Orthopaedic foot and ankle pathologies Flashcards by Andrew Love

What are the treatment options for foot and ankle disease

When should you operate?

Analgesia
shoe wear modification
Weight loss
physio
insoles and bracing

when non-operative management fails

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What are some common diseases of the feet?

Bunions, plantar fascitis, achille tendonitis morton’s neuroma

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What are some common diseases of the forefoot?

Hallux valgus
Hallux rigidus
Lesser toe deformities
Morton's neuroma
Metatarsalgia
Rheumatoid Forefoot

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What is hallux valgus?

Who gets it?

What are the symptoms?

Bunions, prominence of medial big toe tarsal

Genetic, foot wear, female preponderance

Pressure symptoms from show
Pain from crossing over of toes
Metatarsalgia

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What is the pathogenesis of hallux valgus?

How do you diagnose hallux valgus?

Lateral angulation of big toe
Tendons pull realigned to lateral centre of toe,
Vicious cycle of increased pull creating an increased deformity
Sesamoid bones sublux- less weight goes through the big toe
As deformity progresses abnormalities of the lesser toes occur

Diagnosis- look at foot, X-rays

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How do you treat hallux valgus

What are the two main surgical procedures for hallus valgu?

Non-operative- shoe wear modification, orthotics, activity modification, analgesia

Opearative- release lateral soft tissues, osteomy 1st metatarsal, generally goof outcome but recurrence inevitable

Scarf osteotomy- learn for exam
Basal osteotomy- esepcially this one

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What is hallux rigitidis?

Stiff big toe
Hallux limitus
Hallux non exntensus
Osteoarthrtits of 1st MTP joint
Bimodal distrubution age

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Who gets hallux rigitidis?

What are the symptoms?

How do you diagnose it?

not known, possibly genetic, possinly multiple microtrauma

many asymptomatic, pain at extreme dorsiflexion, limits range of movement

clinical, x-rays

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How do you manage hallux rigitidis?

non operative- activity modification, shoe wear with rigid sole, analgesia

Surgery- Cheilectomy, arthrodesis, arthroplasty

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What is a cheilectomy?

What is the gold standard for hallux rigitidus treatment?

What are the benefits/risks with are there with 1st MTPJ hemiarthoplasty

Surgery to remove a small piece of bone to increase dorsiflexion

1st MTPJ fusion

Good ROM, high failure rate, better for lwo demenad patients

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What are common issues of the lesser toe?

What causes them?

Claw toes
Hammer toes
Mallet toes

hyper flexion at the PIP joints

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Who gets lesser foot deformities

What are the symptoms of a lesser foot deformity?

imbalance between flexors/extensors
shoe wear
Neurological/rheumatoid arthrits
idiopathic

deformity
Pain from dorsum
Pain from plantar side(as toe is pushed down)

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What is the treatment for lesser toe deformities?

non operative- activity modification
Shoe wear- falt shoes with high toe
Orthotic insoles

Opearative- flexor to extesnor transfer
Fusion of interphalangeal joint
Shortening osteomy of metatarsal

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What is mortons neuroma?

Inflamation, swelling, severe pain and numbnes caused my a lesion to the nerve between digits

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Who gets mortons neuroma?

What are the symptoms of mortons neuroma?

Mechanically induced degenrative neurtopathy
Affects females ages 40-60
Frequently associated with wearing high heeled shoes
Common digital nerves relatively tethered to one metarsal and movement in adjacent metatarsals causing a mechanical shear

Symptoms- typically affects 3rd following by 2nd webspace/toes
Neuralgic burning pain into toes
Intermittent
Altered sensation in webspace

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How do you diagnose mortons neuroma?

How do you treat it?

clinical, mulder’s click, USS, MRI

injection for small lesions
Surgery- excise lesion
Leads to numbness, recurrence, 30% have pain post op

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What is metatarsalgia?

Symptom not a diagnosis
Careful examination should localise course
Synovitis, bursitis, arthritis, neuralgia
Neuromata, freibergs disese
If no obvious cause consider tight gastrocnemius

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How do you treat rheumatoid forefoot (inflammation that causes toes to be messed up)

non-operative- shoewear orthotics/activity etc

operative- many descrbed techniques, current gold standard, 1st MTPJ arthodesis, 2nd-5th toe excision arthroplasty

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What are some common pathologies of the forefoot

Ganglia
Osteoarthritis
Plantar fibomatosis

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What are dorsal foot ganglia

Who gets them
What are the symptoms?

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Arise from joint or tendon sheath

Idiopathic, underlying arthritis, underlying tendon pathology

Symptoms- pain from pressure from show wear
pain from underlying problem

How are they treayed

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Aspiration
Bible bashing

Excise

High rate of return (50%)

What are the categories of midfoot arthritis

How is it treated?

