Blue Boxes LE

Question 1

Why are adolescents more vulnerable to acute trauma injuries

Answer 1

due to the fact adolescents are still growing and still have cartilaginous models that are being transformed at the endochondral ossification

Question 2

Epiphyseal plate

Answer 2

disc of hyaline cartilage between the metaphysis and the epiphysis of the mature long bone

these are susceptible to fracture due to the combined stress from physical activity and growth via the stretching of the muscles

(osteochondrosis)

Question 3

Pelvic fracture

Answer 3

fractures of the “hip” bone

Question 4

Hip fracture

Answer 4

more commonly applied to fractures of the femoral head, neck and trochanters

Question 5

Avulsion fractures of the hip bone

Answer 5

may occur in sports from sudden acceleration and deceleration forces like sprinting or kicking in a ball

these occur at the apophyses which are bony projections that lack secondary ossification centers

common areas: anterior superior and inferior iliac spines, ischial tuberosities, and ischiopubic rami

Question 6

Coxa vara

Answer 6

significantly decreased angle of inclination between the long axis of the femoral neck and the femoral shaft due to weakening the neck of the femur

the distal limb deviates toward midline

causes mild shortening of the lower limb and limits passive abduction of the hip

Question 7

Coxa valga

Answer 7

increase in the angle of inclination between the long axis of the femoral neck and the shaft due to weakening of the femoral neck

the distal element deviates away from midline

Question 8

Dislocated Epiphysis of femoral head

Answer 8

older children the epiphysis of the femoral head may slip away from the femoral neck due to a weakened epiphyseal plate

due to acute trauma or repetitive microtraumas especially with abduction and lateral rotation of the thigh

often need radiographic examination to find

Question 9

What are the two main locations of fractures of the proximal femur

Answer 9

transcervical: middle of neck
intertrochanteric

these occur due to indirect trauma (stumbling or stepping down hard off a curb)

this is because of the angle of inclination making the fractures inherently unstable and impaction

Question 10

Intracapsular fracture

Answer 10

occurs within the hip joint

complicated by degeneration of the femoral head leading to vasculature trauma

Question 11

how do Fractures of the greater trochanter and femoral shaft occur

Answer 11

results from direct trauma

occur frequently during motor vehicle accidents and sports

Question 12

Spiral fracture

Answer 12

occurs at the femoral shaft resulting in foreshortening as the fragments override or the bone is fractured into multiple pieces

can take up to a year to union

Question 13

Fractures of the inferior or distal femur

Answer 13

may be complicated due to seperation of the condyles and misalignment of the articular surfaces of the knee joint

can cause hemorrhage from cutting the large popliteal artery that runs on the posterior surface of the bone

Question 14

Compound fracture of the tibia

Answer 14

usually occurs in the middle and inferior third of the shaft since it is the narrowest part of the bone

due to direct trauma “bumper fracture” from hitting the bumper of a car

has poor blood supply since anterior part is subcutaneous

if the fracture hits the nutrient canal it predisposes the patient to nonunion of the bone fragments due to the damage of the nutrient artery

Question 15

Transverse march stress fracture

Answer 15

inferior third of the tibia
occurs in people who take long hikes before they are conditioned

may fracture the anterior cortex of the tibia

can also be caused by indirect violence applied to the tibial shaft when the bone turns as the foot is fixed

Question 16

Diagonal fracture

Answer 16

torsion during skiing produce a diagonal fracture of the tibial shaft at the junction ofthe middle and inferior thirds and will fracture the fibula as well

can lead to limb shortening due to the overriding as well

Question 17

Boot top fracture

Answer 17

fracture at where a a skiboot sits due to highspeed forward fall which angles the leg over the rigid ski boot

Question 18

osgood schlatter disease

Answer 18

prominance of tibial tuberosity elongated and fragmented due to disruption of the epiphysial plate causing inflammation of the tuberosity and chronic recurring pain

Question 19

Fibial Fractures

Answer 19

usually occur 2-6 cm to the distal end of the lateral malleolus and are often associated with fracture-dislocations of the whole ankle joint

usually occurs when a person slips and are forced into an excessive inverted position

or can occur with eversion as well

Question 20

Bone Grafts

Answer 20

replacement of affected segments by a bone transplant may avoid amputation

fibula is a common source of bone grafting since normal actions can still be kept even after removal of segments of the fibula

