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*Crozer-Keystone > 6. Clinical Podiatry > Flashcards

6. Clinical Podiatry Flashcards

1
Q

What are the clinical patterns of tinea pedis?

What are common infecting organisms?

A

Chronic (moccasin or papulosquamous)

  • Trichophyton rubrum

Acute (interdigital or vesicular)

  • Trichophyton mentagrophytes

Ulcerative

  • Trichophyton mentagrophytes with Pseudomonas or Proteus
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2
Q

What are the clinical patterns of onychomycosis?

What are common infecting organisms?

A
  • Distal subungual onychomycosis (DSO) ~ 90%
    • Most common
    • Trichophyton rubrum
  • Proximal subungual onychomycosis (PSO) ~ 1%
    • Seen in immunocompromised patients
    • Trichophyton rubrum
  • Superficial white onychomycosis (SWO) ~ 10%
    • Trichophyton mentagrophytes
  • Candidal onychomycosis
    • Candida albicans
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3
Q

What test confirms tinea pedis or onychomycosis?

A
  • Potassium hydroxide (KOH) preparation of skin or nail specimen
  • *Septate hyphae confirms diagnosis
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4
Q

lamisil:

mechanism of action

A

Inhibits ergosterol synthesis

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5
Q

phenol:

define

A

Carbolic acid

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6
Q

during a partial nail avulsion (PNA) procedure,

why is alcohol used after phenol?

A

Phenol is soluble in alcohol, and

the alcohol will irrigate excess phenol from the nail groove

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7
Q

For a nail avulsion, what can be done for anesthesia

if the patient is allergic to all local anesthetics?

A
  • Saline block (pressure induced block)
  • Pressure cuff
  • Benadryl block (blocks histamine release)
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8
Q

For bunion, what does the position of the tibial sesamoid indicate?

Why isn’t the fibular sesamoid evaluated?

A
  • The tibial sesamoid indicates the abnormal effects of the adductor and flexor brevis tendons.
  • Once the fibular sesamoid reaches the intermetatarsal space, it travels in the frontal plane (as opposed to transverse), therefore the tibial sesamoid is a more reliable indicator of deformity.
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9
Q

hallux varus causes:

  • congenital
  • traumatic
  • iatrogenic
A
  • Congenital
    • Clubfoot
    • Metatarsus adductus
  • Traumatic
    • MPJ dislocation
    • Fracture
  • Iatrogenic
    • Overcorrection of intermetatarsal angle
    • Excessive resection of medial eminence or staking the head
    • Fibular sesamoidectomy
    • Overaggressive capsulorrhaphy
    • Bandaging too far into varus
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10
Q

what is staking the head?

(with regards to bunions)

A

Excessive resection of the 1st metatarsal head with cutting into the sagittal groove may lead to hallux varus

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11
Q

types of hammertoes

A
  • Flexor stabilization
    • Most common
    • Stance phase
    • Flexors overpower interossei
    • Pronated foot
  • Extensor substitution
    • Swing phase
    • Extensors overpower lumbricals
    • Anterior cavus, ankle equinus, anterior compartment muscle weakness
  • Flexor substitution
    • Least common
    • Stance phase
    • Deep compartment muscles overpower interossei
    • Supinated, high arch foot or weakened Achilles
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12
Q

accidentally severing the quadratus plantae results in…

A

Adductovarus deformity of digits 4 and 5 as the pull of FDL is unopposed

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13
Q

differences between flexible, semi-rigid, and rigid deformities

A
  • Flexible – reducible when NWB and WB
  • Semi-rigid – reducible when NWB only
  • Rigid – non-reducible
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14
Q

Haglund deformity:

A

pump bump;

bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa

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15
Q

xray measurements to evaluate a Haglund deformity

A
  • Parallel pitch lines
  • Fowler & Philip
  • Total angle
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16
Q

Silfverskiöld test:

purpose, positive, negative

A
  • Determines gastroc vs. gastroc-soleus
  • Positive test
    • Dorsiflexion of the foot to neutral or beyond with the knee in flexion
    • Gastroc equinus
  • Negative test
    • Lack of dorsiflexion of the foot to neutral with knee in flexion and in extension
    • Gastroc-soleus equinus
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17
Q

Lachman test

A
  • Determines if there is a plantar plate tear or rupture.
  • While stabilizing the metatarsal, a dorsal translocation of the proximal phalanx greater than 2 mm is suggestive of rupture.
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18
Q

Mulder sign

A

Identifies a Morton neuroma by a palpable click when compressing metatarsal heads and palpating the interspace

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19
Q

Sullivan sign

A

Separation of digits caused by a mass within the interspace

(e.g. by a neuroma)

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20
Q

Q angle:

define

A

Angle between the:

  • axis of the femur and the
  • line between the patella and tibial tuberosity
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21
Q

what to do if patient has edema with a cast

A
  • If edema goes down in AM → gravity edema → normal
  • If edema does not go down in AM → abnormal
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22
Q

Raynaud phenomenon

A

Recurrent vasospasm of digits usually in response to stress or cold

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23
Q

Raynauds phenomenon:

stages

A

“White → blue → red”

  • Pallor – spasm of digital arteries
  • Cyanosis – deoxygenation of blood pools
  • Rubor – hyperemia
24
Q

what is an ABI?

A

Ankle Brachial Index – compares ankle to arm pressures

  • Normal: 1
  • Intermittent claudication: 0.6-0.8
  • Rest pain: 0.4-0.6
  • Ischemic ulcerations: <0.4
25
Q

what might falsely elevate the

ankle brachial index (ABI)

A

Vessel calcifications/non-compressible vessels

26
Q

What other tests are typically performed with an ABI?

