W14 - ORTHO. FOOT CONDITIONS

Question 1

Ankle stability and significance during certain movements

Answer 1

MALLEOLAR GRIP STRONGEST DURING DORSIFLEXION

WEAKEST DURING PLANTARFLEXION

Question 2

What joints and muscles facilitate inversion and eversion

Answer 2

TRANSVERSE TARSAL JOINT
SUBTALAR JOINT

Invertors:–Tibialis anterior & posterior
Evertors :- Fibularis longus & brevis

Question 3

What is the spring ligament associated with the integrity of the arches?

Answer 3

calcaneonavicular

Question 4

Describe the common causes and presentation painful heel

Answer 4

plantar fasciitis, which affects the bottom of the heel, and Achilles tendinitis, which affects the back of the heel. Causes of heel pain include: Achilles tendinitis. Achilles tendon rupture.

Question 5

Describe the common causes and presentation of tibialis posterior dysfunction

Answer 5

Acquired adult flat foot, common

• MRI to assess tendon but largely clinical dx

> Orthoses
sx: reconstruction, triple fusion

Question 6

Describe the common disorders and principles of management of disorders of the first ray - Hallux Valgus

Answer 6

Bunions; significantly females
* pressure symptoms from shoes, pain from toes crossing over, METATARSALGIA

*XR

> ## Shoe wear mods; Orthotics; Activity; analgesiaOp: release lateral soft tissue, 1st metatarsal osteotomy

Question 7

Describe the common disorders and principles of management of disorders of the first ray - Hallux Rigidus

Answer 7

Osteoarthritis of 1st MTP joint = stiffness

• bimodal age distrib.
• genetic, microtrauma

*XR

> ## Shoe wear mods; Orthotics; Activity; analgesiaSx: 1st MTPJ FUSION = Gold standard tx, permanent
Vs 1st MTPJ hemiarthoplasty = maintains ROM but high failure rate
Sx: Cheilectomy (dorsal impingmenet); Arthrodesis; Arthroplasty

Question 8

Describe the common disorders of the toes and forefoot - Metatarsalgia

Answer 8

Symptom dt localised cause, if no cause consider ight castrocnemius

Question 9

Describe the common disorders of the toes and forefoot and their mgmt - Hammer Toes; Claw Toes

Answer 9

*dt flex/ext imbalance, shoe wear, RA, idiopathic
= deform., dorsum pain, plantar pain

> Shoe mods, activity mods, orthotic insoles
---
> Flexor to extensor transfer
Fusion of interphalangeal joint
Release metatarsophalangeal joint
Shortening osteotomy of metatarsal

Question 10

Describe the features of the foot in diabetes

Answer 10

neuropathy => trauma
* poor vascular supply

> DM control
> Smoking, vascular supply
---
> Debridement of ulers => microbiology
> Deformity correction
> Amputation

Question 11

Describe the features of the foot in rheumatoid arthritis

Answer 11

Diamond shape

> shoeware, orthotics, activity
1st MTPJ arthrodesis
2-5th toe excision arthroplasty

Question 12

Indication of Operation

Answer 12

when non-op management fails

Question 13

Morton’s Neuiroma

Answer 13

= inflamm severe pain and numbness
F>M, high heels
* typically affects 3rd, then 2nd webspace/toes
* neuralgic burning pain, intemrittent + alt. senses

• USS*
• MRI
• Mulder’s Click

> Injection for small lesions
Sx: excision

Question 14

Dorsal Foot Ganglia

Answer 14

Arise from joint or tendon sheath
= pain from pressure of shoewear

dt idiopathic, underlying arth., tendon pathology

> Aspiration
Excision

Question 15

Significance of Simmonds Test

Answer 15

Tendon Rupture detection

Question 16

Mgmt of Achilles Tendinopathy

Answer 16

> Activity
> Wt loss
> shoewear
> Physio
> shockwave treatment
> immobilisation
---
> Gastrocnemius recession
> tendon release and debridement

Question 17

Ankle Arthritis MGMT

Answer 17

> ## Wt loss, etc.

• OPEN/ARTHROSCOPIC ARTHRODESIS*
  joint replacement