Question 21

free vascularized fibular transfers

Answer 21

help restore skeletal integrity to upper and lower limbs in which congenial bone defects exist and to replace segments of bone after trauma

remaining fibula usually doesnt regenerate

nutrient artery is removed with the bone so that the graft will remain alive in the new site it is transplanted too

Question 22

Interosseous infusion

Answer 22

method of delivering hydration, blood, and medications directly into the medullary cavity of a bone when peripheral venous access is difficult to impossible

used in children with traumatic shock or circulatory collapse

usually done in the proximal tibia, needles are inserted 2cm distal and slightly medial to tibial tuberosity

special needles are used to get through the bone

IO infusion must be replaced with peripheral venous or central line access within 24 hours due to risk of osteomyelitis

Question 23

Calcaneal fracture

Answer 23

usually a hard fall on to the heel, fractureing the calcaneus into several pieces and producing a commiuted fracture

this fracture disables walking because it usually affects the subtalar joint where the talus articulates with the calcaneus

Question 24

Fracture of the talar neck

Answer 24

may occur during dorsiflexion of the ankle (occurs when someone is pressing hard on the brake pedal when trying to stop on a head on collision

some cases the talus dislocates posteriorly

Question 25

Dancers fracture

Answer 25

occurs when the dancer looses balance and puts full weight on the metatarsal fracturing the bone

Question 26

Fatigue fractures of the metatarsals

Answer 26

usually occur from prolong walking, these typically are transverse due to repeated stress on the metatarsals

Question 27

Avulsion fracture of the tuberosity of the 5th metatarsal

Answer 27

foot is suddenly and violently inverted and the tuberosity of the 5th metatarsal may be avulsed by the tendon of the fibularis brevis muscle most commonly in basketball and tennis players usually associated with ankle sprain

Question 28

Os trigonum

Answer 28

the secondary ossification center which becomes the lateral tubercle of the talus occasionaly fails to unite with the body of the talus maybe caused to forceful plantarflexion in early teens may result in a bone known as a os trigonum

Question 29

fracture of the sesamoid bone

Answer 29

the sesamoid bones of the great toe can be fractured in a car crash and make it difficult to walk since they are important on the stance phase of walking

Question 30

varicose veins

Answer 30

when a vein becomes dilated so that the cusps of their valves do not close and actually face the wrong way lead to blood flowing wrong way and actually can pool

Question 31

Thrombophlebitis

Answer 31

DVT with inflammation around the involved veins

Question 32

Venous stasis

Answer 32

venous stagnation can be caused by: incompetent, loose fasci that fails to resist muscle epansion, diminishing the effectiveness of the musculovenous pump external pressure on the veins from bedding during a prolonged hospital stay or from a tight cast or bandage muscular inactivity

Question 33

Pulmonary thromboembolism

Answer 33

a large thrombus that breaks free from a lower limb vein that may travel to a lung which will obstruct the pulmonary artery

Question 34

Saphenous Vein grafts

Answer 34

great saphenous vein is sometimes used for coronary arterial bypass because it is readily accessible, there is a sufficient distance occurs between the tributaries and the perforating veins so that usable lengths can be harvested, and the walls contain a higher percentage of muscular and elastic fibers than other superficial veins the vein is inverted so that the valves do not obstruct blood flow.

Question 35

Saphenous cutdown

Answer 35

if need to get blood, plasma expanders, electrolytes, or drugs quickly into the vein you can make a small incision anterior to the medial malleolus and find the great saphenous vein however can cut the saphenous nerve because it runs with the great sapheonous vein patient will complain of pain or numbness along the medial border of the foot

Question 36

Nerve block of the femoral nerve

Answer 36

L2-L4 can be blocked 2 cm inferior the inguinal ligament, approximately a fingers breadth lateral to the femoral artery Paresthesia will radiate to the knee and over the medial side of the leg if the saphenous nerve is affected

Question 37

Enlarged inguinal lymph nodes

Answer 37

look for infection or even uteran cancer since some drainage comes from the perineum

Question 38

Abnormalities of sensory function

Answer 38

to interpet abnormalities of the peripheral sensory function, peripheral nerve distribution of the major cutaneous nerves must be interpreted anatomically different from dermatome distribution of the spinal cord segments

Question 39

Hip Pointer

Answer 39

contusion of the iliac crest that usually occurs on the anterior part (ASIS)

Question 40

Charley horse

Answer 40

ischemia or contusion and rupture of blood vessels sufficient to form a hematoma usually consequence of tearing of fibers of the rectus femoris caused by localized pain or muscle stiffness which follows direct trauma

