Presentation is loading. Please wait.

Presentation is loading. Please wait.

MOHAN LAL Consultant Orthopaedic & Foot/Ankle Surgeon Surrey & Sussex NHS Trust Spire Gatwick Park Hospital North Downs Hospital FOOT & ANKLE Presentation.

Similar presentations


Presentation on theme: "MOHAN LAL Consultant Orthopaedic & Foot/Ankle Surgeon Surrey & Sussex NHS Trust Spire Gatwick Park Hospital North Downs Hospital FOOT & ANKLE Presentation."— Presentation transcript:

1 MOHAN LAL Consultant Orthopaedic & Foot/Ankle Surgeon Surrey & Sussex NHS Trust Spire Gatwick Park Hospital North Downs Hospital FOOT & ANKLE Presentation by Chandar Lal

2 FOOT AND ANKLE EXAMINATION COMMON FOOT DISORDERS ANKLE DISORDERS TENDON DISORDERS SUBCATEGORIES

3 FOOT & ANKLE EXAMINATION General Aspects Gait: tiptoes/heel varus, heel walking Gait: tiptoes/heel varus, heel walking Shoe wear/orthoses Shoe wear/orthoses Expose to knee Expose to knee Look, feel, move Look, feel, move Neurovascular status Neurovascular status Other medical conditions: RA, Gout, CNS Other medical conditions: RA, Gout, CNS

4 LOOK Deformity Deformity Arches: cavovarus, planovalgus Arches: cavovarus, planovalgus Hallux Valgus Hallux Valgus Toes: hammer, mallet, claw Toes: hammer, mallet, claw Callosities represent pressure areas Callosities represent pressure areas Swelling Swelling Bilateral (medical) Bilateral (medical) Unilateral (surgical) Unilateral (surgical) Focal Focal Local Local Lumps (heel, bunion, tailors bunion) Scars Ulcers Colour Trophic changes Nails

5 LOOK CONTD. PES PLANUS CAVOVARUS

6 LOOK CONTD.

7 FEEL TA, heel (Haglaunds, plantar fasciitis) TA, heel (Haglaunds, plantar fasciitis) Peroneal tendons, lateral ligament, 5 th MT base, Tailors bunion Peroneal tendons, lateral ligament, 5 th MT base, Tailors bunion Forefoot: Mortons, MTPJ synovitis, 1 st MTPJ, Freibergs, stress fractures, sesamoiditis Forefoot: Mortons, MTPJ synovitis, 1 st MTPJ, Freibergs, stress fractures, sesamoiditis Midfoot: Kohlers, acc. Navicular, OA Midfoot: Kohlers, acc. Navicular, OA Ankle: OA, OCD, Tib. Post Tendon, tarsal tunnel Ankle: OA, OCD, Tib. Post Tendon, tarsal tunnel Temperature and pulses Temperature and pulses Neurologic: sensation, motor, reflexes Neurologic: sensation, motor, reflexes

8 MOVE Ankle Ankle Subtalar joint Subtalar joint Midfoot Midfoot Hallux Hallux Toes Toes Specific Tendons Specific Tendons

9 Hallux Valgus and Rigidus Hallux Valgus and Rigidus Lesser toe deformities Lesser toe deformities Hammer toe Hammer toe Mallet toe Mallet toe Claw toe Claw toe Flat foot Flat foot Metatarsalgia Metatarsalgia COMMON FOOT DISORDERS

10 Commonly seen in females Commonly seen in females 82% of women report having foot pain, while 72% report one or more foot deformities. 82% of women report having foot pain, while 72% report one or more foot deformities. More than 7 out of 10 women develop a bunion, hammertoe, or other painful foot deformity. More than 7 out of 10 women develop a bunion, hammertoe, or other painful foot deformity. Nine out of 10 womens foot deformities can be attributed to tight shoes. Nine out of 10 womens foot deformities can be attributed to tight shoes. GENERAL PROFILE OF DEFORMITIES

