Brief overview of Disorders of feet-Bunion,Marfan Syndrome,Ehlers–Danlos syndrome,Corn and callus,Morton's neuroma,Toe joint disorders,Tarsal tunnel syndrome (TTS),Hypertophic Ungual Labium

1. Bunion
Marfan Syndrome
Ehlers–Danlos
syndrome
Corn and callus
Morton's neuroma
Toe joint disorders
Tarsal tunnel
syndrome (TTS)
Hypertophic
Ungual Labium
Lorita Furtado
Lor's Class

2. Bunion(hallux valgus)
 Is a deformity of the joint connecting the big
toe to the foot. Females are affected more
often than males
 The condition also becomes more common
with age.
 Signs and symptoms
 The big toe often bends towards the other
toes and the joint becomes red and painful.
 Other symptoms may include irritation of the
skin around the bunion, and blisters may form
more easily at the site. Pain may be worse
when walking
 The onset is typically gradual.
 Complications
 bursitis or arthritis.
 Causes
 Idiopathic
 Risks factors
 Wearing overly tight shoes, high-heeled
shoes, family history, and rheumatoid arthritis

 Diagnosis
 symptoms and by X-rays.
 Treatment
 proper shoes, orthotics, or
NSAIDs.
 If this is not effective for
improving symptoms, surgery
may be performedLor's Class

3. Marfan syndrome
 Marfan syndrome (MFS) is
a genetic disorder of the
connective tissue
 MFS is caused by a
mutation in FBN1, one of
the genes that makes
fibrillin, which results in
abnormal connective
tissue.
 It is an autosomal
dominant disorder and is
mostly inherited from a
parent
Lor's Class

4. Skeletal system
 Above-average height
 disproportionately long, slender
limbs with thin, weak wrists and
long fingers and toes.
 scoliosis, thoracic lordosis
 abnormal indentation (pectus
excavatum) or protrusion (pectus
carinatum) of the sternum
 abnormal joint flexibility
 a high-arched palate with crowded
teeth and an overbite
 flat feet, hammer toes
 stooped shoulders
 Unexplained stretch marks on the
skin.
 Pain in the joints, bones, and
muscles.
 Speech disorders resulting from
symptomatic high palates and small
jaws.
 Early osteoarthritis
 limited range of motion in the hips due
to the femoral head protruding into
abnormally deep hip sockets.
 Eyes
 Lens dislocation because of weakness
in the ciliary zonules, the connective
tissue strands which suspend the lens
within the eye.
 Nearsightedness (myopia),
Farsightedness, corneal flatness,
strabismus, exotropia, esotropia and
blurred vision are common due to
connective tissue defects in the eye.
 They are also at high risk for early
glaucoma and early cataracts.
Lor's Class

5. …….Contd
 Cardiovascular system
 undue fatigue, shortness of
breath, heart palpitations, racing
heartbeats, or chest pain radiating
to the back, shoulder, or arm, Cold
arms, hands, and feet , heart
murmur, and abnormal reading on
an ECG, dilated aorta or an aortic
aneurysm.
 Lungs
 spontaneous pneumothorax, sleep
apnea and idiopathic obstructive
lung disease. Pathologic changes
in the lungs like cystic changes,
emphysema, pneumonia,
bronchiectasis, bullae, apical
fibrosis and congenital
malformations such as middle
lobe hypoplasia.
 Nervous system
 Dural ectasia, the weakening of the
connective tissue of the dural sac
encasing the spinal cord. It can be
present for a long time without
producing any noticeable symptoms.
Symptoms that can occur are lower
back pain, leg pain, abdominal pain,
other neurological symptoms in the
lower extremities, or headaches –
symptoms which usually diminish
when lying flat.
 Other spinal issues associated with
MFS include degenerative disc
disease, spinal cysts, and dysfunction
of the autonomic nervous system.
 Genetics
 Each parent with the condition has a
50% risk of passing the genetic defect
on to any child due to its autosomal
dominant nature Lor's Class

6.  Diagnosis
 Based on family history and a combination of major and minor indicators of the
disorder, rare in the general population, that occur in one individual – for example:
four skeletal signs with one or more signs in another body system such as ocular and
cardiovascular in one individual.
 Ghent criteria
 Management
 Regular checkups -to monitor the health of the heart valves and the aorta.
 The goal of this treatment strategy is to slow the progression of aortic dilation and
prevent any damage to heart valves by eliminating heart arrythmias, minimizing the
heart rate, and lowering the person's blood pressure.
 Medication
 beta blockers such as propranolol to reduce the stress exerted on the aorta and to
decrease aortic dilation
 if not tolerated calcium channel blockers or ACE.
 Surgery
 Aortic graft surgery for aortic aneurysm
 Artificial lens implantation for Ectopia lentis
 Chest Drainage for Pneumothorax
Lor's Class

7. Ehlers–Danlos syndrome
 Ehlers–Danlos syndromes (EDS) are a group of genetic connective tissue disorders.
 Causes
 EDS occurs due to variations of more than 19 different genes which result in defects
in the structure or processing of the protein collagen .The specific gene affected
determines the type of EDS. Some cases result from a new variation occurring during
early development, while others are inherited in an autosomal dominant or recessive
manner.
 Signs and symptoms
 This group of disorders affects connective tissues across the body, with symptoms
most typically present in the joints, skin, and blood vessels. Effects may range from
mildly loose joints to life-threatening cardiovascular complications. Due to the
diversity of subtypes within the EDS family, symptoms may vary widely between
individuals diagnosed with EDS.
 Diagnosis
 Symptoms & genetic testing or skin biopsy.
 Management
 No known cure, treatment is supportive in nature.
 Physical therapy and bracing may help strengthen muscles and support joints.Lor's Class

