Yr 3 MSK > Foot problems > Flashcards

Foot problems Flashcards

(63 cards)

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1
Q

Name some forefoot problems

A
  • Hallux valgus
  • Hallux rigidus
  • Lesser toe deformities
  • Mortons neuroma
  • Metatarsalgia
  • Rheumatoid forefoot
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2
Q

What is hallux valgus?

A
  • Bunions

- Big toe tilts over smaller toes > bony lump appears on inside of foot

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3
Q

Aetiology of hallux valgus?

A
  • Genetic
  • Foot wear
  • Female > male
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4
Q

Symptoms of hallux valgus?

A
  • Pressure symptoms from show wear
  • Pain from toe crossing over
  • Metatarsalgia
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5
Q

Pathogenesis of hallux valgus?

A
  • Lateral angulation of great toe
  • Tendons pull realigned to lateral to central of rotation of toe, worsening deformity
  • Vicious cycle of inc. pull = inc. deformity
  • Sesamoid bones sublux =less weight through big toe
  • As deformity progresses deformity of lesser toes occur
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6
Q

Diagnosis of hallux valgus?

A
  • Clinical

- X-ray

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7
Q

Non operative management of hallux valgus?

A
  • Shoe wear modification
  • Orthotics
  • Activity modification
  • Analgesia
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8
Q

Operative mangement of hallux valgus?

A
  • Release lateral soft tissues

- Osteotomy 1st metatarsal

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9
Q

What is hallux rigidus?

A
  • Latin for stiff big toe
  • Osteoarthritis of 1st MTP joint
  • Bimodal distribution of age
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10
Q

Symptoms of hallux rigidus?

A
  • Pain, often at extreme of dorsiflexion

- Limited ROM

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11
Q

Diagnosis of hallux rigidus?

A
  • Clinical

- X-ray

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12
Q

Non-operative management of hallux rigidus?

A
  • Shoe wear modification
  • Activity modification
  • Analgesia
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13
Q

Operative management of hallux rigidus?

A
  • Cheilectomy
  • Arthrodesis
  • Arthroplasty
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14
Q

What are some lesser toe deformities?

A
  • Claw toes
  • Hammer toes
  • Mallet toes
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15
Q

Aetiology of lesser toe deformities?

A
  • Imbalance between flexors/extensors
  • Show wear
  • Neurological
  • RA
  • Idiopathic
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16
Q

Symptoms of lesser toe deformities?

A
  • Deformity
  • Pain from dorsum
  • Pain from plantar side (metatarsalgia)
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17
Q

Non-operative management of lesser toe deformities?

A
  • Activity modification
  • Shoe wear modification
  • Orthotics
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18
Q

Operative management of lesser toe deformities?

A
  • Flexor to extensor transfer
  • Fusion of IP joint
  • Release MTP joint
  • Shortening osteotomy of metatarsal
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19
Q

What is mortons neuroma?

A

Thickening of nerve in foot causing pain and numbness

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20
Q

Aetiology of mortons neuroma?

A
  • Females 40-60y

- High heeled shoes

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21
Q

Symptoms of mortons neuroma?

A
  • Typically affects 3rd followed by 2nd webspace/toes
  • Intermittent neuralgic burning pain into toes
  • Altered sensation in webspace
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22
Q

Diagnosis of mortons neuroma?

A
  • Clinical
  • Mulders click
  • USS/MRI
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23
Q

Management of mortons neuroma?

A
  • Injections

- Surgical excision

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24
Q

What is metatarsalgia?

