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Podiatry Handbook notes > 1st ray pathology > Flashcards

1st ray pathology Flashcards

1
Q

What are the etiologies of HAV ( 3)

A
  • Structural
  • Positional
  • Other: Iatrogenic
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2
Q

Positional examples that may cause HAV (2)

A

Hypermobile first ray

  • –Metatarsus primus varus
  • –Metatarsus primus elevatus
  • –Normally +/- 5mm PF and DF

Frontal plane deformity
—-eversion/pronation/valgus rotation of 1st MT

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3
Q

Structural examples that may cause HAV (3)

A
  • First Ray insufficiency
  • –imbalance of forces between 1st and 2nd met
  • Atavistic cuneiform
  • —medial deviation which causes an adducted 1st met
  • Met head shape
  • —Rounder (greatest risk for met HAV)
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4
Q

OTHER examples that may cause HAV

A
  • Iatrogenic
  • –Plantar fasciotomy leading to hypermobility, FHL tendon transfer, Tibial sesamoidectomy, PL-PB tenodesis
  • Pathologic
  • —neuromuscular disorder, inflammatory arthropathy
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5
Q

Describe the 1st MTPJ joint (and its meaning)

A

It is a ginglymoarthroidal joint

-Ginglymo: sagittal motion responsible for first 20-30 DF

Arthroidal: transitional gliding responsible for next 30-60 DF

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6
Q

Stages of HAV

A

Described by Root, Orien, Weed

I: Lateral shift of proximal phalanx
II: Hallux abducts
III: Medial buckling of 1st MT head
IV: subluxed/dislocation 1st MPJ

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7
Q

What is Jacks test

A

same as reproduction of Windlass mechanism

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8
Q

What is the Transverse forefoot squeeze test

A

Check for reducibility of IM angle

—Reducible signifies a positional deformity not structrual

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9
Q

Tracking vs trackbound

A

Tracking: deviation of hallux only towards the end of DF and PF

Trackbound : C-shaped ROM. deviation of hallux throughout entire ROM

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10
Q

How to determine between structural and positional deformity of the hallux

A

Structural: PASA+DASA> HAA

Positional: PASA+DASA»HAA

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11
Q

Procedural selection based on positional vs. structural etiology

A

Positional deformity=distal osteotomy

Structural deformity: large IM angle will require a more proximal osteotomy

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12
Q

What is included in a Lateral release

A 
Adductor tendon
Lateral capsule
Transverse MT ligament 
Lateral sesamoid ligament 
FHB tendon 
Fibular sesamoidectomy
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13
Q

What procedures are considered to be capsule tendon balancing

A

Silver bunionectomy

McBride

Modified McBride

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14
Q

What is included in a Silver bunionectomy

A

Bumpectomy, lateral release and medial capsular imbrication

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15
Q

What is included in a McBride

A

Silver+ fibular sesamoidectomy+ adductor hallucis tendon transfer

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16
Q

What is included in a Modified McBride

A

No fibular sesamoidectomy to prevent hallux varus

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17
Q

What procedures are exclusively done on the proximal phalanx

A

Akin and Keller

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18
Q

What is the Akin procedure and what does it correct

A

Closing lateral wedge resection of proximal phalanx

-Proximal Akin: corrects DASA
Distal Akin corrects HIA

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19
Q

What is the Keller procedure and what is it used for

A

Joint destructive procedure to remove 1/3 base of proximal phalanx+ lateral release

Used for IMA > 15

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20
Q

What are the HAV osteotomies that can be done at the head (8)

A
  • Austin/Chevron
  • Youngswick
  • Reverdin
  • Reverdin Green
  • Reverdin Laird

Reverdin Todd

Waterman

Waterman Green

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21
Q

What is the Austin procedure

  • How much correcter
  • Pearls and Contraindications
A

60 degree cuts are made to allow lateral translation of capital fragment up to 50%

  • 1mm lateral shift = 1 degree of IMA correction
  • Pearls: limiting factors for correction are the width of the MT head. Good for bump pain

Contraindications: MTPJ pain

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22
Q

Youngswick What is it, what does it due and what is it used for

A

Chevron with removal of bone in dorsal arm

  • it shortens and plantarlexes
  • Used for MPE
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23
Q

Reverdin What is it and what does it correct

A

closing lateral wedge resection of MT head.

-corrects PASA

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24
Q

Reverdin Green. What is it, what does it correct?