11 HALLUX VALGUS HALLUX VALGUS Definition Lateral deviation of great toe Aetiology Familial Familial Inappropriate footwear Inappropriate footwear Flatfeet Flatfeet Long first ray Long first ray Incongruous 1 st MTP joint articular surface Incongruous 1 st MTP joint articular surface Metatarsus primus varus Metatarsus primus varus Rheumatoid arthritis. Rheumatoid arthritis. HVHV + Claw toes

12 HALLUX VALGUS CONTD. Pathogenesis Complex deformity with angle between 1 st & 2 nd MT > 9 degrees and valgus angle at MTP joint >20 degrees. Complex deformity with angle between 1 st & 2 nd MT > 9 degrees and valgus angle at MTP joint >20 degrees. Valgus posture of great toe causing hammer toe like deformity of second toe. Valgus posture of great toe causing hammer toe like deformity of second toe. Splaying of forefoot causing bunion. Splaying of forefoot causing bunion. Incongruence causing osteoarthritis of 1 st MTP joint. Incongruence causing osteoarthritis of 1 st MTP joint.

13 WHEN TO REFER Symptoms Bunion pain Bunion pain Transfer metatarsalgia Transfer metatarsalgia Significant deformity causing: Significant deformity causing: 2 nd toe deformity 2 nd toe deformity Shoe wear problems Shoe wear problems Cosmesis – relative contraindication Cosmesis – relative contraindication

14 SIGNS Bunion and inflamed overlying bursa and skin Bunion and inflamed overlying bursa and skin Valgus and pronation deformity of hallux. Valgus and pronation deformity of hallux. Painful callus on 2 nd toe Painful callus on 2 nd toe Second toe is forced into hyperextension by deviated great toe Second toe is forced into hyperextension by deviated great toe Transfer metatarsalgia/thickened skin over MT heads. Transfer metatarsalgia/thickened skin over MT heads. Increased valgus angle at first MTP joint Increased valgus angle at first MTP joint Valgus angle at first MTP joint >20 degrees Valgus angle at first MTP joint >20 degrees Angle between 1 st & 2 nd MT >9 degrees Angle between 1 st & 2 nd MT >9 degrees

15 MANAGEMENT MANAGEMENT Entire foot must be assessed first. Entire foot must be assessed first. X-ray of foot –Standing dorso plantar, oblique & axial sesamoid views X-ray of foot –Standing dorso plantar, oblique & axial sesamoid views Medial exostosis (bunion) Medial exostosis (bunion) Lateral displacement proximal phalanx Lateral displacement proximal phalanx Degenerative changes in 1 st MTP/IP Joint Degenerative changes in 1 st MTP/IP Joint Intermetatarsal & Hallux Valgus angles Intermetatarsal & Hallux Valgus angles

16 ANGLES

17 TREATMENT CONSERVATIVE TREATMENT Aim: Relieve pressure over painful bunion prominence Properly fitted, low heeled stiff-soled shoes Properly fitted, low heeled stiff-soled shoes Wide, square shaped toe box Wide, square shaped toe box Toe portion stretched to accommodate bunion Toe portion stretched to accommodate bunion Extra-depth shoe to accommodates dorsiflexed second toe Extra-depth shoe to accommodates dorsiflexed second toe Splint separates first and second toe Splint separates first and second toe Acute pain management Acute pain management Rest Rest Apply moist heat Apply moist heat Analgesics Analgesics

18 SURGICAL MANAGEMENT Indications Refractory to conservative management Refractory to conservative management Severe deformity or bunion pain Severe deformity or bunion pain Factors to be considered before surgery Valgus deviation of great toe Valgus deviation of great toe Varus deviation of first metatarsal Varus deviation of first metatarsal Arthritis of MTP and IP joint Arthritis of MTP and IP joint Bunion Bunion Metatarso-cuneiform joint instability Metatarso-cuneiform joint instability Vascularity & sensibility Vascularity & sensibility Surgical Procedures Soft tissue surgery - rarely indicated in adolescent cases Bone/joint procedure remains the gold standard

