Flashcards in Foot Problems Deck (83)
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1
What non-operative management is there for foot problems?
-Shoe wear modification
-Activity modification
-Weight loss
-Physiotherapy
-Orthotics including insoles and bracing
2
What is the only indication fro operative management of foot problems?
Failure of non-operative management
3
How can disease be pathologically grouped?
-Vascular (ischaemic)
-Infective
-Traumatic
-Autoimmune
-Metabolic (endocrine /drugs)
-Inflammatory
-Inherited (congenital)
-Neurological
-Neoplastic
-Degenerative
-Idiopathic
4
How can foot problems be grouped anatomically?
-Forefoot problems
-Midfoot problems
-Hindfoot problems
-Other
5
What forefoot problems are there?
-Hallux valgus
-Hallux rigidus
-Lesser toe deformities
-Morton’s neuroma
-Metatarsalgia
-Rheumatoid Forefoot
6
What is the colloquial name for hallux valgus?
Bunions
7
What is the aetiology of hallux valgus?
-Genetic
-Foot wear
-Significant female preponderance
8
What are the symptoms of hallux valgus?
-Pressure symptoms from shoe wear
-Pain from crossing over of toes
-Metatarsalgia
9
What is the pathogenesis of hallux valgus?
-Lateral angulation of great toe.
-Tendons pull realigned to lateral of centre of rotation of toe worsening deformity
-Vicious cycle of increased pull creating increased deformity
-Sesamoid bones sublux – less weight goes through great toe
-As deformity progresses abnormalities of lesser toes occur
10
How is hallux valgus diagnosed?
Clinical
X-rays
-Determine severity of underlying bony deformity
-Exclude associated degenerate change
11
How is hallux valgus managed?
Non-operative
-Shoe wear modification (wide +/- high toe box)
-Orthotics to offload pressure/correct deformity
-Activity modification
-Analgesia
Operative (if non-operative failed or unacceptable to patient)
-Release lateral soft tissues
-Osteotomy 1st metatarsal +/- proximal phalanx
-Generally good outcome but recurrence inevitable
12
What are other names for hallux rigidus?
-Stiff big toe
-Hallux limitus
-Hallux non-extensus
13
What is hallux rigidus?
Osteoarthritis of the 1st MTP
14
What is the aetiology of hallux rigidus?
-Not known
-Possibly genetic – typical shape of metatarsal head is slightly pointed rather than rounded
-Possibly multiple microtrauma
15
What are the symptoms of hallux valgus?
-Many asymptomatic
-Pain – often at extreme of dorsiflexion
-Limitation of range of movement
16
How is hallux rigidus diagnosed?
-Clinical
-Radiographs
17
How is hallux rigidus managed?
Non-operative
-Activity modification
-Shoe wear with rigid sole
-Analgesia
Surgery
-Cheilectomy
-Arthrodesis
-Arthroplasty
18
What is a cheilectomy?
Removal of dorsal impingement
19
What is the gold standard operative treatment for hallux rigidus?
1st MTPJ fusion (arthrodesis), though it's permanent
20
What are the features of the 1st MTPJ hemiarthroplasty as operative treatment for hallux rigidus?
-Good option to maintain ROM
-High failure rate
-Probably better for low demand patients
21
Name dome lesser toes deformities.
-Claw toes
-Hammer toes
-Mallet toes
22
What is the aetiology of lesser toe deformities?
-Imbalance between flexors/extensors
-Shoe wear
-Neurological
-Rheumatoid arthritis
-Idiopathic
23
What are the symptoms of lesser toe deformities?
-Deformity
-Pain from dorsum
-Pain from plantar side (metatarsalgia)
24
What is the treatment for lesser toe deformities?
Non-operative
-Activity modification
-Shoe wear – flat shoes with high toe box to accommodate deformity
-Orthotic insoles – metatarsal bar/dome support
Operative
-Flexor to extensor transfer
-Fusion of interphalangeal joint
-Release metatarsophalangeal joint
-Shortening osteotomy of metatarsal
25
What is the aetiology of Morton's neuroma?
-Idiopathic
Frequently associated with wearing high heeled shoes
26
What is Morton's neuroma?
Mechanically induced degenerative neuropathy
27
Who is usually affected by Morton's neuroma?
Females aged 40-60
28
What is the pathogenesis of Morton's neuroma?
Common digital nerve relatively tethered to one metatarsal and movement in adjacent metatarsal causing mechanical shear
29
What are the symptoms of Morton's neuroma?
-Typically affects 3rd followed by 2nd webspace/toes
-Neuralgic burning pain into toes
-Intermittent
-Altered sensation in webspace
30