A

Closing lateral wedge with preservation of the sesamoid apparatus

corrects PASA

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25
Reverdin Laird: What is it and what does it correct
Reverdin Green osteotomy through lateral cortex and still preserve the sesamoids. Corrects PASA+ IMA
26
Reverdin Todd: what is it and what does it correct
Reverdin laird but now through the plantar cortex. Will lose the sesamoid here -corrects PASA+ IMA+ PLANTARFLEXION
27
Watermann: what is it and what does it treat
removal of dorsal wedge and the plantar cortex is kept intact -treats hallux limitus and rigidus
28
Watermann Green: what is it and what does it correct
Watermann procedure with preservation of sesamoid -will help treat hallux limitus/ rigidus
29
What are the neck procedures to correct HAV deformities (5)
Peabody Mitchell Hohmann Wilson DRATO
30
What is the Peabody
just a reverdin that is proximal to the sesamoids
31
Mitchell: What is it and what is the indication
removes medial shelf, shortens and plantarflexes the MT head -Indication is IMA and MPE
32
Hohmann: what is it and what is the indication
Reverdin with capital fragment plantarflexed and lateral shift indications are IMA PASA and MPE
33
Wilson: what is it and what is the indication for it
Shortens the met head with lateral displacement of head indication is a long 1st MT
34
What is the DRATO and what is the indication for it. What is the big con with this procedure
Derotational abductory transpositional osteotomy Indication: IMA, PASA, PF 1st MT, hallux limitus VERY UNSTABLE
35
What are the shaft procedures that can be done for HAV deformity
- Scarf osteotomy - Mau/Ludloff - Kalish - Lambrinudi - Vogler
36
What is a scarf osteotomy, what is the potential complication, what does it correct
60 degrees sideways Z is formed. Large risk for troughing -Corrects the IMA
37
What is the Mau and Ludloff procedure What does it correct
- Mau: proximal plantar to dorsal distal | - Ludloff: proximal dorsal to distal plantar
38
What is the Kalish procedure
long dorsal arm Austin, 55 degrees -able to insert 2 screws
39
What is the Lambrinudi procedure, and what is the indication
oblique cut at the shaft. Indication is for MPE
40
What is the Vogler procedure
offset V osteotomy with apex at metaphyseal diaphyseal junction at a 40 degree cut
41
What are the procedures that address HAV at the Base
- Lapidus - Trethowan - Logroscino - CBWO - Proximal Austin
42
What is the definition of hallux limitus / rigidus
When there is <65 degrees of hallux dorsiflexion -painful aqcuired, arthritic condition of the 1st MPJ, decreased sagittal plane motion
43
What is the definition of metatarsus primus elevatus
- dorsiflexed 1st ray, which results in hallux tries to DF against elevated MT head, which results in decreased sagittal plane motion
44
Etiology of hallux rigidus/limitus
- structural - Functional - Post-traumatic - metabolic - Neuromuscular - Iatrogenic
45
What are some of the structural reasons for hallux rigidus
Long 1st metatarsal Metatarsus primus elevatus -weak PL
46
What are some of the functional reasons for hallux rigidus
- Overpronation - Hypermobile 1st ray - unlocked MTJ
47
Post-traumatic reasons for hallux rigidus
- arthritis - OCD - 1st MPJ injury
48
What are the classification systems for hallux limitus and rigidus
Drago, Orloff, Jacobs, and Regnauld
49
Describe Regnauld
I: Functional limitus - --Pain on end range of motion - --No radiographic findings II: Joint adaptation - --Limited range of motion - --X-ray: joint space narrowing with met head flattening III: Arthrosis - --Pain with entire range of motion - --X-ray:Dorsal osteophytes IV: ankylosis - --<10 degrees range of motion - --X-ray: obliteration of joint space
50
Clinical presentation of hallux limitus/rigidus
- Decreased DF from the 60-95 degrees - Hallux extensus deformity: IPJ hyperextension - Lateral foot pain - Apropulsive gait
51
X-ray presentation of Metatarsus primus elevatus
- Seiberg index: comparison of dorsal cortex of 1st and 2nd MT - First metatarsal declination is affected
52
What are joint preserving procedures for Hallux limitus/rigidus (7)
- Cheilectomy - Chondroplasty - Hyaluronate implantation - Waterman procedure - Watermann Green procedure - Youngswick - Proximal plantar displacement osteotomy
53
What is a Cheilectomy and what test determines whether or not it can be done
- Take off dorsal 1/3 of the articular surface of MT head and proximal phalanx - Grind test: pressing on sesamoids while dorsiflexing the hallux. If pain elicited then cheilectomy may not be effective
54
What is the Waterman procedure
DFWO of MT neck
55
What is the Waterman Green procedure
Preserves sesamoid apparatus, removes rectangular section of bone
56
What is the Youngswick
Remove bone in dorsal arm and also corrects for high IMA
57
What is the proximal plantar displacement osteotomy
corrects long MT
58
What are joint destructive procedures that can be done for hallux rigidus (12)
- Kessel and Bonney - Regnauld - Keller - Moberg - Heuter - Valenti - Stone - Mayo - 1st MTPJ arthrodesis - McKeever arthrodesis - 1st MTPJ implant arthroplasty - Interpositional arthroplasty
59
What is the Kessel and Bonney procedure
DFWO of proximal phalanx base - Will decompress the joint - Originally for adolescents
60
What is the Regnauld
Peg in hole, loss of flexor function
61
What is the What is the Keller procedure
Resection of the proximal phalanx
62
What is the Moberg procedure
osteotomy at base of proximal phalanx, with or without cheilectomy
63
What is the Heuter
complete resection of MT head -also used to treat osteo
64
Valenti
Dorsal portion of proximal phalanx and 1st MT head removed
65
What is the stone procedure
Resection of MT head -Preserve sesamoids
66
WHat is the Mayo procedure
-remove sesamoids
67
What is the 1st MTPJ arthrodesis
Gold standard procedure
68
What is the McKeever arthrodesis
when the toe is fused in a : - Abducted/valgus 10 degrees - DF at 15 degrees - Parallel to the 2nd digit in transverse plane
69
What is the 1st MTPJ implant arthroplasty
Hemi-metallic total: double stem flexible silicone hinge Two component
70
Interpositional arthroplasty
-Interposition of EHB and dorsal capsule sutured to the plantar plate

Podiatry Handbook notes (10 decks)

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