Education regarding shoe wear
- extra wide / large toe box
Insoles
- longitudinal arch support
- pre MT dome for metatarsalgia
- podiatry to attend to callosities
Toe spacers
Analgesia
1. Continued pain and discomfort
2. Difficulties with shoe wear
Resuscitation
EMST
Neurovascular assessment
Investigations - exclude Pipkin, NOF
Emergent reduction / skeletal stabilisation
Assess stability
Re-evaluate sciatic nerve
Indications
- displaced acetabular fracture
Intra-articular proximal ulna fracture
Articulates with trochlea
- may have a central bare area
Triceps insertion
- via broad aponeurosis which blends with anconeus and CEO
Undisplaced fracture
- need to ensure triceps mechanism is intact
Progressive and chronic disorder associated with cord cavitation & gliosis
Muscle wasting
Dissociate anaesthesia
Scoliosis
Neuropathic arthropathy
M > F
No familial tendency
1. Idiopathic
Congenital fibrous, cartilaginous or bony connection of 2 or more tarsal bones
- due to failure of segmentation
Peroneal Spastic Flat Foot
- tarsal coalition
- tarsal pain
- reduced STJ motion
- rigid pes planus
- peroneal muscle spasm / tightness
Present in 6% of population
- symptomatic in 1% of population
Bilateral in 50%
Jacques LisFranc De St-Martin (1790 - 1847)
General Surgeon in Napoleonic army
High energy
1. Twisting / Abduction injury of forefoot
- original description is fall from horse with foot caught in stirrups
- MVA
2. Axial Loading
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
Sciatica > 2/52 1.6%
M:F = 1:1
Most common L4/5
L5/S1 inherently stable
Sedentary lifestyle
Smokers
Frequent driving
Heavy lifting
Annulus Fibrosis
- circumferential, multilayered rim
Clinical diagnosis
- based on a sclerotomal distribution of motor &/or sensory symptoms or signs
Caused by impingement of exiting nerve roots
- HNP
- zygo-apophyseal / facet joint hypertrophy
- neuro-central joint hypertrophy
May be acute or chronic
M>F
Peak age 50-54
C7 > C6