T

T


T1-weighted images; T1W magnetic resonance imaging (MRI) sequencing that demonstrates anatomy (i.e. fat-/hydrogen-containing structures appear white); contrast with short T1 inverse recovery imaging; STIR


T2-weighted images; T2W MRI sequencing that demonstrates pathology (favours imaging water content within structures e.g. inflammation or infection)


T4 and T3 see thyroxine


T strap; T-bar strap interconnected transverse/longitudinal straps; form positive shoe-fixing overlying dorsum of foot


tabes dorsalis; TD chronic inflammation, progressive central and peripheral neural sclerosis, loss of muscular coordination and muscle atrophy, peripheral neuropathy and sensory anaesthesia, neuralgia and lancinating pains, neuroarthropathy (Charcot joint formation) and visceral crises; characteristic of late-stage (tertiary) syphilis


tachycardia pathological heart rate increase (>100 beats/minute)


tacit consent see consent


tactile relating to touch/sense of touch


tactile papilla skin papilla containing a touch-modulating sensory nerve ending (e.g. Merkel disc, Meissner corpuscle)


Tagamet see cimetidine


tailor’s bunion transverse-plane and rotational fifth-ray deformity, characterized by fifth metatarsal abduction, hypertrophy of lateral aspect of fifth metatarsal head, adduction and varus rotation (supination) of fifth toe at fifth metatarsophalangeal joint; associated with severe hallux abductovalgus (contributes to ‘diamond-shaped’ forefoot); characterized by fifth metatarsophalangeal joint lateral bursa/bursitis and/or heloma molle at depth of 4/5 interdigital space


talar beak osteophyte formation at neck of talus; caused by previous or chronic trauma; characterized by anterior ankle pain and limited ankle dorsiflexion


talar compression syndrome see syndrome, talar compression


talar declination angle; TDA angle subtended between longitudinal bisection of medial column (body of talus, navicular, medial cuneiform and first metatarsal) and the radiographic base plate on a lateral foot radiograph; low TDA indicates valgus/planovalgus foot; high TDA indicates cavus foot Figure P2


talar tilt test see test, talar tilt


talc; talcum finely powdered hydrous magnesium silicate; used as a base for topical application of an active medicament; reduces friction at skin surface; does not absorb moisture (see Tables A19 and V2)


talipes congenital foot deformity, about the talus


talipes calcaneovalgus congenital vertical orientation of longitudinal axes of talus and calcaneum secondary to soft-tissue deformity of lower leg and foot; characterized by marked ankle joint dorsiflexion, subtalar joint eversion, loss of concavity of medial longitudinal arch; the foot cannot be placed passively in a plantigrade position

talipes equinovarus significant congenital skeletomuscular deformity of lower limb and foot; absence of pronatory rotation at neck of talus causes the foot to retain the early embryological relationship to the lower limb (Figure T1); occurs ideopathically, but is also associated with significant congenital neurological dysfunction/dysplasias; characterized by heel inversion + very marked forefoot inversion, underdevelopment and contracture of lower-limb posterior musculature, ankle plantarflexion, near horizontal talar axis, marked inversion of subtalar and midtarsal joints, forefoot adduction, weight-bearing lateral rearfoot, talar head prominence at dorsolateral aspect of rearfoot, exaggerated concavity of medial longitudinal arch exaggerated, and inability to place the foot passively in plantigrade position; treatment aims to achieve a plantigrade foot, e.g. early-infancy strapping and soft-tissue stretching (a Denis Browne splint may be used to maintain correction gained by strapping/stretching therapy, once the child can walk); reduction of persistent soft-tissue contractures with injection of botulinum toxin into posterior-group muscles (+ below-knee cast); surgical options include Achilles tendon lengthening, or plantar fasciotomy; skeletal deformity/dysfunction is corrected by osteotomy (e.g. of calcaneum and metatarsals) and/or triple arthrodesis in order to achieve a plantigrade and functional foot

image

Figure T1 Uncorrected talipes equinovarus in a new-born infant. This article was published in Neale’s Disorders of the Foot, Lorimer, French, O’Donnell, Burrow, Wall, Copyright Elsevier, (2006).


