Painful restriction of dorsiflexion of the great toe
- secondary to degenerative changes in MTPJ
- initially pain and synovitis
- osteophytes don't form medially or on plantar aspect
Two peaks
1. Adolescence F > M
2. Middle Age M > F
Often Idiopathic
Trauma
Inflammation of achilles tendon; insertional or noninsertional
Tendonitis / Tendonosis / Rupture
Triceps surae
- medial and lateral gastrocnemius
- soleus
- surrounded by paratenon which allows gliding and supplies nutrition
Inserts middle 1/3 calcaneal tuberosity
- 2 x 2 cm area
- 90o rotation distally
Retrocalcaneal bursa (x2)
Acquired Adult Flatfoot Deformity (AAFD)
- collapse of medial longitudinal arch
- secondary to ligament / tendon / joint or bony pathology
Flexible / Physiological
Ligamentous Laxity (DIAL HOME)
Rigid
- Congenital Vertical Talus
- Tarsal Coalition
Pure Cavus Deformity characterised by
- dorsiflexion of Calcaneus
- plantarflexion of Forefoot
Weakness of Tendoachilles
Usually neuromuscular
- Polio (Most common worldwide)
- Spina bifida
- CP (can be due to overcorrection of T Ach)
- Spinocerebellar Degen (Friedreich's Ataxia)
Crushing osteochondritis of metatarsal head
Usually 2nd metatarsal (80%)
- occasionally third
- can occur in any
Age 10-15 years
- peak 15 year old girls
- F:M = 3:1
- occurs during the growth spurt at puberty
Bilateral in 6%
Neuropathic Arthropathy
Progressive destructive arthropathy 2° to neurological condition
- usually minimal to no trauma
A. Ankle Fracture
Types
- Weber A 4%
- Weber C 33%
- Displaced large posterior malleolar
Any OA develops in first 2 years
Causes
- articular damage at time of injury
- non anatomical reconstruction
- complications i.e. infection
Forward slip of one vertebra relative to inferior one
Wiltse "DID TIP"
Dysplastic
Isthmic
Degenerate
Traumatic
Iatrogenic
Pathological
Congenital Dysplasia of Upper Sacrum
- occurs at L5-S1
Spondylolithesis caused by
- facet joint degeneration
- no pars or dysplastic pathology
- disc space usually preserved
Most common at L4/5 level
More common in elderly females
- F: M = 5:1
Diabetics
0.05% incidence
- rare due to stabilising effect of rib cage
- even more rare to have symptoms
Reasoning
1. Discs are narrower
2. Foramina larger
3. Thoracic spine
- facet joints orientated for rotation
- lumbar spine for flexion extension
- flexion is typically the motion which ruptures annulus