A
  • Symptom, not a diagnosis

- Synovitis, bursitis, arthitis, neuralgia, neuromata, freiburgs disease

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25
What is the treatment of rheumatoid forefoot?
- Shoe wear modification - Activity modification - Orthotics - 1st MTP arthrodesis - 2-5th toe excision arthroplasty
26
What are some midfoot problems?
- Ganglia - OA - Plantar fibromatosis
27
.Aetiology of dorsal foot ganglia?
- Idiopathic - Underlying arthritis - Underlying tendon pathology
28
Symptoms of dorsal foot ganglia?
- Pain from wearing shoes | - General pain
29
Treatment of dorsal foot ganglia?
Non-op: -Aspiration Op: -Excision
30
Different variations of arthritis affecting midfoot?
- Post traumatic - OA - RA
31
Treatment of midfoot arthritis?
``` Non op: -Activity/shoewear/orthotics -Injections Op: -Fusion ```
32
What is plantar fibromatosis?
- Ledderhose disease - Progressive - 'Dupytrens of foot' - Symptomatic on large/weightbearing areas
33
Treatment of plantar fibromatosis?
``` Non op: -Shoewear/orthotics/activities etc Op: -Excision -RT ```
34
Name some hindfoot problems?
- Achilles tendonitis/tendinosis - Plantar fasciitis - Ankle OA - Tibialis posterior dysfunction - Cavovarus foot
35
What is achilles tendinosis?
- Degenerative/overuse condition with little inflammation | - Tendinopathy describes symptoms
36
What is achilles tendinopthy?
->1 clinical condition >Insertional tendinopathy: <2cm of insertion >Non insertional tendinopathy: 2-7cm of insertion >Bursitis: retrocalcaneal/superficial calcaneal >Paratendinopathy
37
What is the aetiology of - Paratendonopathy - Tendonopathy?
Paratendonopathy - Athletic populations - 30-40y - 2:1 male Tendonopathy - Non-athletic populations - 40+y - Obesity - Steroids - DM
38
Symptoms of achilles tendinopathy?
- Pain during/after exercise - Recurrent - Difficulty fitting shoes - RUPTURE
39
Diadnosis of mono?
- Clinical (simmonds, matles, angle of dangle) - USS - MRI
40
Treatment of achilles tendinopathy?
``` Non op: -Activity/shoewear etc -Weight loss -Physiotherapy -Extra corporeal shockwave treatment -Immobilisation Op: -Gastrocnemius recession -Release and debridement of tendon ```
41
What is plantar fasciitis?
Chronic degenerative change, fibroblast hypertrophy, absent inflammatory cells, avascularity
42
Aetiology of plantar fasciitis?
- High intensity training/rapid inc in training intensity - Poorly padded shoes when running - Obesity - Prolonged standing
43
Symptoms of plantar fasciitis?
- Pain in morning/weight bearing | - Located at origin of plantar fascia
44
Differential diagnosis of plantar fasciitis?
- Nerve entrapment syndrome - Arthritis - Calcaneal pathology
45
Diagnosis of plantar fasciitis?
- Clinical | - Xrays/USS/MRI
46
Initial treatment of plantar fasciitis?
- Rest - Stretching - Ice - NSAIDS - Orthotics (heel pads) - Physio - Weight loss - Corticosteroid injection - Night splinting
47
Newer/third line treatments of plantar fasciitis?
- Extracorporeal shockwave therapy - Topaz plasma coblation - Nitric oxide - Platelet rich plasma - Endoscopic/open surgery
48
Aetiology of ankle arthritis?
- 46y on average - Commonly post traumatic - Idiopathic
49
Symptoms of ankle arthritis?
- Pain | - Stiffness
50
Diagnosis of ankle arthritis?
- Clinical - Xray - CT
51
Non operative management of ankle arthritis?
- Weight loss - Activity modification - Analgesia - Physiotherapy - Steroid injections
52
Operative management of ankle arthritis?
- Arthrodesis | - Joint replacement
53
What is tibialis posterior tendon dysfunction?
- Acquired adult flat foot planovalgus - Relatively common - Clinical diagnosis mainly (MRI can assess tendon) - Medial/lateral pain
54
Management of tibialis posterior tendon dysfunction?
- Orthotics (medial arch support) - Reconstruction of tendon - Triple fusion (subtalar, talonavicular and calcaneocuboid)
55
What is the aetiology of diabetic foot ulcer?
- Diabetic neuropathy - Diabetic autonomic neuropathy - Poor vasc supply - Lack of patient education
56
Non op treatment of diabetic foot ulcer?
-Prevention -Modify detriments to healing >Diabetic control >Smoking >Vasc supply >External pressure >Internal pressure (deformity) >Infection >Nutrition
57
Op treatment of diabetic foot ulcer?
- Improve vasc supply - Debride ulcers - Correct deformity - Amputate
58
Prognosis of diabetic foot ulcer? - Ulceration - Amputations preceded by ulcers - Ulcers leading to amputation - Mortality
- 15% diabetics get ulcers - 85% amputations preceded by ulcers - 25% ulcers lead to amputation - 50% mortality
59
Aetiology of charcots foot(neuroarthropathy)?
-Any neuropathy cause (DM commonest)
60
Pathophysiology theories of charcots foot?
- Neurotraumatic (lack of propioception and protective pain sensation) - Neurovascular (abnormal ANS = inc vasc supply and bone resorption)
61
What is charcots foot?
Characterised by rapid bone destruction occuring in 3 stages: - Fragmentation - Coalescence - Remodelling
62
Diagnosis of charcots foot?
- Clinical - Consider in neuropathy - Frequently not painful - Xray - MRI
63
Management of charcots foot?
- Prevention - Immobilisation unti acute fragmentation resolved - Correct deformity (can lead to ulceration)
Yr 3 MSK
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