talocalcaneal coalition see tarsal coalitions


talocalcaneal ligament interosseous ligament occupying sinus tarsi; becomes taut during eversion (i.e. during midstance), preventing overpronation, and assisting rearfoot resupination at end of stance phase of gait


talocalcaneal navicular joint; TCNJ; talonavicular joint; TNJ ‘ball and socket’ part of subtalar joint (STJ), i.e. between head and adjacent part of body of talus (the ball) and proximal surface of navicular, plantar calcaneonavicular ligament and anteromedial part of calcaneum and sustentaculum tali (the socket); TCNJ moves with STJ in inversion and eversion; TCNJ axis of movement orientes from lateral–posterior–inferior to medial–anterior–superior; posterior part of TCNJ capsule forms interosseous talocalcaneal ligament within sinus tarsi


talonavicular joint; TNJ see talocalcaneal navicular joint


talus; astragalus ankle bone


inferior surface of body of talus articulates with superior aspect of calcaneum, forming subtalar joint

head of talus articulates with navicular forming TNJ itself a component of midtarsal joint

superior (trochlear) surface of body of talus articulates with inferior ends of tibia and fibula, forming ankle joint

tamoxifen hormone antagonist used to treat/prevent breast cancer; patients on tamoxifen are prone to thromboembolism, especially postsurgery or following prolonged rest


tannic acid astringent agent in dusting powders and lotions; used to treat tinea pedis Table A13


tap using a tendon hammer to elicit a tendon reflex


taping soft splintage used to immobilize/impose rest following trauma, sprain or overuse injury; non-elastic tape (2.5 cm wide) is applied in strips to maintain underlying structures in a position that minimizes further trauma and promotes healing; taping may also be applied for injury prophylaxis


tar see coal tar


tardive dyskinesia slow voluntary body movements; side-effect of long-term use of psychotropic drugs


target lesion characteristic skin lesion of erythema multiforme


target organ; target tissue tissue/cells (e.g. endocrine gland/non-endocrine gland/specific tissues) on which a hormone acts


tarsal arthritis tarsal joint osteoarthritis, especially first metatarsal–medial cuneiform joint in feet with pes cavus or pes planovalgus; characterized by midfoot pain with later development of osteophytes at affected joints, and increased dorsiplantar midfoot depth, hyperkeratosis of overlying plantar skin and dorsal adventitious bursa formation


tarsal bones see tarsus


tarsal coalitions; tarsal fusion; peroneal spastic flat foot synchondrosis of two or more tarsal bones due to conjunction of two or more midfoot and/or rearfoot bones because of failure of development of the intervening joint/s; normally asymptomatic during early childhood; becomes symptomatic (and painful) after fibrous/cartilaginous synchondrosis undergoes ossification, with resultant loss of normal interosseous movement, fixed heel eversion, loss of height of medial longitudinal arch, adaptive painful peroneal muscle spasm with shortening of peroneal tendons (hence the name peroneal spastic flat foot); tarsal coalitions affect 1–4% of population; talocalcaneal, calcaneocuboid and calcaneonavicular coalitions are most common presentations


tarsal cradle clinical or orthotic padding fitted within a shoe, providing neutral support and restricting movement of painful tarsal joints; often formed as a combined tarsal platform + valgus pad


tarsal disintegration tarsal resorption/collapse due to midfoot Charcot neuroarthropathy; associated with Hansen’s disease or diabetes mellitus


tarsal platform; filler pad clinical or orthotic padding added to a shoe to infill medial and lateral transverse arches in a foot with pes cavus; often combined with a valgus pad


tarsal projections radiographic views highlighting rearfoot joints, e.g. axial calcaneal projection, Harris–Beath projection (see Table R1)


tarsal tunnel tubular structure (formed by medial band of retinacula and medial side of body of talus) through which the tibial nerve passes before it enters the foot