19 HALLUX RIGIDUS/DORSAL BUNION Painful limitation of motion at 1 st MTP joint Pathogenesis: synovitis, cartilage destruction, osteophyte proliferation, subchondral cysts and sclerosis Clinical presentation: pain, limited dorsiflexion and dorsal osteophyte, dorsal tenderness Aetiology: Trauma, Repeated microtrauma, osteochondritis dissicans and abnormally long first metatarsal

20 TREATMENT Grade I: Mild osteophytes, joint space preserved NSAID, orthosis and injection NSAID, orthosis and injection Grade II: Moderate osteophyte formation, joint space narrowing & subchondral sclerosis Cheilectomy: e xcision of 20-35% of dorsal metatarsal head aiming for up to 70º of dorsiflexion. Cheilectomy: e xcision of 20-35% of dorsal metatarsal head aiming for up to 70º of dorsiflexion. Grade III: Severe arthritis Arthrodesis/joint replacement Arthrodesis/joint replacement

21 LESSER TOE DEFORMITIES Hammer, Claw and Mallet Hammer, Claw and Mallet Association with HV, RA, DM and NM disorders Association with HV, RA, DM and NM disorders Pain, corns, ulcers, shoe wear difficulties Pain, corns, ulcers, shoe wear difficulties Flexible and fixed Flexible and fixed Conservative treatment: manipulation, corn pads, accommodative shoe wear Conservative treatment: manipulation, corn pads, accommodative shoe wear Surgical treatment: tendon release and transfers for flexible deformities; fusion and excision arthroplasties for fixed deformities. Surgical treatment: tendon release and transfers for flexible deformities; fusion and excision arthroplasties for fixed deformities.

22 FLAT FOOT/PES PLANUS Flexible (99%) or Rigid (1%) Distinguished by Jack test and tiptoeing Distinguished by Jack test and tiptoeing Pathology - Loss of normal medial longitudinal arch in combination with valgus posture of heel, mild subluxation of subtalar joint & eversion of calcaneum Arch develops till the age of 7-10 years so there is no treatment required 15-20% of adults have asymptomatic pes planus

23 TREATMENT OF FLEXIBLE PES PLANUS 3-9 years: symptomatic - arch support years require investigation Symptomatic patient - rule out accessory navicular or incomplete tarsal coalition and treat accordingly. Adults with painful pes planus not responding to conservative management will benefit with surgery

24 RIGID PES PLANUS Aetiology: Congenital vertical talus & tarsal coalition Aetiology: Congenital vertical talus & tarsal coalition Tarsal coalition: calcaneo-navicular & talocalcaneal; can be bony, cartilagenous or fibrous. Tarsal coalition: calcaneo-navicular & talocalcaneal; can be bony, cartilagenous or fibrous. Symptoms: Foot pain, difficulty walking on uneven surfaces, foot fatigue, peroneal spasm. Symptoms: Foot pain, difficulty walking on uneven surfaces, foot fatigue, peroneal spasm. Treatment: 4-6 weeks of cast immobilization; surgical treatment includes resection of connecting bar & soft tissue interposition, subtalar arthrodesis, triple arthrodesis. Treatment: 4-6 weeks of cast immobilization; surgical treatment includes resection of connecting bar & soft tissue interposition, subtalar arthrodesis, triple arthrodesis.