A
  • Segment pressures
    • Measured at high thigh, above the knee, below the knee, ankle, midfoot, and toe
    • Normal 70-120 mm Hg
    • Drop between segments >30 mm Hg indicate disease in vessel above
  • Pulse volume recordings (PVRs)
    • Normal waveforms are triphasic
    • Waveforms are widened and blunted with severe disease
27
Q

most common type of skin cancer

A

Basal cell carcinoma –

found on sun-exposed parts of the body

28
Q

skin cancer with “cauliflower-like” appearance

A

Squamous cell carcinoma

found on sun-exposed parts of the body

29
Q

most common type of melanoma

A

Superficial spreading melanoma

found on any part of the body

30
Q

most malignant skin cancer

A

Nodular melanoma

may be misdiagnosed as pyogenic granuloma

31
Q

most benign skin cancer

A

Lentigo melanoma

typically found on back, arms, neck, and scalp

32
Q

skin cancer typically found on the palms, soles, and nail beds?

A

Acral lentiginous melanoma

33
Q

Hutchinson sign

A

Pigment changes in the eponychium seen with subungual melanoma

34
Q

most common vascular proliferation

A

hemangioma

35
Q

vascular malignancy appears as

red-blue plaques or nodules and has a high incidence in AIDS

A

Kaposi sarcoma

36
Q

plantar fibromatosis:

associated conditions

A
  • Ledderhose disease
  • Dupuytren contracture
  • Peyronie disease
37
Q

another name for congenital convex pes valgus

A

vertical talus

38
Q

congenital convex pes valgus (CCPV):

radiographic findings

A
  • Calcaneus in equinus,
  • plantarflexed talus,
  • dorsally dislocated navicular,
  • increased talo-calc angle
39
Q

additional radiographic study recommended for

neonates with congenital convex pes valgus (CCPV) aka vertical talus

A

Lumbosacral films

40
Q

three coalitions of the rearfoot

A
  • talocalcaneal (TC)
  • calcaneonavicular (CN)
  • talonavicular (TN)
41
Q

percentage of bilateral tarsal coalitions

A

50%

42
Q

most symptomatic rearfoot coalition

A

calcaneonavicular (CN)

43
Q

asymptomatic rearfoot coalition

A

talonavicular (TN)

44
Q

most common rearfoot coalition to least

A

T-C > C-N > T-N

45
Q

Which T-C facet is most commonly fused?

A

*Medial > anterior > posterior

46
Q

What are the ages of fusion

for rearfoot coalitions?

A
  • T-N (3-5 years)
  • C-N (8-12 years)
  • T-C (12-16 years)
47
Q

tarsal coalitions:

clinical symptoms

A
  • Pain
  • Limited ROM of STJ and possibly MTJ
  • Peroneal spastic flatfoot
48
Q

tarsal coalitions:

radiographic findings

A
  • Rounding of lateral talar process
  • Talar beaking due to increased stress on talonavicular ligament
  • Asymmetry of anterior subtalar facet
  • Narrowing or absence of middle and posterior subtalar facets
  • Halo sign – circular ring of increased trabecular pattern due to altered compressive forces
  • Anteater sign – C-N coalition in which calcaneus has elongated process on lateral view
  • Putter sign – T-N coalition in which neck of talus unites with broad expansion of navicular
49
Q

anterior facet of calcaneus

is best seen by which radiographic views

A
  • Medial oblique
  • Ischerwood
50
Q

middle and posterior facets of calcaneus

are best seen by which radiographic view?

A

Harris Beath

51
Q

symptomatic tarsal coalitions:

treatments

A
  • Orthotics or supportive therapy
  • Immobilization
  • NSAIDs
  • Badgley – surgical resection of coalition or bar with interposition of muscle belly
  • Isolated fusion or triple arthrodesis
52
Q

clubfoot:

3 components

A
  • FF adductus
  • RF varus
  • ankle equinus
53
Q

clubfoot:

contracted ligaments/capsules

A
  • Posterior
    • Posterior tib-fib
    • Posterior talo-fib
    • Lateral calcaneofibular
    • Syndesmosis
  • Medial
    • Superficial deltoid
    • Tibionavicular
    • Calcaneonavicular
    • Talo-Navic, Navic-Cunei, and Cunei-1st MT joints
    • Spring ligament
54
Q

clubfoot:

which muscles/tendons are contracted

A
  • Posterior
    • Achilles tendon
    • Plantaris tendon
  • Medially
    • PT, FDL, and FHL
    • Abductor hallucis
  • Anteriorly
    • Tibialis anterior
55
Q

clubfoot:

technique for treatment

A

Ponseti technique

  • Serial casting
  • First correct the FF and RF deformities, and then correct ankle equinus
  • During manipulation, pressure is applied to the head of the talus (not the calcaneus)
  • 4-8 casts, percutaneous Achilles tenotomy (last cast for 3 weeks), occasional TA transfer, and D-B bar brace until age 3 y/o to prevent relapse
56
Q

clubfoot:

most accepted theory of etiology

A

Germ plasma defect-malposition of head and neck of talus

57
Q

Simon Rule of 15

A
  • For clubfoot, children <3 years → talo-navicular subluxation
  • T-C angle is <15° and talo-1st metatarsal angle is >15°

*Crozer-Keystone (14 decks)

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