tarsal tunnel syndrome; TTS see syndrome, tarsal tunnel


tarsometatarsal joints articulations between tarsal and metatarsal bones


fifth tarsometatarsal joint lateral area of distal aspect of cuboid and fifth metatarsal base

first tarsometatarsal joint distal aspect of medial cuneiform and first metatarsal base

second tarsometatarsal joint distal aspect of intermediate cuneiform and second metatarsal base; movement at second tarsometatarsal joint is restricted by intermediate cuneiform mortise (into which second metatarsal base fits), and strong interosseous ligaments binding proximal areas of first and second metatarsals

third tarsometatarsal joint distal aspect of lateral cuneiform and third metatarsal base

fourth tarsometatarsal joint articulation medial area of distal aspect of cuboid and fourth metatarsal base

tarsus midfoot (i.e. medial, intermediate and lateral cuneiforms, cuboid, navicular, associated joints and articulations)


taxonomy classification by categorization into specific and logical groups, e.g. classification of living organisms to show similarity/evolutionary relationships, in descending order: phylum, class, order, family, genus, species, subspecies, variety


TB tuberculosis


TBCo see friars’ balsam


TB spine; tuberculous spondylitis; Pott’s disease tuberculous (TB) infection of vertebral column; characterized by sharp spinal angulation (due to collapse of infected vertebra), with associated neurological symptoms (radiculopathy, due to compression of local nerve roots)


tea tree oil; ti-tree oil essential oil extracted from Melaleuca alternifolia; 0.05–1% solution = antimicrobial; 4% solution = topical treatment of fungal infections and verrucae (see Table A13)


technetium-99 m;99mTc radioisotope of technetium, used during body-imaging scans


technetium (Tc) bone scan means of imaging blood flow through bone; inflamed areas (e.g. site of hairline/microfracture, or infection) show increased take-up of Tc


Tegasorb hydrocolloid wound dressing (see Table D10)


telangiectasia; telangectiasis dilatation of small or terminal vessels; showing in skin as irregular, thread-like, red or purple dilated capillaries


telencephalon central nervous system cerebral hemispheres (cerebrum)


temperature heat content, i.e. measure of kinetic energy of molecules within a substance


axillary temperature 36 °C

normal body temperature; core body temperature 37 °C (98.4 °F)

skin temperature of feet ~ 31 °C (note: toe pulps are often up to 5 °C cooler); skin temperature is dependent on vascular status of lower limb, recent activity levels, footwear type, environmental temperature and skin site tested

temporal arteritis; TA; giant-cell arteritis inflammatory arteritis of large arteries (often associated with polymyalgia rheumatica in older patients); characterized by severe unilateral headache, scalp tenderness, jaw muscle claudication when chewing, severe malaise, tiredness, pyrexia and sometimes visual loss


tendinitis; tendonitis, tendon inflammation due to overuse/trauma; also characteristic of rheumatoid tendinopathy


extensor tendinitis pain in extensor digitorum longus and/or tibialis anterior tendons due to exaggerated out-toed gait required in ballet, or in patients with excessive foot pronation

flexor hallucis longus tendinitis pain, crepitus and tendon pathology posterior to the medial malleolus, associated with en pointe ballet dancing

peroneal tendinitis pain in peroneus longus and peroneus brevis tendons, due to excess pronation and resultant forced external foot rotation

tendo Achilles tendinitis pain in distal part or point of insertion of Achilles tendon; common in ballet dancers due to stresses imposed by jumping and landing whilst en pointe

tendinopathy tendon degeneration and dysfunction due to synovitis associated with inflammation and vasculitis; characteristic of rheumatoid arthritis


tendinous relating to, or composed of, tendon


tendon ‘strap’ of non-elastic collagenous fibrous tissue conveying muscle force to bone, to bring about movement of an interposed joint; formed of white, non-elastic tissue; continuous with muscle sheath and intramuscular septa; inserts into periosteum and underlying cortical bone see sharpey’s fibres