25 METATARSALGIA Pressure from subluxed MTPJs with painful callosities Pressure from subluxed MTPJs with painful callosities Freibergs AVN (treatment: conservative and surgical) Freibergs AVN (treatment: conservative and surgical) Stress Fractures Stress Fractures Transfer from first metatarsal insufficiency/HV Transfer from first metatarsal insufficiency/HV Sesamoiditis Sesamoiditis Mortons Mortons

26 MORTONS METATARSALGIA Commoner in middle-aged women; 85% unilateral Commoner in middle-aged women; 85% unilateral Aetiology: trauma, ischaemia, entrapment Aetiology: trauma, ischaemia, entrapment Pathology: degenerative rather than a true neuroma with perineural fibrosis and demyelination. Pathology: degenerative rather than a true neuroma with perineural fibrosis and demyelination. Diagnosis: symptom of shooting/constant pain on walking, relieved by rest and removal of footwear; clinical sign of third/second cleft tenderness and palpable click on metatarsal squeeze test. Diagnosis: symptom of shooting/constant pain on walking, relieved by rest and removal of footwear; clinical sign of third/second cleft tenderness and palpable click on metatarsal squeeze test. Treatment: orthoses, injection and excision Treatment: orthoses, injection and excision

27 ANKLE DISORDERS Instability Instability Impingement Impingement Osteochondritis Dissecans of talus Osteochondritis Dissecans of talus Arthritis Arthritis Posttraumatic Posttraumatic Inflammatory Inflammatory Degenerative Degenerative

28 ANKLE INSTABILITY Repeated acute inversion injuries/laxity Repeated acute inversion injuries/laxity Presentation with pain and instability Presentation with pain and instability Diagnosis: tenderness, anterior draw Diagnosis: tenderness, anterior draw Imaging: stress X-rays, MRI Imaging: stress X-rays, MRI Treatment Treatment Conservative - physiotherapy, splints Conservative - physiotherapy, splints Surgical – primary repair/reconstructive procedures Surgical – primary repair/reconstructive procedures

29 ANKLE IMPINGEMENT Repeated sporting dorsiflexion injuries Repeated sporting dorsiflexion injuries Presentation with anterior ankle pain Presentation with anterior ankle pain Diagnosis: clinical anterior tenderness and ± anterior osteophytes on X-rays Diagnosis: clinical anterior tenderness and ± anterior osteophytes on X-rays Treatment Treatment Conservative: activity modification/NSAIDs Conservative: activity modification/NSAIDs Surgical: open/arthroscopic decompression Surgical: open/arthroscopic decompression

30 OSTEOCHONDRITIS DISSECANS Posttraumatic in young patients Posttraumatic in young patients Presentation with persistent pain and swelling with stiffness Presentation with persistent pain and swelling with stiffness Diagnosis: clinical tenderness, diffuse swelling Diagnosis: clinical tenderness, diffuse swelling Imaging: X-rays and MRI scan Imaging: X-rays and MRI scan Treatment: undisplaced lesions treated with rest and cast immobilisation; displaced lesions require arthroscopic removal/drilling Treatment: undisplaced lesions treated with rest and cast immobilisation; displaced lesions require arthroscopic removal/drilling

31 ANKLE ARTHRITIS Posttraumatic: rare in commonly injured joint; associated with displaced intra-articular fractures and significant lateral ligament complex injury. Posttraumatic: rare in commonly injured joint; associated with displaced intra-articular fractures and significant lateral ligament complex injury. Inflammatory: RA in low-demand patients Inflammatory: RA in low-demand patients Degenerative: relatively uncommon Degenerative: relatively uncommon Presentation with pain, swelling, stiffness, limited mobility, limping. Presentation with pain, swelling, stiffness, limited mobility, limping.

32 ANKLE ARTHRITIS (CONTD.) Diagnosis: clinical swelling, tenderness, ROM Diagnosis: clinical swelling, tenderness, ROM Imaging: X-rays, bone scan to assess surrounding joints Imaging: X-rays, bone scan to assess surrounding joints Treatment Treatment Conservative: NSAIDs, walking stick, weight reduction and activity modification. Conservative: NSAIDs, walking stick, weight reduction and activity modification. Surgical: arthroscopic/open decompression; ankle arthrodesis (up to 25% non-union, 3 month casting); ankle replacement gives satisfactory mid-term results in properly selected low-demand patients (long-term results?) Surgical: arthroscopic/open decompression; ankle arthrodesis (up to 25% non-union, 3 month casting); ankle replacement gives satisfactory mid-term results in properly selected low-demand patients (long-term results?)

