AAOS Ch 12 Foot Flashcards
In ankle arthroscopy, the anteromedial portal is located between what structures?
1: Medial malleolus and saphenous vein
2: Saphenous vein and anterior tibial tendon
3: Anterior tibial tendon and extensor hallucis longus
4: Anterior tibial tendon and anterior tibial neurovascular bundle
5: Extensor hallucis longus tendon and anterior tibial neurovascular bundle
2: Saphenous vein and anterior tibial tendon
The anteromedial portal is placed just medial to the anterior tibial tendon and lateral to the saphenous vein at the level of the ankle joint. The anterolateral portal is located just lateral to the tendon of the peroneus tertius.
Which of the following ligaments is intracapsular?
1: Lisfranc
2: Deltoid
3: Calcaneofibular
4: Anterior talofibular
5: Anterior-inferior tibiofibular
4: Anterior talofibular
The anterior talofibular ligament lies within the lateral capsule of the ankle, similar to the anterior glenohumeral ligaments of the shoulder. The other four ligaments mentioned are extracapsular.
When performing ankle arthroscopy through the anterolateral portal, what anatomic structure is at greatest risk?
1: Anterior tibialis tendon
2: Anterior tibial artery
3: Sural nerve
4: Deep peroneal nerve
5: Superficial peroneal nerve
5: Superficial peroneal nerve
The superficial branch of the peroneal nerve travels subcutaneously anterior to the lateral malleolus at the ankle. It can be easily damaged by deep penetration of the knife blade when making this portal or when passing shavers in and out of the portal. Anesthesia or dysesthesia from laceration or neuroma formation can cause significant postoperative morbidity. The anterior tibialis tendon, anterior tibial artery, and the deep peroneal nerve are located much more anterior and central on the ankle. The sural nerve is posterior lateral to the ankle and is not at risk from this portal.
Sensation on the plantar aspect of the great toe is derived from which of the following nerves?
1: Sural
2: Lateral plantar
3: Medial plantar
4: Lesser saphenous
5: Greater saphenous
3: Medial plantar
The medial and lateral plantar nerves supply all the musculature of the sole of the foot. The medial plantar nerve supplies most of the terminal sensory branches, including the proper digital nerves to the great toe and the common digital nerves to the next three interspaces. The three and one-half toes supplied by the medial plantar nerve are analogous to the median nerve innervation in the hand.
The modified Broström lateral ankle ligamentous reconstruction uses which of the following structures to provide supplementary stabilization?
1: One half of the peroneus brevis tendon
2: The entire peroneus brevis tendon
3: Peroneus longus tendon
4: Plantaris
5: Inferior extensor retinaculum
5: Inferior extensor retinaculum
The modified Broström lateral ankle ligament stabilization procedure uses the remnants of the anterior talofibular and the calcaneofibular ligaments, supplemented by the inferior extensor retinaculum and the transferred talocalcaneal ligament to stabilize the lateral ankle. Chrisman and associates described the use of one half of the peroneus brevis. Watson-Jones and Evans used the entire peroneus brevis. The peroneus longus has been taken by mistake. The plantaris has been used in triligamentous reconstruction.
The so-called high ankle sprain from an external rotation mechanism of injury typically involves injury to which of the following structures?
1: Posterior talofibular ligament
2: Deltoid ligament
3: Anterior inferior tibiofibular ligament
4: Calcaneofibular ligament
5: Extensor retinaculum
3: Anterior inferior tibiofibular ligament
Ankle sprains most commonly involve injury to the lateral collateral ligaments of the ankle (anterior talofibular, posterior talofibular, and calcaneofibular) from an inversion mechanism of injury. A different entity has been more recently described that involves an external rotation mechanism of injury that widens the ankle mortise and disrupts the anterior inferior tibiofibular ligament. Deltoid ligament and extensor retinaculum injuries do occur, although infrequently, and involve eversion and extreme plantar flexion mechanisms, respectively.
A 60-year-old man reports that he has had shoe pressure pain over his right great toe for several years but has minimal discomfort when barefoot or in sandals. A clinical photograph and radiographs are shown. Management should consist of
1: cheilectomy.
2: extra-depth shoes.
3: steroid injection.
4: arthrodesis.
5: joint replacement arthroplasty.
2: extra-depth shoes.
Some patients have minimal symptoms associated with hallux rigidus despite significant radiographic evidence of osteoarthritis. This patient’s symptoms are primarily related to shoe pressure from the exostosis and can be managed with extra-depth shoe wear.