tendon hammer rubber-tipped hammer used to percuss (tap) tendon, to elicit a tendon reflex


tendon jerk see tendon reflex


tendon reflex; muscle stretch reflex skeletal muscle undergoes reflex contraction when it or its tendon is subjected to sudden stretch/tension; usually exaggerated in patients with an upper motor neurone lesion, and reduced/absent in the elderly or patients with a lower motor neurone lesion; often incorrectly termed ‘deep reflex’; see reflex and Table P10


tendonitis see tendinitis


tennis leg tear/rupture of medial head of gastrocnemius, caused by simultaneous ankle joint plantarflexion and subtalar and midtarsal joint supination in a weight-bearing foot


tennis toe see toes, tennis


tenodesis suturing of tendon to bone, to reattach a detached tendon/alter its point of insertion/achieve a different vector of pull


tenography visualization of tendon structures by introduction of radiopaque material into the tendon sheath


tenolysis surgical release of fibrous/abnormal tissues surrounding a symptomatic/chronically inflamed tendon


tenorrhaphy surgical repair of a divided tendon


tenosynovitis inflammation of tendon and synovial sheath


acute simple synovitis traumatic synovitis; due to over-/unaccustomed use causing tendon and synovial sheath inflammation; characterized by pain/crepitus on movement, local swelling and tendon warmth; treated by rest, appropriate padding and strapping, orthoses, shoe advice (especially for tenosynovitis of extensor hallucis longus)

acute suppurative synovitis infected synovitis due to puncture of the tendon sheath (e.g. a ‘spike’ injury of tendo Achilles) or breakdown of tissue deep to a persistent corn (e.g. overlying prominent extensor hallucis longus tendon; characterized by acute infection (see sepsis); treated as an infected lesion (see Table S3) with systemic antibiosis

chronic simple synovitis; repetitive strain injury; RSI chronic inflammation of tendon/sheath (due to repetitive overuse), together with subserved muscle weakness/wasting; treated as chronic inflammation; note: cause must be established and resolved to achieve permanent resolution

tenotomy surgical division of a tendon, e.g. to correct contraction deformity


tenotoplasty reparative/plastic surgery to a tendon


tensile stress see tension


tension imposition of load tending to stretch an object (object becomes longer and thinner along line of applied force)


tension strain applied linear load, e.g. to tendon (by muscle contraction)


tension strapping see figure-of-eight bandage


tension stress pressure (in pascals) occurring within a structure under load/during use


tensor muscle rendering a part firm/tense


tensor fascia lata short, thick muscle at the junction of gluteal region and upper anterior thigh; enclosed by fascia continuous with the iliotibial tract


origin anterior iliac crest

insertion iliotibial tract, 3–5 cm inferior to level of femoral great trochanter

nerve supply superior gluteal nerve

action hip joint flexion/internal rotation; knee extension (via action on iliotibial tract)

teratogen; teratogenic agent causing abnormal fetal development


terbinafine; Lamisil topical/systemic fungicidal agent; prevents formation of normal fungal cell walls (has inhibitory action on cellular squalene epioxidase); oral dose = 250 mg daily for 2–6 weeks for tinea pedis, or 6 to >12 weeks for onychomycosis (note: must be used with caution on patients with cardiac arrhythmia and those taking drugs that prolong cardiac QT interval); topical dose for skin infections = 1% cream for 7 days for tinea pedis, or as topical single-dose formulation (e.g. Lamisil Once)


terminal Syme’s amputation amputation of terminal part of toe through distal interphalangeal joint + anterior reflection of plantar digital pad to dorsum, to cushion stump; note: the lateral horns of the nail matrix must be excised to prevent nail spike regrowth


