9. Heel Sx (Pontious)

Question 1

hubscher maneuver

Answer 1

(or Jack’s test) is a method of evaluating the flexibility of a pes planus or flat foot type. The test is performed with the patient weight-bearing, with the foot flat on the ground, while the clinician dorsiflexes the hallux and watches for an increasing concavity of the Arches of the foot;

https://www.youtube.com/watch?v=j-mqaiKfsZQ

Question 2

iontophoresis

Answer 2

PT treatment for plantar fasciitis;

procedure in which an electrical current is passed through skin soaked in tap water (not distilled water), normal saline (0.9%), or a solution containing an anticholinergic medication, which allows ionised (charged) particles to cross the normal skin barrier

Question 3

Endoscopic plantar fasciotomy (EPF):

high level description

Answer 3

removing medial 1/3rd (1/3rd to ½) of fascia, not destabilizing lateral column

https://www.youtube.com/watch?v=71DFCb8eWnk&feature=youtu.be

Question 4

Q: Know Baxter’s nerve and what it is

Answer 4

entrapment of lateral plantar nerve

Question 5

Q: what is the most common complication of heel spur surgery?

Answer 5

CONTINUED PAIN and RECURRENCE

Question 6

Q: what is the inflammatory condition resulting from over-stretching of the plantar fascia?

Answer 6

plantar fasciitis

Question 7

Q: what is the NON-inflammatory and degenerative condition resulting from over-stretching of the plantar fascia?

Answer 7

plantar FASCIOSIS

Question 8

Q: the Fowler-Phillip angle is used for what condition?

Answer 8

haglund’s deformity;

>75 is abnormal

Question 9

Q: if assessing a patient for Haglund’s deformity and patient has a cavus foot, what angle would be best to use?

Answer 9

Total angle - cavus foot

Question 10

Q: what material does an Achilles Suturebridge utilize?

Answer 10

Enables an hourglass pattern of FiberWire suture to be laid over the distal end of the tendon;

Recall: FiberWire suture is a non-absorbable, synthetic, multifilament polyethylene core with a braided polyester jacket

https://www.youtube.com/watch?v=SUlU9yVo-DY&feature=youtu.be

Question 11

Q: what material does an Achilles Speedbridge utilize?

Answer 11

Hourglass pattern of FiberTape suture laid over the distal end of the tendon

• Thought to be STRONGER than suturebridge
• True knotless repair;
• FiberTape stretches over the tendon – flat and wider –> less likely to cut into tendon (as the wire does) therefore less likely to fail

https://www.youtube.com/watch?v=n_Ou3Kbo9Tg&feature=youtu.be

Question 12

Q: when doing an EPF, how much of the fascia is being removed?

(endoscopic plantar fasciotomy)

Answer 12

removing medial 1/3rd (1/3rd to ½) of fascia, not destabilizing lateral column

• (but doesn’t exactly REMOVE it, more so it just cuts it)*
• has roughly a 90% success rate

Question 13

Q: what were the results of the restrospective study “comparing EPF to Open plantar fasciotomy w/ heel spur resection for chronic plantar fasciitis”?

Answer 13

• EPF group returned to work 55 days sooner
  
  • (EPF=29 days, open=84 days)
• Condsiderations: Lost wages, increased compensation payments may need to be considered