orthopaedics: foot and ankle

Question 1

what is hallux valgus

Answer 1

inflammation bursa on medial metatarsal –> bunion

Question 2

how does hallux valgus arise

Answer 2

joint is out of placed and rubs with shoe

Question 3

who commonly gets hallux valgus

Answer 3

females, elderly, people with RA, inflamm arthritis and NM disease

Question 4

what are the symptoms of hallux valgus

Answer 4

bunion, ulceration between big toe and second toe, hallux can override the second toe

Question 5

what non-surgical treatment can be done for hallux valgus

Answer 5

wearing wider shoes and a spacer to prevent bunions and rubbing

Question 6

what is hallux rigidus

Answer 6

OA of first MTPJ

Question 7

how do you manage hallux rigidus conservatively

Answer 7

stuffed soled shoes, metal bar in shoes, removal of oseotphytes

Question 8

how do you manage hallux rigidus surgically and what does it involve

Answer 8

arthrodesis (first line), fusing joints, no joint motion afterwards

Question 9

what is morton’s neuroma

Answer 9

interdigital nerves on top of ligaments become damaged after repeated trauma, become inflammed and swollen and form a neuroma

Question 10

what are symptoms of morton’s neuroma

Answer 10

pain and burning in affected toes, loss of sensation in web space, Mudler’s click test

Question 11

how do you diagnose morton’s neuroma

Answer 11

USS

Question 12

how do you treat morton’s neuroma

Answer 12

offloading insole, steroids and local anaesthetic injection, excision

Question 13

where are you likely to get a metatarsal stress fracture

Answer 13

2nd and 3rd metatarsal

Question 14

who gets metatarsal stress fracture

Answer 14

runners, soldiers, dancers, hill walkers

Question 15

how do you identify metatarsal stress fracture

Answer 15

x rays and bone scans

Question 16

how do you treat metatarsal stress fractures

Answer 16

rest and rigid sole boot

Question 17

how do you get tendonitis

Answer 17

strain from sport, degenerative, quinolone ABs’, RA or inflamm arthropathies

Question 18

what symptoms are there of tendonitis

Answer 18

pain at insertion of tendon tendon itself, swelling, eases with walking, morning stiffness

Question 19

how do you treat tendonitis

Answer 19

normally self-limiting, physio, NSAIDs, heel raises, splint/ boot

Question 20

how do you treat tendonitis surgically

Answer 20

tendon decompression or rupture

Question 21

who normally gets achilles tendon rupture and how

Answer 21

middle aged/ older, sudden deceleration with resisted calf muscle

Question 22

what causes achilles tendon rupture (pathology)

Answer 22

degeneration or recurrent tendonitis

Question 23

how do you treat achilles tendon rupture non-operatively

Answer 23

casts –> good outcomes

Question 24

how do you treat achilles tendon rupture operatively

Answer 24

suture repair of damaged tendon, cast afterwards

Question 25

what causes plantar fasciitis

Answer 25

repetitive stress or degeneration

Question 26

what are symptoms of plant fasciitis

Answer 26

pain after rest, worse when exercising, tinkle's test positive, localised tenderness on palpation site (heel and medial)

Question 27

what can cause plantar fasciitis

Answer 27

diabetes, obesity, poor cushioning, over exercise

Question 28

how do you treat plantar fasciitis

Answer 28

usually self-limiting, NSAIDs, physio, stretching, gel pads, steroid injections

Question 29

what do you never do in achilles tendonitis and why

Answer 29

steroid injection as it risks rupture

Question 30

what is flat foot

Answer 30

normal variation where medial arch does not develop

Question 31

what can cause flat foot

Answer 31

familial, ligament laxity

Question 32

what does flat foot increase risk of

Answer 32

tendonitis

Question 33

what are secondary causes of flat foot

Answer 33

tibialis posterior tendon rupture, RA, diabetes

Question 34

where does tibialis posterior tendon attach on to

Answer 34

medial navicular tuberosity and plantar cuneiforms

Question 35

what can cause tibialis posterior tendon dysfunction

Answer 35

flat foot, elderly, obese, diabetes, hypertension, steroids, inflam arthritis

Question 36

how can repeated stress cause tibialis posterior tendon dysfunction

Answer 36

stress --> tendonitis --> rupture

Question 37

how can RA cause tibialis posterior tendon dysfunction

Answer 37

RA --> synovitis --> rupture

Question 38

what are symptoms of tibialis posterior tendon dysfunction

Answer 38

pain and swelling in medial malleolus, harder to walk and balance esp uneven ground, hallux valgus, midfoot ankle pain

Question 39

how do you treat tibialis posterior tendon dysfunction

Answer 39

splint, physio, insole, surgical decompression

Question 40

what are complications of tibialis posterior tendon dysfunction

Answer 40

flat foot, OA of hindfoot

Question 41

what is pes cavus

Answer 41

normal variant causing abnormally high arch

Question 42

what neuromuscular conditions can cause pes cavus

Answer 42

sensory and motor neuropathy, cerebral palsy, polio, spina bifda

Question 43

what normally accompanies pes cavus

Answer 43

claw toes

Question 44

how do you treat pes cavus

Answer 44

soft tissue release and tendon transfer, severe need arthrodesis

Question 45

what causes claw and hammer toes

Answer 45

imbalance between flexor and extensor tendons causing hyperextension at joints

Question 46

what symptoms can be present with claw and hammer toes

Answer 46

can be painful and rub causing corns and bleeding

Question 47

what treatment can be done for claw and hammer toes

Answer 47

plasters and sleeves, tendon transfer, arthrodesis, amputation