found in areas of high pressure
-plantar aspect of foot at met heads
-plantar aspect of toes
Callousing tends to appear first with skin breakdown underneath

97
Q

Neuroischaemic foot

A

Fragile, shiny skin
Loss of foot pulses
Cold

98
Q

Neuroischaemic ulcers

A

Tend to be found on borders of foot
1st and 5th mtpj
Tips of toes
Friction causes superficial blister which in turn causes ulceration

99
Q

Charcot foot

A

Most likely to occur in those with peripheral neuropathy
Progresses rapidly eg twisting/damaging the foot
Breakdown of tarsal and metatarsal bones/ligaments
Presents as pes planus foot with rocker bottom
Symptoms include hot swollen and red foot/ankle

100
Q

Eicheholtzs classification

A 
Clinical stage stage 0
-painful, swollen and red
-difference of around 2degrees between feet
-Absence of broken skin-no infection
Fragmentation stage stage 1
-joint dislocation, instability and deformation
-treatment with tcc or ppwb
Coalescence stage stage 2 
-reabsorption of bone debris
-tcc followed by crow
Reparative stage stage 3
-stable foot
-possibility for surgery
101
Q

Orthotic management of the diabetic foot

A 
Tci
-redistribute plantar pressure and decrease peak forces
Tcc
-evenly distributes pressure
-cant be removed
-gives lld
-cant get wet
-cant see wound
-needs changed weekly
-can be cause of ulceration 
Removable cast walker
Charcot relief orthotic walker
Bivalved afo
102
Q

Removable cast walker for diabetes (rcw)

A

Removable
Easy and quick to apply
Not total contact/custom fit
Edge pressure

103
Q

Crow for diabetes

A 
Implications
-patient acceptance
-compliance
-cost
-previous orthotic intervention
Adv
-custom made
-rocker bottom soles
-total contact insole
Dis
-can be removed
-lld
-volume fluctuation
104
Q

Bivalved afo for diabetes

A 
Two shells
Anterior shell increases force application area
Stage between tcc and fwr
Immobilises ankle joint
Reduces shear forces
105
Q

Prefabricated pneumatic walking boot for diabetes

A 
Four inflatable areas of total contact
Removable
Quick and easy to apply
Cheaper than tcc
Patient seen weekly
Gives lld and not custom fit
106
Q

Healing wedge shoe for diabetes

A

Redirects pressure from forefoot to heel, as foot is dorsiflexed
Not suitable if foot dorsiflexion <10degrees
Can impair balance

107
Q

Royce pressure relief shoe (darco) for diabetes

A

Temporary footwear solution
Accommodates large dressings
Low opening for easier entry

108
Q

Tcis for diabetes

A 
Redistribute plantar pressure
Reduces peak plantar pressure (ppp) 
Reduces pressure time interval (pti) 
Material can influence function
-hard materials not suitable for diabetic patients (reduces walking speed and step length)
109
Q

A good diabetic shoe

A 
Smooth (minimal seams)
Rocker sole (10mm behind met heads) 
Good suspension (lace/velcro) 
Extra depth to accommodate tci
Rimmed toe puff/butterfly toe puff
-maintains shape, but won't affect claw toes

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