16.1. Foot Problems - Forefoot Problems

Question 1

What are the Pathological Groupings of Disease of the Foot?

Answer 1

1. Vascular
2. Infective
3. Traumatic
4. Autimmune
5. Metabolic (Endocrine / Drugs)
6. Inflammatory
7. Inherited (Congenital)
8. Neurological
9. Neoplastic
10. Degenerative
11. Idiopathic

Question 2

What are the Anatomical Groupings of Disease of the Foot?

Answer 2

1. Forefoot Problems
2. Midfoot PRoblems
3. Hindfoot Problems

Question 3

What are the major Forefoot Problems?

Answer 3

1. Hallux Valgus
2. Hallux Rigidus
3. Lesser Toe Deformities
4. Morton’s Neuroma
5. Metatarsalgia
6. Rheumatoid Forefoot

Question 4

What is Hallux Valgus better known as?

Answer 4

Bunions

Question 5

What is the Aetiology of Hallux Valgus (Bunions)?

Answer 5

1. Genetic
2. Footwear
3. Being Female

Question 6

What is the Pathogenesis of Hallux Valgus (Bunions)?

Answer 6

1. Lateral Angulation of the Great Toe leads to Tendons being pulled
2. They are then realigned to the Lateral Center of Rotation of worsening deformity
   Note - Vicious Cycle of Increased Pull causing Increased Deformity
3. The Sesamoid Bones Sublux, due to the changes, and Less Weight goes through the Great Toe
4. Abnormalities of the Lesser Toe occur as it progresses

Question 7

What are the Symptoms of Hallux Valgus (Bunions)?

Answer 7

1. Pressure Symptoms from Shoe-wear
2. Pain from crossing over Toes
3. Metetarsalgia

Question 8

How is a Diagnosis of Hallux Valgus (Bunions) made?

Answer 8

1. Clinical

2. X-Rays - Determine Severity of underlying bone deformity

Question 9

What are the Non-Operative managements of Hallux Valgus (Bunions)?

Answer 9

1. Shoe-wear Modification
2. Orthotics to offload pressure
3. Activity Modification
4. Analgesia

Question 10

What are the Operative managements of Hallux Valgus (Bunions)?

Answer 10

1. Release Lateral Soft Tissue
2. Osteotomy - 1st Metatarsal +/- Proximal Phalanx
   Note - Generally good outcome but recurrence inevitable

Question 11

What is Hallux Rigidus?

Answer 11

Osteoarthritis of the 1st Metatarsophalangeal Joint

Note - This is also known as Hallux Limitus / Non-Extensus

Question 12

What is the aetiology of Hallux Rigidus?

Answer 12

Unknown - possibly genetic

Question 13

What are the Symptoms of Hallux Rigidus?

Answer 13

1. Many are Assymptomatic
2. Pain - Often at extreme Dorsiflexion
3. Limitation of Range of Movement

Question 14

How is a Diagnosis of Hallux Rigidus made?

Answer 14

1. Clinically

2. With Radiographs

Question 15

What are the Non-Operative managements of Hallux Rigidus?

Answer 15

1. Activity Modification
2. Shoe-Wear with Rigid Soles
3. Analgesia

Question 16

What are the Operative Managements of Hallux Rigidus?

Answer 16

1. Cheilectomy
2. Arthrodesis -Fusion of bones (Gold Standard)
3. Arthroplasty - Better for Low Demand Patients (High Failure Rate but good Maintenance for ROM)

Question 17

What are the Lesser Toe Deformities?

Answer 17

1. Claw Toes
2. Hammer Toes
3. Mallet Toes

Question 18

What is the Aetiology of the Lesser Toe Deformities?

Answer 18

1. Imbalance between Flexors / Extensors
2. Shoe-Wear
3. Neurological
4. Rheumatoid Arthritis
5. Idiopathic

Question 19

What are the Symptoms of the Lesser Toe Deformities?

Answer 19

1. Deformity
2. Pain of the Dorsum of the Foot
3. Pain from the Plantar Side of the Foot (Metatarsalgia)

Question 20

What are the Non-Operative Treatments of Lesser Toe Deformities?

Answer 20

1. Activity Modification
2. Shoe-Wear - Flat Shoes with High Toe Box
3. Orthotic Insoles - Metatarsal Bar / Dome Support

Question 21

What are the Operative Treatments of Lesser Toe Deformities?

Answer 21

1. Flexor to Extensor Transfer
2. Fusion of Interphalangeal Joints
3. Release Metatarsophalangeal Joint
4. Shortening Osteotomy of Metatarsal

Question 22

What is Morton’s Neuroma also known as?

Answer 22

Interdigital Neuralgia

Question 23

What are the Symptoms of Morton’s Neuroma?

Answer 23

1. Typically affects 3rd followed by 2nd Webspace / Toes
2. Neuralgic Burning Pain in Toes
3. Intermittent
4. Altered Sensation in the Webspace

Question 24

How is Morton’s Neuroma Diagnosed?

Answer 24

1. Clinically
2. Mulder’s Click
3. Ultrasound / MRI

Question 25

How is Morton’s Neuroma managed?

Answer 25

1. Injection for Small Lesions 2. Surgery - Excision of Lesion, including a section of normal nerve: 2. a) Numbness 2. b) Recurrence 2. c) 30% have pain 1 year post surgery

Question 26

What is characteristic for Morton’s Neuroma?

Answer 26

If the pain is under the Metatarsal Head, then it is, in fact, a Morton’s Neuroma

Question 27

What is Metatarsalgia?

Answer 27

``` A Symptom (Not a Diagnosis) Pain of the Metatarsals ```

Question 28

What can cause Metatarsalgia?

Answer 28

1. Synovitis 2. Bursitis 3. Arthritis 4. Neuralgia 5. Neuromata 6. Freiberg's Disease 7. Tight Gastrcnemius

Question 29

What is the Treatment of Rheumatoid Forefoot?

Answer 29

1. Non-Operative - Shoe-Wear / Orthotics / Activity etc. 2. Operative: 2. a) 1st Metatarsophalangeal Arthrodesis 2. b) 2-5th Toe Excision Arthroplasty