Question 41

Psoas abcess

Answer 41

pyogenic infection from chrons disease or TB that when getting into the lymph in the psoas region looks like a inguinal hernia and causes pain

Question 42

Paralyzed quadriceps

Answer 42

person cant extend the leg against resistance walk with a forward lean pressing on the distal end of the thigh with their hand as the heel contacts the ground to prevent inadvertent flexion of the knee joint injury just to the vastus medialis or vastus lateralis lead to abnormal patella movement and loss of joint stability

Question 43

Chondromalacia patellae

Answer 43

called runners knee softening of the articular cartilage of the patella occurs in marathon runners due to overstressing of the knee region can occur from blow to the patella or extreme flexion of the knee can be caused due to quadriceps imbalance

Question 44

Transverse patellar fractures

Answer 44

may result from a blow to the knee or sudden contraction of the quadriceps the proximal fragment is pulled superiorly with the quadriceps tendon and the distal fragment remains with the patellar ligament

Question 45

Bipartite or tripartite patella

Answer 45

ossification abnormality to have multiple segments attached to a patella

Question 46

diminution or absence of the patellar tendon reflex

Answer 46

result may be to lesion that interrupts the innervation of the quadriceps

Question 47

Transplantation of the Gracilis

Answer 47

surgeons transplant the muscle to help replace damaged muscles of the hand i.e. digital flexion and extension muscle has also been used to recreate a nonfunctional external anal sphincter

Question 48

riders strain

Answer 48

muscle strain of the adductor longus due to fast accleration, also due to horseback riding from constant adduction to stay on their horse

Question 49

vascular surgeon naming of femoral artery

Answer 49

common femoral artery and the continuation distally as the superficial femoral artery

Question 50

Femoral pulse

Answer 50

place little finger on the ASIS and the tip of thumb on the pubic tubercle then the midpalm is just inferior to the inguinal ligament which is where you can palpate the pulse

Question 51

coronary arteriography

Answer 51

insert a probe into the femoral artery at this location to visualize the heart also same thing done for the left cardial angiography

Question 52

blood gas analysis

Answer 52

the determination of oxygen and carbon dioxide concentrations and pressures, this blood is taken from the femoral artery

Question 53

Laceration of the femoral artery

Answer 53

can be easy due to the superficial position, when ligating the femoral artery the cruciate anastomosis will still get blood still down to the leg due to the meeting of the medial and lateral femoral circumflex artaeries and the inferior gluteal artery and the first perforating artery inferiorly

Question 54

Saphenous Varix

Answer 54

a localized dilation of the terminal part of the great saphenous vein that may cause an edema in the femoral triangle this should be considered if varicose veins are present

Question 55

Trochanteric bursitis

Answer 55

inflammation of the trochanteric bursa caused by constant moving of the gluteus maximus (climbing stairs) over the bursa that can lead to friction bursitis point tenderness over greater trochanter and the pain radiates along the iliotibial tract

Question 56

Ischial bursitis

Answer 56

recurrent microtrauma resulting from repeated stress (biking or rowing, tasks involving repetitive hip extension while seated affects the ischial bursa and causes inflammation

Question 57

pressure sores

Answer 57

calcification of the ischial bursa leading to chronic bursitis can lead to pressure sores in debilitated people because these tuberosities bear the body weight of people sitting

Question 58

Hamstring strains

Answer 58

happens in people who involve quick violent muscular exertion tear part of the proximal tendinous attachments of the hamstrings to the ischial tuberosity (more common than quadricep strains) usually accompanied by hematoma that is contained in the fascia lata (bruising) can also lead to avulsion of the ischial tuberosity due to the forcible flexion with the knee extended

Question 59

injury to superior gluteal nerve

Answer 59

gluteus medius limp or a gluteal gait weakened abduction of the thigh due to the lost of medius and minimus medial rotation is also severly impaired body compensates by putting the center of gravity over the supporting lower limb

Question 60

Trendelenburg test

Answer 60

person asked to stand on one leg and the pelvis on the unsupported side descends (gluteus medius and minimus affected) other cases of this would be fracture of the greater trochanter and dislocation of the hip joint

Question 61

gluteal gait

Answer 61

when the pelvis descends on the unsupported side, the lower limb becomes in effect, too long and does not clear the ground. to compensate the individual leans away from the unsupported side raising the pelvis to allow adequate room for the foot to clear the ground as it swings forward

