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Flashcards in Foot Problems - Forefoot Deck (21)
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1
Q

Contains:

A
Hallux Valgus
Hallux Rigidus
Lesser Toe deformities 
Morton's Neuroma
Metatarsalgia
Rheumatoid forefoot
2
Q

What is hallux valg\us?

A

A bunion
Lateral angulation of the big toe, the tendons then pull lateral to the toes center of rotation leading to worsening angulation

3
Q

What are the risk factors Hallux Valgus?

A
  • Genetics
  • Foot Wear
  • female
  • FH
  • Neuromuscular disease
  • Hypermobility
4
Q

Symptoms of Hallux Valgus?

A
  • Pressure symptoms from the shoe
  • Pain of the toes crossing over
  • Metatarsalgia
  • some report massive pain with small deformities
  • others report little pain with large bunions
5
Q

How do we diagnose Hallux Valgus?

A

Clinical diagnosis

Can use X-rays to determine severity of deformity

6
Q

How do we manage Hallux Valgus?

A

Non-operative:

  • Shoe wear modification
  • Orthotics
  • Activity Modification
  • Analgesia

Operative:
- Release lateral soft tissue
- Osteotomy of 1st metatarsal
+/- proximal phalanx

7
Q

What is Hallux Rigidus?

A

Literally “Stiff Big Toe”

Its osteoarthritis of the 1st MTP join

8
Q

What causes Hallux Rigidus?

A

Possibly genetic or due to multiple microtrauma

9
Q

How does hallux rigidus present?

A
  • Many are asymptomatic.
  • limited range of motion
  • pain (often at extreme of dorsiflexion)
10
Q

How do we diagnose hallux rigidus?

A

Clinically and with radiographs to spot the Osteoarthritis

11
Q

How do we manage Hallux Rigidus?

A

Non-operative:

  • Activity modification
  • Shoe wear modification
  • Analgesia

Operative

  • Cheilectomy (removing the dorsal impingement a.k.a lump)
  • Arthrodesis (1st MTPJ fusion is gold standard but permanent)
  • Arthroplasty (1st MTPJ hemiarthroplasty is good for maintaining ROM but fails alot)
12
Q

What are the types of lesser toe deformities?

A

Claw Toe - both IP joints deformed
Hammer Toe - 1st IP joint deformed
Mallet Toe - 2nd IP joint deformed

13
Q

What causes a lesser toe deformity?

A
  • Flexor/extensor imbalance
  • Shoe Wear
  • Neurological conditions
  • Rheumatoid arthritis
  • Idiopathic
14
Q

How does a lesser toe deformity present?

A

-Visible deformity
+/- dorsal pain
+/- plantar pain (metatarsalgia)

15
Q

How do we treat a deformed lesser toe?

A

Non-operative:

  • Activity Modification
  • Shoe wear modification
  • Orthotic insoles

Operative:

  • Flexor to extensor transfer
  • IP joint fusion
  • MTP joint release
  • Shortening osteotomy of metatarsal
16
Q

What is Morton’s Neuroma aka Interdigital Neuroma?

A

a mechanically induced degenerative neuropathy of a common digital nerve, typically in the 3rd then 2nd web spaces.

Associated with women in their 40s/50s who frequently wear high heels

17
Q

How does Morton’s Neuroma present?

A
  • Intermittent Neuralgic burning pain into toes
  • Altered sensation in the webspaces.
  • Typically affects the 3rd then 2nd webspaces
  • Swelling over the nerve
18
Q

How do we diagnose Morton’s Neuroma?

A

Clinical presentation
Mulder’s Click
US or MRI

19
Q

How do we manage Morton’s Neuroma?

A

Injection
Nitrogen freezing
Insoles
Surgical excision of lesion (associated with numbess & recurrence)

20
Q

How do we treat Rheumatoid Forefoot?

A

Non-operative:

  • Shoewear
  • Orthotics
  • Activity
  • Analgesia

Operative:

  • 1st MTPJ arthrodesis
  • 2-5th toe excision arthroplasty
21
Q

What is metartalsalgia?

A

Adult forefoot pain