33 ANKLE ARTHRITIS (CONTD.)

34 TENDON DISORDERS Commonly affected tendons: Tibialis posterior Tibialis posterior Tibialis anterior Tibialis anterior Peroneus tendons Peroneus tendons Tendoachillis Tendoachillis

35 TIBIALIS POSTERIOR TENDON Anatomy - posteromedial tendon, origin from posterior surface of tibia & inserts on to the medial cuneiform Anatomy - posteromedial tendon, origin from posterior surface of tibia & inserts on to the medial cuneiform Function - plantar flexion, inversion, stabilizes medial longitudinal arch Function - plantar flexion, inversion, stabilizes medial longitudinal arch Important tendon in foot, affection of which causes more functional disability than TA rupture Important tendon in foot, affection of which causes more functional disability than TA rupture Aetiology - trauma, chronic flat foot, inflammatory arthropathy, degenerative tendonopathy, chronic tenosynovitis, abnormal insertion, steroid use. Aetiology - trauma, chronic flat foot, inflammatory arthropathy, degenerative tendonopathy, chronic tenosynovitis, abnormal insertion, steroid use. Deformity - collapse of medial longitudinal arch, hindfoot valgus, midfoot abduction, forefoot pronation Deformity - collapse of medial longitudinal arch, hindfoot valgus, midfoot abduction, forefoot pronation

36 PATHOLOGY/PRESENTATION PRESENTATION Fatigue of foot with limited activity, medial and lateral pain Fatigue of foot with limited activity, medial and lateral pain Flat foot on weight bearing Flat foot on weight bearing Standing tip toe – heel will go into valgus Standing tip toe – heel will go into valgus Clinical examination confirms tenderness, weak/ruptured tendon, hindfoot valgus (flexible/fixed) and a lack of heel varus on tiptoeing Clinical examination confirms tenderness, weak/ruptured tendon, hindfoot valgus (flexible/fixed) and a lack of heel varus on tiptoeing Pathogenesis: tenosynovitis, incomplete tear, complete disruption Two groups of patients: Younger patients with inflammatory arthropathy/traumatic rupture Older, typically female patients with degenerative tears

37 MANAGEMENT Imaging: X-ray (degeneration), MRI Tenosynovitis - rest, NSAIDs, short leg walking cast, orthoses, steroid injection in tendon sheath, synovectomy. Tenosynovitis - rest, NSAIDs, short leg walking cast, orthoses, steroid injection in tendon sheath, synovectomy. Incomplete tear - repair or augmentation with either FDL or FHL. Incomplete tear - repair or augmentation with either FDL or FHL. Complete disruption – repair in traumatic young cases; tendon transfer with medial calcaneal displacement osteotomy (mobile hindfoot) and subtalar/triple arthrodesis (fixed hindfoot). Complete disruption – repair in traumatic young cases; tendon transfer with medial calcaneal displacement osteotomy (mobile hindfoot) and subtalar/triple arthrodesis (fixed hindfoot). Satisfactory results in spite of prolonged rehabilitation Satisfactory results in spite of prolonged rehabilitation

38 TIBIALIS ANTERIOR Anatomy: Anatomy: Origin - lateral condyle of tibia, proximal 2/3 of lateral surface of tibia, interosseous membrane Origin - lateral condyle of tibia, proximal 2/3 of lateral surface of tibia, interosseous membrane Insertion - base of first metatarsal and medial plantar surface of 1st cuneiform Insertion - base of first metatarsal and medial plantar surface of 1st cuneiform Action - dorsiflexes and inverts foot Action - dorsiflexes and inverts foot Disorders are common in athletes and old age group Disorders are common in athletes and old age group Diagnosis- weakness of dorsiflexion of foot, pain, use of toe extensors for dorsiflexion of foot. Diagnosis- weakness of dorsiflexion of foot, pain, use of toe extensors for dorsiflexion of foot. Treatment- steroid injection or synovectomy. Tendon repair rarely required as deformity is not functionally significant. Treatment- steroid injection or synovectomy. Tendon repair rarely required as deformity is not functionally significant.

