Common Foot and Ankle Pathology DOTS 17th April Nick Savva Orthopaedic Foot and Ankle Surgeon. Monday, 29 April 13
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1 Common Foot and Ankle Pathology DOTS 17th April 2013 Nick Savva Orthopaedic Foot and Ankle Surgeon Monday, 29 April 13
2 Topics Forefoot pain Hindfoot/Ankle pain Hallux rigidus Bunions Toe deformity Mortons inter-digital neuroma Metatarsalgia Plantar fasciitis Arthritis Fusions Total Ankle Replacement (TAR) Red Flags + Post Op Problems Sundries Charcot Ulceration Counselling patients for surgery Good footwear Information Monday, 29 April 13
3 Treatment Algorithm Live with problem Change lifestyle/job Lose weight Change shoes Modify shoes Inserts/Orthotics (Ray MacIntosh) Physiotherapy NSAIDs/Analgesia Injections Surgery Monday, 29 April 13
4 Hallux Rigidus Presenting complaints Lumps that rubs on foot wear Painful stiff joint Monday, 29 April 13
5 Hallux Rigidus Monday, 29 April 13
6 Hallux Rigidus
7 Hallux Rigidus Treatment Footwear adjustments MUA and injection Cheilectomy Fusion/Arthodesis Replacement Monday, 29 April 13
8 Cheilectomy Monday, 29 April 13
9 Cheilectomy
10 Cheilectomy
11 Cheilectomy
12 Fusion
13 Replacement
14 Replacement
15 Bunions
16 Scarf and Akin Osteotomies
17 Lesser Toes Presenting complaints Rubbing on shoes Painful corns Metatarsalgia Monday, 29 April 13
18 Lesser Toes Treatment Silicon sleeves Bigger shoes Chiropody Surgery Monday, 29 April 13
19 Lesser Toes Treatment Silicon sleeves Bigger shoes Chiropody Surgery Monday, 29 April 13
20 Percutaneous Flexor Tenotomy
21 Percutaneous Flexor Tenotomy
22
23 Surgical fusion
24 Lesser Toes
25 Metatarsalgia Aetiology Idiopathic Tight Achilles tendon Transfer metatarsalgia Inflammatory arthropathy High arch feet (Cavus) Morton s intrerdigital neuroma Exacerbating Factors Over weight Over use Poor foot wear Tight Achilles tendon Monday, 29 April 13
26 Disorders of First Ray
27 Cavus Foot Monday, 29 April 13
28 Natural Progression
29 Natural Progression
30 Metatarsalgia Treatment Lose weight Gastrocnemius stretches Metatarsal dome orthotics Injections/NSAIDS Surgery Monday, 29 April 13
31 Tight Gastrocnemius
32 Tight Gastrocnemius
33 Weil s Osteotomy
34 Morton s Inter-Digital Neuroma Sharp electric pain in forefoot Radiates into 3rd and 4th toes Intermittent Worse in tight shoes Numbness in 3rd web space History is usually diagnostic Monday, 29 April 13
35 Morton s Inter-Digital Neuroma Tenderness between 3/4 metatarsal heads Mulder s click Reproduction of pain Altered sensation Metatarsophalangeal joints not sore Can occur in other web spaces Occasionally bilateral Often asymptomatic Monday, 29 April 13
36 Morton s Inter-Digital Neuroma Differential Diagnosis Joint pain (Metatarsalgia) Stress fracture Freibergs infraction Monday, 29 April 13
37 Investigations Radiographs Ultrasound Bone Scan MRI Monday, 29 April 13
38 Treatment Wide well padded shoes Metatarsal dome orthotics Image guided injection Radio-frequency ablation Alcohol ablation Image guided injection Monday, 29 April 13
39 Surgery
40 Ankle Osteoarthritis Aetiology Primary osteoarthritis Post trauma Rheumatoid Monday, 29 April 13
41 Treatment Aetiology Footwear Braces Injections Arthroscopic debridement Fusion/Arthrodesis (Gold standard) Replacement/Arthroplasty Monday, 29 April 13
42 Arthroscopic Debridement
43 Arthrodesis Fusion Monday, 29 April 13
44 Hindfoot Arthrodesis Nail (HAN)
45 Hindfoot Arthrodesis Nail (HAN)
46 Total Ankle Replacement (TAR)
47 TAR
48 Replacament versus Fusion
49 Plantar Fasciitis Policeman s heel Start up pain Obesity Standing occupation Insidious onset New shoes Monday, 29 April 13
50 Differential Diagnosis Plantar Fasciitis Plantar fasciosis (fasciitis) Infracalcaneal fat pad atrophy Medical calcaneal nerve entrapment Tarsal tunnel syndrome Rheumatoid arthritis Reiter s syndrome Ankylosing spondylitis Psoriatic arthritis Gout Posterior enthesopathies Behet s syndrome Systemic lupus erythematosus Fibromyalgia Sciatica Lateral plantar nerve branch to abductor digiti quinti Calcaneal stress fracture Calcaneal tumors/cysts Intraosseous edema of calcaneus Monday, 29 April 13
51 Plantar Fasciitis
52 Plantar Fasciitis
53 Plantar Fasciitis Treatment Resolves within 18 months Heat/cold NSAIDs Stretches Monday, 29 April 13
54 Plantar Fasciitis Treatment Heel cups Night splints Monday, 29 April 13
55 Plantar Fasciitis Shockwave Lithotripsy 3 6 sessions at least 1 week apart Approved by NICE Reduces length of symptoms by 80% Monday, 29 April 13
56 Plantar Fasciitis
57 Nerve Entrapments
58 Nerve Entrapments Monday, 29 April 13
59 Nerve Entrapments
60 Charcot and the Diabetic Foot
61 Take Home Messages Non-Operative Lose weight NSAIDs Footwear Orthotics Image guided injections Monday, 29 April 13
62 Take Home Messages Weight bearing xrays Elevate elevate elevate Try everything else first Monday, 29 April 13
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