8. Hypermobile
joints
Kyphoscoliosis
Atrophic scar
Ehlers–Danlos syndrome Lor's Class

9. Translucent skin
Skin Hyperelasticity
Piezogenic
papules(painful fat
herniation)
Lor's Class

10. Corn and callus
 A corn is a distinctively shaped callus of
dead skin that usually occurs on thin or
glabrous (hairless and smooth) skin
surfaces, especially on the dorsal surface
of toes or fingers.
 A callus is an area of thickened skin that
forms as a response to repeated friction,
pressure, or other irritation.
 Causes
 Friction and pressure
 Treatment
 paring of the lesions
 Corn plaster- a felt ring with a core of
salicylic acid that relieves pressure and
erodes the hard skin.
 If the source of any abnormal pressure is
detected, this may be avoided, usually
through a change to more comfortable
footwear or with various types of shoe
inserts or footwear with extra toe space.
 Callus Shaver
Lor's Class

11. Morton's neuroma
 is a benign neuroma(tumor of nervous tissue) of an
intermetatarsal plantar nerve, which results in the
entrapment of the affected nerve.
 Symptoms
 Pain and/or numbness, sometimes relieved by
ceasing to wear footwear
 Risk factors
 Frequent wearing of shoes with tight toeboxes and
high heels
 Treatment
 Orthosis (an externally applied device used to
modify the structural and functional characteristics
of the neuromuscular and skeletal system)
 Corticosteroids
 Sclerosing alcohol injection
 Radiofrequency ablation
 Cryogenic Neurablation
 Surgery- neurectomy Lor's Class

12. Hammer toe
 is a deformity of the muscles and
ligaments of the proximal
interphalangeal joint of the
second, third, or fourth toe
causing it to be bent, resembling a
hammer.
 In the early stage a flexible
hammertoe is movable at the
joints; a rigid hammertoe joint
cannot be moved and usually
requires surgery.
 Mallet toe is a similar condition
affecting the distal interphalangeal
joint.
 Claw toe is another similar condition,
with dorsiflexion of the proximal
phalanx on the lesser
metatarsophalangeal joint, combined
with flexion of both the proximal and
distal interphalangeal joints. Claw toe
can affect the second, third, fourth, or
fifth toes.
Lor's Class

13.  Risk factors
 Older people, women, injuries to the toes, and being born with
a longer second toe, arthritis and diabetes
 Causes
 Wearing poorly fitting shoes that can force the toe into a bent
position, such as high heels or shoes that are too short or
narrow for the foot. Having the toes bent for long periods of
time can cause the muscles in them to shorten, resulting in
the hammer toe deformity.
 Toe deformities can also be caused by muscle, nerve, or joint
damage, resulting from conditions such as osteoarthritis,
rheumatoid arthritis, stroke, Charcot–Marie–Tooth disease,
complex regional pain syndrome or diabetes.
 Hammer toe can also be found in Friedreich's ataxia
 Treatment
 physical therapy and new shoes with soft, spacious toe
 Toe exercises
Lor's Class

14. Tarsal tunnel syndrome (TTS)
 is a compression neuropathy and painful foot condition in which the tibial nerve is
compressed as it travels through the tarsal tunnel
Signs and symptoms
 Pain and tingling in and around ankles and sometimes the toes
 Swelling of the feet and ankle area.
 Painful burning, tingling, or numb sensations in the lower legs. Pain worsens and
spreads after standing for long periods; pain is worse with activity and is relieved by
rest.
 Electric shock sensations
 Hot and cold sensations in the feet
 A feeling as though the feet do not have enough padding
 Pain while operating automobiles
 Pain along the Posterior Tibial nerve path
 Burning sensation on the bottom of foot that radiates upward reaching the knee
 "Pins and needles"-type feeling and increased sensation on the feet
 A positive Tinel's sign ( is a tingling electric shock sensation that occurs when you tap
over an affected nerve. The sensation usually travels into the foot but can also travel
up the inner leg as well.)
Lor's Class

15. Causes
 Anything that creates pressure in the Tarsal Tunnel like benign tumors or cysts, bone spurs,
inflammation of the tendon sheath, nerve ganglions, or swelling from a broken or sprained
ankle.
 Idiopathic
Risk factors
 Varicose veins, flat feet, athletes and other active people, those with lower back problems,
Rheumatoid Arthritis , Neurofibromatosis, compressed shoes, pregnancy, diabetes and
thyroid disease.
 Diagnosis
 Physical examination -a positive Tinel's sign
 X-ray , MRI, nerve conduction tests
Prevention
 Immobilization, of the foot in a neutral position with a brace while sleeping
 Properly fitting shoes
Treatement
 Rest, casting with a walker boot, Wrapping
 manipulation
 strengthening of tibialis anterior, tibialis posterior, peroneus and short toe flexors
 Corticosteroid and anesthetic injections
 hot wax baths
 compression hose
 Orthotics
 Medications - anti-inflammatories and analgesics
Lor's Class

16. Hypertophic Ungual Labium
 Chronic Hypertrophy of
nail lip
 Caused by improper
nail trimming
 Results from untreated
ingrown toenails
 Rx
 Surgical removal
 Treating secondary
infecn
Lor's Class