Question 62

Steppage gait

Answer 62

to lift the foot higher as it is brought forward used against foot drop and injury to common fibular nerve

Question 63

Swing out gait

Answer 63

to swing the foot outward laterally while walking used to counter footdrop that results from common fibular nerve paralysis

Question 64

foot drop

Answer 64

results in common fibular nerve paralysis

Question 65

popliteal abscesses

Answer 65

because of the deep popliteal fascia that is strong and limits expansion pain from a abscess or tumor is usually severe

Question 66

Severance of the tibial Nerve

Answer 66

Paralysis of the flexor muscles of the leg and the intrinsic muscles in the sole of the foot cant plantarflex the ankle or flex the toes sensation is lost at the sole of the foot can happen due to posterior dislocation of the knee joint

Question 67

Spread of infection in the leg

Answer 67

because of the compartments the only spreading occurs in the lateral compartment the infection can ascend proximal into the popliteal fossa along the course of the fibular nerve fasciotomy must be done to relieve pressure and remove the suppuration infection

Question 68

uniqueness of the foot compared to higher primates

Answer 68

humans feet are everted more so that we walk on our heels more this pronation leads too the medial migaration of the distal attachment of the fibularis longus across the foot and the development of the fibularis tertius

Question 69

injury to the common fibular nerve

Answer 69

occurs often since the common fibular nerve wraps around the neck of the fibula this can also get severed during fracture of the fibular neck or when the knee joint is dislocated lose all muscles on the anterior and lateral compartments lose dorsiflexion and evertors of the foot leads to foot drop

Question 70

Deep fibular nerve entrapment

Answer 70

excessive use of muscles supplied by the deep fibular nerve may result in muscle injury and edema in the anterior compartment which may compress and entrap the nerve pain occurs i the dorsum of the foot and radiates to the web space between the 1st and 2nd toes common in skiing so called the ski boot syndrome

Question 71

Superficial fibular entrapment

Answer 71

caused by chronic ankle sprains may lead to stretching of the superficial fibular nerve may lead to numbness and parasthesia

Question 72

Calcaneal tendinitis

Answer 72

inflammation of the calcaneal tendon due to running injuries microscopic tears of collagen fibers in the tendon just superior to the attachment on to the calcaneus can be caused by poor footwear or take up running after prolonged inactivity

Question 73

ruptured calcaneal tendon

Answer 73

occurs during plantarflextion with knee extended and hear a snap happens in people of history of calcaneal tendinitis gap is palpable and patient presents in dorsiflexion

Question 74

Calcaneal tendon reflex

Answer 74

reflex tests S1 and S2 nerve root

Question 75

Absence of plantarflexion

Answer 75

to walk people will rotate the foot as far laterally as possible during the stance phase to disable passive dorsiflexion to allow a more effective push off through hip and knee extension exerted at the midfoot

Question 76

tennis leg

Answer 76

gastrocnemius strain usually occurs in the partial tearing of the medial belly at the musclutendinous junction seen in individuals older than 40 years age and is caused by overstretchig of the muscle by concomitant full extension of the knee and dorsiflextion of the ankle joint

Question 77

Calcaneal bursitis

Answer 77

inflammation of the deep bursa of the calcaneal tendon between the calcaneal tendon and the superior part of the posterior surface of the calcaneus caused by excessive running and leading to excessive friction

Question 78

Venous return from the leg

Answer 78

the venous plexus deep to the triceps surae is involved in pushing the blood back through and acting as a musculovenous pump

Question 79

Accessory soleus

Answer 79

an extra muscle belly that appears as a distal belly medial to the calcaneal tendon. thismuscle may be associated with pain and edema during prolonged exercise 3 percent of people have this muscle

Question 80

Posterior Tibial pulse

Answer 80

can be found at the posterior surface of the medial malleolus and the medial border of the calcaneal tendon

Question 81

Calcaneal spur

Answer 81

protrudes from the medial tubercle and the plantar fasciitis is likely to cause pain on the medial side of the foot when walking. bursa usually develops under this

Question 82

Contusion of extensor digitorum brevis

Answer 82

abnormal edema and cuntusion of extensor digitorum brevis and extensor hallucis brevis make it look like the paitent has a severely sprained ankle

Question 83

Sural Nerve grafts

Answer 83

pieces of the sural nerve are used asnerve grafts and the sural nerve can easily be found since it runs with the small saphenous vein

