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orthopaedic foot conditions Flashcards

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1
Q

What are the treatment options for orthopaedic foot conditions

A

analgesia
show wear change
activity changes
weight loss
physiotherapy
orthotics e.g insoles and bracing

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2
Q

What is the indication of surgery in orthopaedic foot conditions

A

When the non surgical treatment fails

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3
Q

What is seen in hallux valgus (bunions)

A

medial deviation of the first ray and vagus agulation of the big toe

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4
Q

What are the causes of hallux valgus

A

genetic
foot wear

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5
Q

Which gender is hallux valgus more common in

A

female due to men wearing more accomodating foot wear

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6
Q

What are the symptoms of hallux valgus

A

pressure symptoms from shoe wear

Pain from crossing over of the toes

metatarsalgia - pain in the metatarsals

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7
Q

What is used to diagnose hallux valgus

A

Xray - determine severity of the bony deformity and exclude associated degenerative changes

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8
Q

What is the management of hallux valgus

A

shoe wear modification

orthotics to offload pressure and correct the deformity

activity modification

analgesia

Operative - if non-op fails :
Release the lateral soft tissues
osteotomy of the first metatarsal - breaking the bone

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9
Q

What is hallux rigidus

A

Stiff big toe

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10
Q

What causes hallux rigidus

A

osteoarthritis of the first metatarsal-phalangeal joint

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11
Q

What is the main symptom of hallux rigidus

A

Pain at extreme dorsiflexion but usually asymptomatic

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12
Q

How is hallux rigidus diagnosed

A

clinically and radiographs

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13
Q

What is the management of hallux rigidus

A

activity modification

Shoe wear with rigid sole - very helpful option

analgesia

Surgical treatment :
Cheilectomy - if the pain is only during dorsiflexion of the big toe and the rest of the toe is fine
Arthrodesis
Arthroplasty

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14
Q

What is a cheilectomy

A

Remove the dorsal osteophytes - provides better range of dorsiflexion with less pain

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15
Q

What is 1st MTPJ fusion (arthrodesis)

A

The surface of the joint is debrided - fixation is then used to allow bone to cross over the joint
This is the gold standard surgical treatment of hallux rigidus

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16
Q

What is hammer toe

A

Flexion of the proximal inter-phalangeal joint and dorsiflexion of the metacarpal-phalangeal joint

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17
Q

What is claw toe

A

flexion of the proximal and distal inter-phalangeal joint

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18
Q

What is mallet toe

A

flexion of the distal inter-phalangeal joint

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19
Q

What are the causes of lesser toe deformities

A

imbalance between flexors and extensors

shoe wear

rheumatoid arthritis

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20
Q

What are the symptoms of lesser toe deformities

A

deformities

Pain from the dorsum and plantar sides

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21
Q

What is the treatment of lesser toe deformities

A

Non surgical:
Activity modification
Shoe wear - flat shoes with high toe box
Orthotic insoles

Surgical:
Flexor to extensor transfer - dividing the flexor tendon of the toe and moving it to the extensor
fusion of interphalangeal joint
release metatarsophalangeal joint
shortening osteotomy of metatarsal

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22
Q

What is mortons neuroma

A

Inflammation and swelling with severe pain and numbness

common plantar nerve is traumatised and new nerve sprouts grow with fibrous tissue around them and there is a painful lump which presses on them called a mortons neuroma