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Post raumatic
Osteoarthits
Rheumatoid

Non operative- shoe wear, orhtotics
Injections-x-ray guided
Operative-fusion

What is plantar fibromatosis

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Dupuytren’s of the foot
Progressive
usually asymptomatic unless very large of in weight bearing area

How is plantar fibromatosis treated?

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Non operative- avoid pressure
Excision (80% recurrence)
Radiotheraoy
Combination radiotherapy and surgery

What are some common pathologies of the hindfoot?

``` Achilles tendonitis Plantar fascitis Ankle osteoarthritis Ankle osteoarthritis Tibialis posterior dysfunction tion Cavovarus foot ```

What is achilles tendonitis?

Degernative/overuse condition with very little inflammation can be caused bu bursitis, non insertional/mid substance issues Insertional tendinopathy Paratendinopathy

Who gets achilles tendinopathy?

``` Athletic populations aged 30/ More likely in males Obesity steroids diabetes ```

What are the symptoms of achilles tendinopathy?

``` Pain durin exercis Pain following exercise Recurrent epiosdes Difficulty fitting shoes RUPTURE ```

How do you diagnose achilles tendinopathy?

Clinical- tenderness, test for rupture | Investigations- USS, MRI

What is the treatment of achilles tendinopathy?

Non-operative- activity modification, weight loss, modify shoes, Physio Operative treatment- gastricnemius rescession, release and debride tendon

What is plantar fascitis?

Chronic degenerative changem fibroblast hypertrophy, disorgansied and dysfuncitonal lood vessles and colalgen microtears

What causes plantar fasciatis?

``` Not known Atheltes high intesnity/ rapid increases Running with poorly padded shoes Obesity Prolonged standing Foor rotational deformities Tight gastro-soleus complex ```

What are the symptoms of plantar fascitis?

Pain first thing in the morning Pain on weight bearinfg after rest Pain at origin of plantar fascia Frequently long lasting

What are differentials fro plantar fascitis

Nerve entrapment Arthtrits Calcaneal pathology Mainly clincial Occasionally X-rays USS and MRI

How do you treat plantar fascitis?

``` Restm change training Stretch achilles Ice NSAIDS orthoses- heel pads Physio Weight loss Injections Night splints ```

What are some new age treatments of plantar fascitis?

``` Extracorpeal shockwave therapy Topaz plasma coblation Nitric oxide Platlet rich plasma Endoscopic/ open surgery ```

Who gets ankle arthritis? What are the symptoms?

Mean age of presentaiton is 46 years Commonly post traumatic idiopathic Pain/stiffness

How do you diagnose ankle arthritis? What is the non operative management?

Clinical, radiographs, CT scan (exclude adjacent joitn arthrits) Non operatie management- weight loss, activity modification, analgesia, physio, steroid injection

What is the operative management of ankle arthritis?

Athroscopic anterior debridement- only for anterior symptoms Athrodesis(ankle fusion) gold standard Joint replacement- maintains ROM, long term outocmes?, not easy to fix

What is tibiali posterior tendon dysfunction

``` Acquired adult flat foor planovalgus Relatively common under recognsied 4 stages Largely clinical diagnosis- double and single heel raise Medial or lateral pain Orthoses or surgery ```

What is the double single limb heel raise? How is it diagnosed How is it managed

Heels go from varus to valgus and they rise Clinical, MRI to assess tendon ``` Orthotics-medial arch support Reconstruction of tendon (tendon transfer) Triple fusion (subtalar, talonavicular and calcaneocuboid) ```

How does a diabetic foot ulcer develop?

``` DIabetic neuropathy lack of sweting dry cracked skin skin more sensitive to minro trauma Poor vascular supply Lack of patient education ```

How do you treat a diabetic foot ulcer?

``` Prevention Modify the main detriments to healing Diabetic control Smoking Vascular supply External pressure (splints, shoes, weight bearing) Internal pressure Infection, nutrition ```

What surgical options are available for a diabetic foot ulcer?

Improve vascular supply Debride ulcers and get deep samples from microbiology Correct any deformity to offload area Amputation

What is charcot neuropathy?

Rapid bone destruction in 3 areas, | fragmentation, coalescene and remodelling

Who gets charcots neuropathy What are the theories of pathophysiology?

Any causes of neuropathy Diabetes commonest cause Historically originally described and most common with syphillis Lack of proprioception and protective pain sensation Neurovascualr- abnormal autonomic nervous system results in increased vascular supply bone resorption

How is charcots neuropathy diagnosed?

High index of suspicion, consider an diabetic with swollen erythematous foot, espicially with neuropathy Radiographs MRI

How is charcots foot managed?

Prevention Immobilisation-non weight bearing until fragmentation resolves Deformity leads to ulceration lead to amputation

What is the minimum knowledge for exams?

BOA syllabus

Orthopaedic foot and ankle pathologies Flashcards

(49 cards)