Question 84

Anesthetic block of superficial fibular nerve

Answer 84

occurs when the superficial nerve pierces the deep fascia to become a cutaneous nerve, to inject the anesthetic agent the patient will plantar flex their foot and the injection will be given

Question 85

Plantar reflex

Answer 85

L4,L5,S1, and S2 deep tendon reflex tested during neurological examinations lateral aspect of the sole of the foot is stroked with a blunt object, flextion of toes is a normal response fanning of the lateral four toes and dorsiflexion of the great toe is a abnormal response (babinski sign) which means brain injury or cerebral disease this sign will be only be present in children until 4 years old

Question 86

Medial plantar nerve entrapment

Answer 86

compression of the medial plantar nerve as it passes deep to the flexor retinaculum or curves deep to the abductor hallucis this causes numbness and tingling to the medial side of the sole of the foot and region of the navicular tuberosity may occur during repetitive eversion of the foot sometimes called joggers foot

Question 87

Dorsalis pedis artery pulse

Answer 87

palpated with the feet slightly dorsiflexed and they are subcutaneous that pass along a line from the extensor retinaculum to a point just lateral to the extensor hallucis longus tendons

Question 88

Hemorrhaging wounds of sole of foot

Answer 88

puncture would of the sole of the foot involving the deep plantar arch and its branches usually result in severe bleeding typically from both ends of the cut artery because of the abundant anastomoses ligation is difficult due to the depth and structures around it

Question 89

Lymphadenopathy

Answer 89

enlargement of the lymphnodes medial side foot infection shows up in the inguinial lymph nodes lateral side of foot infection shows up in the popliteal lymph nodes

Question 90

Acetabulum

Answer 90

overlies the femoral head to add stability and is important for transferring weight to the femur

Question 91

osteoprosis

Answer 91

femoral neck fractures common in woman over 60 years due to the degeneration of the bone tissue the femoral neck fractures are often intracapsular and requires internal skeletal fixation pain edema, limitation of motion, erosion of articular cartilage

Question 92

Aseptic vascular necrosis

Answer 92

when fracturing of the neck of the femur can also lose blood supply from the medial circumflex femoral artery and the breaking of the retinacular arteries the only artery that may still be intact is the artery to the ligament of the femoral head but isnt sufficient to supply the head

Question 93

Necrosis of femoral head in children

Answer 93

dislocations of the hip joint can disrupt the artery to the head of the femur or fractures that result in seperation of the superior femoral epiphysis can lead to inadequate blood supply lead to avascular necrosis of the head of the femur also lead to development issues in growth of the bone if it occurs at the epiphysis in children 3-9

Question 94

Congenital dislocation of the hip joint

Answer 94

common occurring bilaterally in girls the femoral head is not properly placed in the acetabulum patient cant abduct the thigh and appears shorter than normal

Question 95

Aquired dislocation of the hip joint

Answer 95

very uncommon since the hip joint is so strong and stable usually occurs during an automoblie accident when the hip is flexed adducted and medially rotated posterior dislocations of the hip joint are the most common (head on collision) this may affect the sciatic nerve and paralysis of the hamstrings and distal to the knee Anterior dislocation occurs from a violent injury that causes hip extension, abduction, and lateral rotation

Question 96

Q angle

Answer 96

greater in woman due to the wider pelves

Question 97

Genu varum

Answer 97

close to zero Q angle and the distal leg points inward stretches the lateral collateral ligament stress on the medial meniscus

Question 98

Genu valgum

Answer 98

great Q angle and the leg points outward greater than 17 degrees stretches the medial collateral ligament stress on the lateral meniscus

Question 99

Patellar Dislocation

Answer 99

always dislocates laterally more common in women due to greater Q angle this is due to the pull of the quadracips which makes it pull laterally also the lope of the lateral patellar facet and the more anterior projection of the lateral femoral condyle make it go laterally

Question 100

Patellofemoral syndrome

Answer 100

runners knee which is pain deep to the patella caused by repetitive microtrauma caused by abnormal tracking of the petella can occur from osteoartheritis weakness of the vastus medialis leaves people predisposed to this

Question 101

ACL rupture

Answer 101

hyperextension and severe force directed anteriorly against the femur with the knee semiflexed this allows for the tibia to slide anteriorly under the fixed femur lachmann test, anterior drawer test

Question 102

PCL rupture

Answer 102

occur when a player lands on the tibial tuberosity with the knee flexed usually occur with fibular and tibial ligament tears allow for the free tibia to slide posteriorly under the fixed femur