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23
Q

Who is mortons neuroma more common in

A

40-60 year old females

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24
Q

What are the symptoms of mortons neuroma

A

affects the 3rd and 2nd webspace/ toes

neuralgic burning sensation in the toes

Intermittent

altered sensation in the webspace

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25
What is the best way to diagnose mortons neuroma
Mulder's click - pain should localise between the metatarsal heads - if there is a lump on the nerve, if you press onto it, moving it dorsally and then squeeze it over the metatarsal head, it will make a clicking which is very painful Ultrasound
26
What is the management of mortons neuroma
Injection for small lesions Surgery: excision of the lesion including part of the normal nerve which can lead to numbness and pain
27
What is metatarsalgia
A symptom and not a diagnosis Pain coming from the forefoot - the digits and the metatarsals
28
What is rheumatoid forefoot
Pain Hallux valgus hammer toe pressure areas with bursitis caused by rheumatoid arthritis
29
What is the treatment of rheumatoid forefoot
Shoe wear to accomodate the deformity orthotics reduction in activity or a change in activity Operative Gold standards: 1st metatarsalphalangeal joint arthrodesis (fusion) 2-5th toe excision arthroplasty
30
Where do dorsal foot ganglia come from
joints or the tendon sheath
31
What causes dorsal foot ganglia
underlying arthritis underlying tendon pathology
32
What are the symptoms of dorsal foot ganglia
Pain from pressure due to the shoes that are worn Pain from underlying problem
33
34
What is the treatment of dorsal foot ganglia
aspiration of the ganglia - can confirm diagnosis as well Surgical - excision - has a high rate of occurance
35
What kind of arthritis can affect the midfoot
Post traumatic arthritis osteoarthritis rheumatoid arthritis
36
What is the treatment of midfoot arthritis
activity modification shoe wear modification orthotics Xray guided injections Surgical: Fusion of a joint
37
What is plantar fibromatosis
(Ledderhose disease) Considered as the dupuytren's of the foot Causes lumps in the sole of the foot and is progressive
38
What is the treatment of plantar fibromatosis
Show wear management orthotics Surgical: Excision - high recurrence rate combination radiotherapy and surgery - low recurrence but high complication risk
39
What is achilles tendonitis/tendinosis
Degenerative condition with little inflammation of the achilles tendon
40
Who does paratendinopathy commonly affect
athletic individuals 30-40 years old male 2:1 female
41
Who is commonly affected in tendonopathy
non-athletic >40 Years obese steroid use diabetics
42
What are the symptoms of achilles tendinopathy
Pain during exercise pain after exercise recurrent episodes difficulty fitting shoes due to the rubbing feeling - suggests it is insertional
43
How is achilles tendonopathy diagnosed
Ultrasound MRI - shows the severity
44
What is the achilles rupture test and describe it
Simmonds test - calf squeeze test - squeeze the calf and if the achilles tendon is normal the foot will move plantar flexion wise but if the achilles is ruptured, there will be no movement
45
What is the treatment of achilles tendonopathy
Activity modification weight loss shoe wear modification physiotherapy extra-corporeal shockwave treatment- vibrates tissue and stimulates fibrous tissue to form and heal Immobilisation Surgical treatment - Gastrocnemius recession - lengthening the gastrocnemius release and debridement of tendon
46
What is plantar fasciitis
Can't make extra cellular matrix which is required for repair and remodelling Chronic degenerative change, fibroblast hypertrophy, absent inflammatory cells, disorganised and dysfunctional blood vessels and collagen, avascularity
47
What are the symptoms of plantar fasciitis
Pain first thing in the morning Pain on weight bearing after rest Pain at the origin of plantar fascia Commonly lasts for over 2 years
48
How is plantar fasciitis diagnosed
Mainly clinical ultrasound and MRI can be used Xrays can be used but are not that helpful
49
What is the treatment of plantar fasciitis
rest activity modification stretching of the achilles ice NSAIDs orthoses - heal pads physiotherapy weight loss corticosteroid injections - short tem night splinting Extracorporeal shockwave therapy can be done as a third line treatment
50
Who most commonly gets ankle arthritis
46 year old is the average age commonly post traumatic
51
What are the symptoms of ankle arthritis
pain and stiffness of the ankle joint
52
How is ankle arthritis diagnosed
clinical radiographs CT scan
53
What is the treatment of ankle arthritis
weight loss activity modification analgesics physiotherapy steroid injections Surgical treatment: Arthrodesis (fusion) is the gold standard - screws are passed through the ankle joint to fuse it Ankle replacement - can fail after few years
54
What happens when the tibialis posterior tendon malfunction
planovalgus foot - flat foot occurs in people who normally have a good arch
55
How is tibialis posterior tendon dysfunction diagnosed
Clinical - double and single heel raise - checking if the patient can stand on the tip toes MRI to assess the tendon
56
What is the management of tibialis posterior tendon dysfunction
Orthotics - resting the tibialis posterior with medial arch support Surgical: reconstruction of tendon triple fusion - subtalar, talonavicular and calcaneocuboid joints are fused
57
What are the foot conditions that can occur in diabetic foot
Ulceration and charcot foot
58
What is the cause of diabetic foot ulcer
Diabetic neuropathy - patient is unaware of trauma to the foot
59
What are features of diabetic neuropathy
Decreased sweating and sebum production so there is dry cracked skin
60
What is the treatment of diabetic foot ulcer
Prevention of the ulcers is the best method but treatment is hard once an ulcer is formed Diabetic contro stop smoking reduce pressure where the ulcer is by using splints, shoes and weight bearing changes Surgical treatment: Improve vascular supply debridement of ulcer and get samples for microbiology correct any deformity which is causing increased pressure on the ulcer amputation
61
What is the cause of charcot neuroarthropathy
any cause of neuropathy - diabetes is the most common Syphillis
62
What happens in charcot neuropathy
Neurotraumatic - Lack of proprioception and protective pain sensation tso the joints are being put through excessive movements which cause damage Neurovascular - abnormal autonomic nervous system results in increased vascular supply and bone resorptio
63
What are the 3 stages of bone destruction in charcot neuropathy
fragmentation coalescence remodelling
64
How is charcot neuropathy diagnosed
Clinically - Consider any diabetic with acute swollen erythematous foot with neuropathy Radiographs MRI scans
65
How is charcot neuroarthropathy treated
Prevention is best Immobilisation Surgical: Correct the deformity as it could lead to increased pressure in an area which could cause ulceration and infection which would then lead to amputation

MSK (36 decks)

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