Terry’s onychodermal band see onychodermal band


test trial/experiment assisting diagnosis


Allen’s test test of arterial occlusion in the foot, i.e. leg elevation (until plantar skin blanches and Doppler sound at dorsalis pedis [DP] pulse is lost) followed by compression of DP pulse (by clinician’s thumb) and lowering of leg to dependency; if posterior tibial artery flow is adequate the foot rapidly resumes its normal colour; test is repeated at posterior tibial pulse, to test patency of DP

anterior drawer test; ADT; Lachman’s test test of stability/integrity of lateral collateral ligaments of ankle joint, i.e. flex knee to >45 ° (to relax posterior muscle group), stabilize lower tibia (with one hand) whilst grasping posterior aspect of patient’s heel (with the other); calcaneum is pulled forward as a simultaneous retrograde force is applied to lower tibia; positive ADT = > 4 mm anterior displacement of foot relative to tibia together with positive ‘suction sign’

Buerger’s test test of arterial status of lower limb, i.e. patient reclines supine on couch; leg is elevated (from hip) for 1 minute (whilst patient alternately dorsi- and plantarflexes ankle joint, to drain venous circulation); limb is lowered to dependency or patient stands up (foot shows brief hyperaemia before returning to normal skin colour); time (in seconds) for normal colour return is noted; >20 seconds = inadequate arterial supply; >40 seconds = severe limb ischaemia; note: clinician should note whether cyanosis (rather than brief hyperaemia) occurs on dependency, and duration of cyanosis; persistent dusky red/purple coloration in dependent limb that appears to resolve to normal skin tone on raising limb to horizontal indicates severe arterial compromise

Clarke’s test diagnostic test of chondromalcia patellae; with the patient supine and the affected knee fully extended, the clinician applies gentle pressure to the patella whilst the patient attempts to contract the quadriceps muscle group; the test is positive if severe patellar pain occurs

Coombs test test to predict donor and receiver blood compatibility, i.e. assay for presence/absence of specific antibodies on donor erythrocytes

coordination tests tests of cerebellar coordination of lower-limb motor function, i.e. heel–shin test; fingertip test

fingertip test test of cerebellar function, i.e. patient repeatedly attempts to place his/her fingertip on tip of assessor’s moving finger; alternatively, patient attempts to put tip of his/her index finger alternately on his/her nose then on assessor’s moving finger

glass test test for meningitis, i.e. test is positive when there is no blanching of a pruritic rash when it is pressed with a glass

glucose tolerance test; GTT diagnostic test of diabetes mellitus, and assessment of patients with fasting blood glucose levels just above normal range (i.e. 5.6–6.7 mmol/L), i.e. 75 mg glucose is given (as a drink) after starving for 12–14 hours; its rate of blood clearance is monitored over the next 3 hours; in normal patients, there is an immediate and sharp rise in blood glucose which falls during subsequent 2 hours to normal glycaemic levels (i.e. 2.9–5.9 mmol/L); in diabetes/insulin resistance cases, blood glucose levels rise initially to a higher level and do not return to normal range within 2 hours

Heaf test test of immunity to tubercle bacillus (tuberculosis [TB]), i.e. subdermal injection of attenuated tuberculin toxin

heel–shin test test of cerebellar function, i.e. patient repeatedly places one heel on anterior aspect of other shin and slides heel down to dorsum of foot; inability to perform this test indicates cerebellar dysfunction and other conditions characterized by loss of motor coordination

interdigital test reduced blunt/sharp discrimination, paraesthesia, hyper-/hypoaesthesia of interdigital skin at toe cleft affected by neuritis/Morton’s neuroma

Jack’s test passive dorsiflexion of hallux at first metatarsophalangeal joint in weight-bearing foot

Kelikian push-up test intraoperative check of adequate surgical correction of lesser-toe deformity, i.e. elevation of head of relevant metatarsal with thumb pressure

Lachman’s test see test, anterior drawer

Mantoux test, tuberculin test screening test for exposure to tuberculosis (TB); administration of an intradermal dose of tuberculosis antigen (tuberculin) to the skin of the forearm; a localised, small, firm inflammatory skin reaction developing within 2 days shows positive exposure to tuberculosis