Figures show a clinical photograph and radiograph of a patient who has difficulty wearing shoes and has persistent symptoms medially and laterally at the first and fifth metatarsophalangeal joints. Because shoe modifications have failed to provide relief, management should now consist of
1: bunion repair only.
2: bunionette repair only with lateral condylectomy.
3: repair of both with lateral condylectomy.
4: repair of both with a proximal fifth metatarsal osteotomy.
5: repair of both with a fifth metatarsal head excision.
2: bunionette repair only with lateral condylectomy.
A significant bunionette deformity that fails to respond to conservative management is best addressed surgically, in this case with the bunion deformity. The radiograph reveals a prominent lateral condyle at the fifth metatarsal head without a significant increase in the intermetatarsal angle. Simple exostectomy is preferred with less risk of complications. Complete excision would risk transfer lesions to the medial metatarsals.
Which of the following procedures is used for acute repair of dislocated peroneal tendons?
1: Deepening the fibular groove with an osteotome
2: Borrowing fascia to create new retinacula
3: Repairing the periosteal tendon sheath attachment
4: Creating a fibular bone-block extension
5: Rerouting the tendons through the fibula
3: Repairing the periosteal tendon sheath attachment
Acute dislocation of the peroneal tendons involves avulsion of the periosteal attachment of the peroneal sheath and the superior retinaculum. Repair of these structures and cast immobilization for several weeks provides excellent functional stability of the tendons and avoids chronic subluxation. The other methods are used in chronic tendon dislocation.
Which of the following nerves is most likely responsible for symptoms associated with plantar fasciitis?
1: Medial plantar
2: Medial calcaneal
3: First branch of lateral plantar
4: Lateral plantar
5: Lateral calcaneal
5: Lateral calcaneal
The first branch of the lateral plantar nerve innervates the abductor digiti minimi. It is reported to be trapped at the interval between the abductor hallucis and the quadratus plantae muscles.
A Canale view best visualizes which of the following structures?
1: Posterior facet of the subtalar joint
2: Lisfranc joint
3: Talar neck
4: Sustentaculum tali
5: Lateral column of the foot
3: Talar neck
The Canale view, which visualizes the talar neck, is taken with the ankle in maximum plantar flexion and the foot pronated 15°. The radiograph is directed at a 75° angle from the horizontal plane in the anteroposterior plane. The Broden view, which is different from the Canale view, is best for imaging the posterior facet of the subtalar joint.
The dorsal-medial aspect of the great toe receives sensory innervation from which nerve?
1: Deep peroneal
2: Saphenous
3: Posterior tibial
4: Superficial peroneal
5: Medial plantar
4: Superficial peroneal
The medial or internal division of the superficial peroneal nerve consistently provides sensory innervation to the dorsal-medial aspect of the great toe.
Talar compression syndrome in ballet dancers typically involves injury to which of the following structures?
1: Sustentaculum tali
2: Lateral process of the talus
3: Posterior process of the calcaneus
4: Os tibialis externum
5: Os trigonum
5: Os trigonum
Talar compression syndrome is also known as os trigonum syndrome or posterior ankle impingement syndrome and occurs in activities involving extreme ankle plantar flexion. It involves pinching of the posterior talus (os trigonum or posterior process of the talus) between the calcaneus and tibia. The flexor hallucis longus also may be impinged. The other structures are not commonly injured in this syndrome.
A patient requires excision of a symptomatic os trigonum employing a posterolateral approach. What intermuscular interval is used?
1: Peroneus longus and peroneus brevis
2: Tibialis posterior and flexor hallucis longus
3: Flexor digitorum longus and flexor hallucis longus
4: Flexor hallucis longus and peroneus brevis
5: Tibialis posterior and flexor digitorum longus
4: Flexor hallucis longus and peroneus brevis
The posterolateral approach to the ankle uses an intermuscular plane (which is also internervous) between the peroneus brevis (superficial peroneal nerve) and the flexor hallucis longus (tibial nerve). The flexor hallucis longus courses directly medial to the os trigonum and is at risk for injury.
The abductor digiti quinti muscle of the foot is most frequently innervated by what peripheral nerve?
1: Medial plantar
2: Deep peroneal
3: Saphenous
4: Sural
5: Lateral plantar
5: Lateral plantar
Distal to the laciniate ligament the tibial nerve divides into four or five branches. The nerve to the abductor digiti quinti arises as a branch off the lateral plantar nerve or may come directly off the tibial nerve. It passes beneath the deep fascial edge of the abductor hallucis muscle where it can become compressed. It continues laterally, deep to the origin of the plantar fascia and flexor digitorum brevis muscle, and terminates in the proximal portion of the abductor digiti quinti.