39 PERONEAL TENDONS Anatomy: Peroneus longus & brevis are posteolateral tendons originating from fibula and interosseous membrane and are inserted at base of I & V MT respectively.

40 PERONEAL TENDONS (CONTD.) Pathology: Pathology: Tenosynovitis - common in high arch foot because of increase in excursion. Tenosynovitis - common in high arch foot because of increase in excursion. Sprain/ subluxation - inversion ankle injuries. Sprain/ subluxation - inversion ankle injuries. Symptoms: pain in the outer part of the ankle or just behind the lateral malleolus. This pain commonly worsens with activity and eases with rest. Symptoms: pain in the outer part of the ankle or just behind the lateral malleolus. This pain commonly worsens with activity and eases with rest. Diagnosis: Diagnosis: Examination - tenderness/subluxation Examination - tenderness/subluxation X-rays to exclude fracture X-rays to exclude fracture MRI MRI

41 PERONEAL TENDONS (CONTD.) Treatment Non-surgical Non-surgical Rest, short-leg walking cast/brace, lateral heel wedge, physical therapy, NSAIDs and Cortisone injection Rest, short-leg walking cast/brace, lateral heel wedge, physical therapy, NSAIDs and Cortisone injection Surgical Surgical Tenosynovectomy and repair of split Tenosynovectomy and repair of split Stabilisation of dislocating tendons by groove deepening, peroneal retinaculum reconstruction and bone block procedures Stabilisation of dislocating tendons by groove deepening, peroneal retinaculum reconstruction and bone block procedures

42 ACHILLES TENDINITIS/TENDINOSIS Tendinosis - there will be clinical inflammation, but objective pathologic evidence for cellular inflammation is lacking Tendinosis - there will be clinical inflammation, but objective pathologic evidence for cellular inflammation is lacking Tendinitis - there will be a peritendinous inflammation Tendinitis - there will be a peritendinous inflammation Seen in adults in their 30s and 40s Seen in adults in their 30s and 40s Most commonly affects runners Most commonly affects runners Heel cord contracture can exacerbate symptoms Heel cord contracture can exacerbate symptoms Two types: Two types: Non-insertional Non-insertional Occurs proximal to retrocalcaneal bursa Occurs proximal to retrocalcaneal bursa Generally responds well to non-operative treatment Generally responds well to non-operative treatment Insertional Insertional Tenderness is localized to calcaneal tendon insertion Tenderness is localized to calcaneal tendon insertion More difficult to treat More difficult to treat

43 TREATMENT Conservative Rest, ice, NSAIDs, physical therapy, orthoses Operative Achilles tendon decompression and debridement if unrelieved by 6 months of conservative measures 90% will have significant relief of symptoms; 10% will have some symptom improvement Complete symptomatic cure not guaranteed

44 ACHILLES TENDON RUPTURE Common sporting incidence affecting the young to middle-aged Common sporting incidence affecting the young to middle-aged Mechanism usually involves loading on a dorsiflexed ankle with the knee extended (soleus and gastroc on maximal stretch) or repeated microtrauma Mechanism usually involves loading on a dorsiflexed ankle with the knee extended (soleus and gastroc on maximal stretch) or repeated microtrauma Consider systemic conditions such as gout or hyperparathyroidism (esp. with pure avulsion injury); previous steroid injections Consider systemic conditions such as gout or hyperparathyroidism (esp. with pure avulsion injury); previous steroid injections Disabling condition requires approx. 6 months to recover when treated adequately Disabling condition requires approx. 6 months to recover when treated adequately