Mulder’s test diagnostic test for Morton’s neuroma, i.e. simultaneous lateral compression across metatarsal heads + thumb pressure at affected plantar web space in a foot with symptoms of plantar digital neuritis (Morton’s neuroma); positive result (i.e. induction of characteristic symptoms of a nerve entrapment pain, and examiner’s awareness of a fluid thrill [or click] within the palpated tissue) indicates neuritis or neuroma

Nobel’s test test for iliotibial band (ITB) syndrome, i.e. palpation of lateral tibial condyle causes ITB pain

Ober’s test test for iliotibial band (ITB) syndrome, i.e. excessive tightness/tension on palpation of the ITB

patch test; skin test test of hypersensitivity, i.e. application of a range of potential sensitizing agents to skin (e.g. back, ulnar aspect of arm); degree of inflammatory reaction (provoked by test agents) is compared with a control (innocuous substance) and ‘read’/assessed after 48–96 hours

pole test test to estimate foot systolic pressures in limbs with arterial calcification, i.e. with patient supine, leg is elevated until Doppler foot pulses cease, and elevation height (in cm) from apex of hallux to bench is noted and multiplied by 7.35

Romberg’s test test comparing amount of body sway of an erect patient with eyes closed and eyes open; test is positive if patient shows loss of balance/increased tendency to sway when standing with eyes closed

screening test any test that categorizes by predetermined characteristic/property

single-leg raise test; tiptoe test test of tendo Achilles (TA), tibialis posterior and peroneal integrity/function, i.e. patient stands on one leg and weight-bears on tiptoe; patient with TA damage will not be able to rise normally to tiptoe on affected side; with TA rupture, patient will not be able to rise up on to tiptoe on the affected limb at all; heel pain during single-leg raise is indicative of Sever’s disease see sever’s

skin test see test, patch

talar tilt test test of integrity of lateral collateral ligament of the ankle, calcaneofibular ligament and tibialis posterior tendon, i.e. with the ankle joint at neutral (0 ° dorsiflexion) the calcaneum is passively inverted by the examiner; if the lateral collateral ligament is damaged (e.g. anterior talofibular ligament rupture) excessive talar excursion occurs; tissue dimpling inferior to the lateral malleolus indicates rupture of the calcaneofibular ligament; greater than expected talar eversion and flattening of the medial longitudinal arch indicate tibialis dysfunction

Thompson’s test test of Achilles tendon function, i.e. with the patient lying prone, the posterior calf muscle group is squeezed, causing ankle joint plantarflexion; the foot does not plantarflex in total Achilles tendon rupture

thumb roll test test for ‘runner’s knee’, i.e. the knee is flexed by 30–40 ° and the examiner’s thumb rolled across the medial aspect of the patella, causing a painful ‘snap’ or ‘click’, and detection of a fibrous ridge/‘shelf’ at anterior knee compartment

Trendelenburg’s test test of the quality of venous filling time, and quality of venous drainage in the leg, i.e. carried out as Buerger’s test, but the time (in seconds) taken for the dorsal foot veins to refill and the direction of blood flow into the dorsal foot veins is noted; refill from proximal to distal indicates venous backflow and vein valve incompetence

Tuberculin test see Mantoux test

urea breath test test to detect Helicobacter pylori gastritis, or confirm its eradication, i.e. by analysis of exhaled breath

Valsalva’s test test to detect autonomic neuropathy, i.e. the patient exhales into an empty plastic syringe (the other end of which is connected to a manometer to be maintained at 40 mmHg) for 10 seconds, and changes in heart rate are noted (i.e. maximum expiratory heart rate and minimum heart rate after test cessation), and compared as a ratio; ratio of <1:10 indicates autonomic neuropathy (normal = >1:21)

vertical stress test test of plantar plate rupture, i.e. application of vertical stress to metatarsal head; translocation (i.e. > 2 mm dorsal elevation) of base of toe in relation to dorsum of metatarsal head indicates plantar plate rupture

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