Question 103

Meniscal tears

Answer 103

usually medial meniscus tears and will be indicated by pain on the medial rotation of the tibia lateral menisus will show with pain on lateral rotation of tibia

Question 104

Arthroscopy

Answer 104

endoscopic examination that allows for visualization of the interior of the knee joint cavity goes through an incision called a portal use equipment or probe to remove the damaged tissues like the menisci or the loose bodies of the joint ligament repair can also be done by this

Question 105

Aspiration of the knee joint

Answer 105

if the knee joint becomes infected maybe after a laceration or fracture, inflammation and the amount of synovial fluid may increase occurs when the knee joint is approached laterally when it is flexed. use the three bony landmarks (anterolateral tibial tubercle, lateral epicondyle of the femur and the apex of the patella

Question 106

Prepatellar bursitis

Answer 106

caused by excessive and repeated friction between the skin and the patella can also occur via compression forces from a direct blow to the knee if chronic, the bursa becomes distended with fluid and forms a swelling anterior to the knee

Question 107

subcutaneous infrapatellar bursitis

Answer 107

excessive friction between the skin and the tibial tuberosity, edema occurs over the proximal end of the tibia called clergymans knee and occurs more commonly in tilers and roofers if they do not wear knee pads can also get a deep infrapatellar bursitis

Question 108

Total knee replacement arthroplasty

Answer 108

artificial knee is inserted if the knee is diseased resulting from osteoarthritis

Question 109

Ankle sprains

Answer 109

usually an inversion injury, involving twisting of the weight bearing plantarflexed foot

Question 110

Lateral ligament sprains

Answer 110

occurs in jumping sports and particularly basketball occcurs fairly frequently because the lateral ligaments are much weaker than the medial ligaments Anterior talofibular ligament is the most vulnerable the calcaneofibular ligament can also be torn if severe the lateral malleolus may be sheared or avulsion fractures could occur

Question 111

Pott fracture dislocation

Answer 111

foot is forcibly everted, this action pulls on the extremely strong medial ligament which will shear off the medial malleoulus talus will then move laterally shearing off the lateral malleolus or more cmmonly breaking the fibula superior to the tibiofibular syndesmosis if the tibia is carried anteriorly, the posterior margin of the distal end of the tibia is also sheared off by the talus, producing a trimalleolar fracture

Question 112

Tarsal tunnel syndrome

Answer 112

there is edema and tightness in the ankle involving the synovial sheaths of the tendons of the muscles in the posterior compartment the area involved is from the medial malleolus to the calcaneus these both lead to entrapment and compression of the tibial nerve

Question 113

Hallux valgus

Answer 113

lateral deviation of the great toe sometimes the great toe can overlap the 2nd toe causes a decrease in the medial longitudinal arch can cause a medial shift of the sesamoid bones

Question 114

Bunion

Answer 114

inflammed bursa found at the 1st metatarsal and usually caused by hallux valgus

Question 115

Hard corns

Answer 115

inflammed areas of thick skin that form over the proximal interphalangeal joint especially the little toe

Question 116

Hammer toe

Answer 116

foot deformity when the proximal phalanx is permanently and markedly dorsiflexed (hyperextended) at the metatarsophalangeal joint and the middle phalanx is strongly plantarflexed at the proximal interphalangeal joint the distal phalank of the digit is often hyperextended

Question 117

claw toes

Answer 117

hyperextension of the metatarsophalangeal joints and flexion of the distal interphalangeal joints usually involved with the lateral four toes callosities or corns develop on the dorsal surfaces of the toes due to the pressure of the shoes and callositiess can develop on the plantar surfaces of the metatarsal heads and the toe tips because they bear extra weight

Question 118

Pes planus

Answer 118

flat feet flat appearance before age 3 is normal can be flexible or rigid flexible flat feet result from degenerated intrinsic ligaments (inadequate passive arch support) usually resolves with age Rigid flat feet: result from a bone deformity like a fusion of the tarsal bones acquired flat feet or fallen arches are likely secondary to dysfunction of the tibialis posterior (dynamic arch support) the plantar calcaneonavicular ligament fails to support the head of the talus making it go inferomdially and become prominent this then will cause flattening of the medial part of the longitudinal arch and lateral deviation of the forefoot

Question 119

Talipes equinovarus

Answer 119

clubfoot congenital due to the lack of limb rotation during development in the embryo the foot is inverted, and the ankle is plantarflexed and the forefoot is adducted looks like a horses hoof