45 ACHILLES TENDON RUPTURE (CONTD.) Diagnosis (suspect in all ankle injury cases): Diagnosis (suspect in all ankle injury cases): Characteristic history Characteristic history Classical signs: Classical signs: Local tenderness and gap Local tenderness and gap Hyper-dorsiflexion at ankle Hyper-dorsiflexion at ankle Thompson/Simmonds test Thompson/Simmonds test Imaging: Imaging: Ultrasound and MRI scan in doubtful cases Ultrasound and MRI scan in doubtful cases

46 TREATMENT Non-operative treatment is indicated in older patients and minimally displaced ruptures and involves serial casting over weeks (complete equinus, mid equinus, neutral walking). Non-operative treatment is indicated in older patients and minimally displaced ruptures and involves serial casting over weeks (complete equinus, mid equinus, neutral walking). Operative repair is indicated in younger patients with clinically displaced ruptures, delayed presentation ( hours) and neglected ruptures followed by similar casting regime. Operative repair is indicated in younger patients with clinically displaced ruptures, delayed presentation ( hours) and neglected ruptures followed by similar casting regime. Complications: wound healing and sural nerve injury Complications: wound healing and sural nerve injury Consider DVT prophylaxis Consider DVT prophylaxis

47 NON-OPERATIVE VS. OPERATIVE Return to the preinjury level of activity Patient satisfaction Re-rupture Non- operative 69%66% Up to 33% Operative83%93%2-3%

48 HEEL PAIN Commonly caused by plantar fasciitis. Commonly caused by plantar fasciitis. Heel spurs often associated. Heel spurs often associated. Pain is worst on waking up. Pain is worst on waking up. Causes - obesity, excessive walking/sporting activity, tight plantar fascia & flattening of the arch. Causes - obesity, excessive walking/sporting activity, tight plantar fascia & flattening of the arch. Treatment – orthoses, physical therapy, injection, NSAIDs and (rarely) surgical release in resistant cases. Treatment – orthoses, physical therapy, injection, NSAIDs and (rarely) surgical release in resistant cases.

49 RETROCALCANEAL BURSITIS Two bursae: retrocalcaneal (subtendinous) bursa & subcutaneous calcaneal bursa Two bursae: retrocalcaneal (subtendinous) bursa & subcutaneous calcaneal bursa Causes Causes Repetitive trauma from shoe wear and sports Repetitive trauma from shoe wear and sports Gout, RA and ankylosing spondyloarthropathies Gout, RA and ankylosing spondyloarthropathies Bursal impingement between the Achilles tendon and an excessively prominent posterior-superior aspect of the calcaneus (Haglund deformity). Bursal impingement between the Achilles tendon and an excessively prominent posterior-superior aspect of the calcaneus (Haglund deformity). Symptoms: pain, swelling, shoe wear difficulty Symptoms: pain, swelling, shoe wear difficulty Signs: tenderness, lump, inflammation Signs: tenderness, lump, inflammation

50 MANAGEMENT Imaging: X-rays for calcification and Haglund deformity. Imaging: X-rays for calcification and Haglund deformity. Conservative: physical therapy, appropriate shoe wear, injection (risk of tendon rupture). Conservative: physical therapy, appropriate shoe wear, injection (risk of tendon rupture). Surgical Intervention includes resection of Haglund deformity (removal of the calcaneal superoposterior prominence), excision of the painful bursa and debridement of tendon insertion Surgical Intervention includes resection of Haglund deformity (removal of the calcaneal superoposterior prominence), excision of the painful bursa and debridement of tendon insertion

51 THANK YOU


Download ppt "MOHAN LAL Consultant Orthopaedic & Foot/Ankle Surgeon Surrey & Sussex NHS Trust Spire Gatwick Park Hospital North Downs Hospital FOOT & ANKLE Presentation."

Similar presentations


Ads by Google