Foot Disorders

Common Foot Disorders

• Hall Hallux valgus
• Plantar fasciitis
• Achilles tendinitis

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Hallux Valgus

• Definition: lateral deviation of the great toe (hallux) and medial deviation of the first metatarsal
• A common deformity
• F > M
• Types:
  • Adolescent
  • Adult → commonest
  • Geriatric

Etiology - Hallux Valgus

• Familial: > 60%

• 2-4 % of the population

• Wearing shoes

• Shoes:

  • High heels, or
  • Pointed front
    • Increase deformity & Cause?

• Metatarsus primus varus:

  • Congenital, or
  • Geriatric

• Rheumatoid arthritis

• Deformity / Bunion / medial deviation MT-1

• Issues in wearing shoes

• Pain → over the bunion, forefoot

Radiology - Hallux Valgus

• XR views:
  • AP standing:
    • Lateral deviation of big toe
    • Increased varus of 1st MT
    • Subluxation of MT-Phal. joint

Treatment - Hallux Valgus

• General: reducing symptoms – does not correct deformity

  • Rest
  • Elevation
  • Cold / ice compressions
  • NSAID:
    • Oral & gel
  • Changes in shoe wear
    • Wide front
  • Activity modifications

• Adolescent:

  • Main complaint: cosmetic
  • Wise to try conservative 1st (to delay surgery):
    • Shoes: wide front, no high heals
    • Silicon spacer / splints
  • Surgery

• Adult:

  • Surgery usually
  • Many operations

• Aim:

  • Re-align the 1^st metatarsal
  • Correct valgus deformity of big toe
  • Soft tissue balancing

bunion

• Bunion may be (usually) inflamed / painful

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Plantar Fasciitis

• Definition → inflammation of the plantar fascia
• In the posterior 2/3 of the foot
• Painful & sometimes disabling

Causes - Plantar Fasciitis

• Insidious (not clear H/O an incident)
• Some times:
  • Increased sport / repetitive stress
  • Change of footwear
  • Change of walking surface
  • Gain of weight (pregnancy, obese)
  • Prolonged standingZ
  • Connective tissue disorders (as D.M, Gout, …)

Symptoms - Plantar Fasciitis

• Gradual onset
• “Start-up Pain”:
  • When wake up in the morning
  • After sitting for some time
• Pain:
  • Pins and needles, or sharp, or persistent aches
  • At hind & mid foot area
  • Improves with:
    • Walking for sometime
    • Elevation
    • NSAID

Radiology - Plantar Fasciitis

• “Calcaneal Spur” on XR:
  • It’s a result NOT the cause
  • Implies chronicity
  • Not diagnostic
  • Present in 10% of normal

Treatment

• Conservative Management
  • Rest
    • Avoid repeated stress
    • Elevation
    • Heel cushionZ
  • Reduce inflammation
    • Ice compressors
    • NSAID
  • Physical Therapy
    • Stretching (calf & plantar fascia)
    • Massage Advanced Treatment Options If conservative treatments fail:
• Injection therapy
  • Local anesthesia & steroid at the most tender point

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Achilles Tendinitis

Overview

Achilles tendinitis is a condition characterized by inflammation of the Achilles tendon.

Types of Achilles Tendinitis

• Insertional
  • at insertion into Calcaneum
  • not related to activity
• Non-insertional
  • within the tendon
  • in younger active patients

Clinical Picture

• Pain: posterior foot / lower leg
• Pain is worse
  • Getting up from sleep in the morning
    • Gradually improves throughout the day
  • After a prolonged period of inactivity/activity
• Difficulty in plantar flexion of the foot
• Tenderness:
  • Over the lower calf muscle
  • Achilles tendon
• Some swelling over the tendon (+/-)

Causes of Achilles Tendinitis Extrinsic Factors

• Prolonged walking/standing
  • Repeated stress
• Sports
  • Sudden increase in activity
  • No proper warm-up before exerciseZ
• Shoes:
  • Rubbing against tendon
  • Improper shoes

Intrinsic Factors

• Tight gastrocnemius
• Tight Achilles tendon
• Flat feet
• Genu valgus

Workup for Achilles Tendonitis

• A clinical diagnosis
• X-ray:
  • may show calcification around the tendon

• U/S:
  • Edema in tendon
  • some effusion around the tendon

Treatment of Achilles Tendonitis

• Rest
• Elevation
• Cold/Ice compressions
• NSAID: oral & gel
• Physiotherapy: stretch the tendon
• Heel pads in proper home shoe to rest the tendon

Advanced Treatment for Achilles Tendonitis

• If no improvement → below knee cast with the foot in equinus, for 3-6 weeks may work
• Surgery may be needed in persistent cases

Complications of Untreated Achilles Tendonitis

• Achilles tendon pain should be treated
• If left untreated, the tendon can become weak, frayed, and eventually may rupture

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Take Home Message

Key Points

• Hallux Valgus
  • Conservative is still 1st line of management
  • Surgery for adult moderate/severe hallux valgus
  • Prevention → by proper shoes education
• Plantar fasciitis
  • Conservative treatment
  • Patient education is a must
• Achilles Tendinitis
  • Conservative treatment