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**Forefoot > Chpt 13-18: lesser digital deformities > Flashcards

Chpt 13-18: lesser digital deformities Flashcards

lesser digital deformities/flail toe/FDL transfer/surgical repair of 5th digit

1
Q

Normal IM angle and lateral deviation angle

A

IM: 7 deg

lateral deviation angle: 3 deg

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2
Q

most common complication for condylectomy for high IM angle

A

joint subluxation

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3
Q

for an extensor Z-lengthening, where should the EDL and EDB be transected

A

EDL transected distal to the MPJ and EDB transected proximal to MPJ to complete Z plasty

” cut the longus long and the brevis short”

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4
Q

Claw toe deformity

A

MPJ: DF
PIPJ and DIPJ: PF

common with extensor substitution

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5
Q

foot type/causes for extensor substitution

A

pes cavus, anterior cavus, CMT, equinus

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6
Q

pre-axial vs post axial polydactyly post op complication

A

hallux varus - pre

residual valgus:post axial

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7
Q

post op protocol for weil osteotomy

A

PWB in surgical shoes for 4-6 weeks, then transfer to shoes

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8
Q

Mechanical advantage of extensor substitution

A

when the extensors overpower the lumbricals causing retrograde buckling of digits , often seen in anterior cavus, anterior compartment muscle weakness, and equinus.

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9
Q

Mechanical causes for flexor stabilization

A

long flexors gain mechanical advantage over interosseous muscles, and quadratus plantae causing adductovarus to 4th and 5th digit

STJ pronation–>unlocking midtarsal joint–>hypermobile forefoot–>Flexor overpower interosseous muscles

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10
Q

Fallat and Buckholtz classification

A

Type I: enlarged head
Type II; lateral bowing
type III: increase 4th and 5th IM angle

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11
Q

Distal reverse chevron osteotomy is best indicated for which tailor bunionette

A

lateral bowing with IM angle <12 deg or normal IM angle

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12
Q

for mpj arthroplasty what would you rather resect

A

met head over the base of proximal phalanx due to floppy toe

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13
Q

Indications for Weil osteotomy

A

Metatarsalgia
elongated metatarsal w/ or without transverse plane deformity

crossover toes
subluxed, dislocated MPJ
Rheumatoid

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14
Q

Mallet toe deformity

A

MPJ: neutral
PIPJ: neutral
DIPJ: plantarflexed

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15
Q

how long would the weil osteotomy cut be?

A

2.5- 3 cm long

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16
Q

complications for MPJ arthroplasty

A

stiffness to MPJ, transfer metatarsalgia, floating toe

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17
Q

which type of polydactyly is most common

A

post axial polydactyly

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18
Q

why is it suggested to fuse toe in mild plantarflexion

A

to prevent mallet deformity from unstrained flexor pull

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19
Q

Anatomical relation of lumbricals, interossei and DTML

A

lumbricals is plantar to DTML and interossei dorsal to DTML

20
Q

normal thickness of plantar plate vs inflamed

A

2-3 mm; 4-6 mm and 10-12mm wide medial to lateral

21
Q

The average amount of metatarsal head shortening of weil osteotomy

A

3-5 mm normal amount of shortening ( 3 mm preferred)

22
Q

Claw toe is due to what muscular imbalance

A

EDL overpowering the intrinsics

23
Q

Where should the flexor tenotomy be made for claw toe?

A

DIPJ—> only FDL released–> indicated for flexible claw toes

24
Q

the greater the angle of osteotomy for weil, will have what effect

A

the greater the osteotomy angle, the greater the plantar displacement

25
Q

Indication for syndactylization

A

flail digits, heloma molle

26
Q

where should flexor tenotomy be made for hammer toe

A

PIPJ–> release long and short flexors

27
Q

incisional placement for adductovarus 5th digit? how will incision change the position of toe as it gets more vertical

A

incision with axis of orientation from proximal lateral to distal medial centered over the PIPJ to allow for bone resection. The more vertical the incision, the more abduction

28
Q

what is a test to evaluate for metatarsophalangeal synovitis?

A

pain with motion that is decreased with traction and motion

29
Q

possible surgical options for flail toe

A

implant arthroplasty

syndactylization

bone graft

amputation

30
Q

pathomechanics of a floating toe from weil osteotomy

A

The most common complication of a Weil osteotomy is a floating toe, or a MTP dorsiflexion contracture, which results from altered mechanics of the interossei leading to conversion of interossei from plantarflexors to dorsiflexors.

31
Q

foot type and causes for flexor stabilization

A

pronated foot, equinus, peripheral neuropathy, tarsal tunnel

32
Q

for lachmann test, subluxation greater than _______ indicates displacement/rupture

A

2mm

33
Q

Where should the extensor tenotomy be made

A

stab incision made PROXIMAL to extensor hood (ie at least 2 cm proximal to the MPJ)

34
Q

what is the average screw length for weil osteotomy

A

2.0 or 2.4 x 12 mm screw fits most without penetrating plantar met head

35
Q

Hammer toe deformity

A

MPJ: DF
PIPJ: PF
DIPJ: neutral

36
Q

CBPS Dx: Lesser met pain

A

Metatarsalgia

Capsulitis

brachymetatarsalgia

37
Q

what is the most common mechanical etiology for HT

A

flexor stabilization

38
Q

what do you want to avoid when doing a condylectomy on 5th met

A

removing lateral and plantar condylectomy as it will weaken met head and lead to fragmentation

39
Q

advantages for peg in hole arthrodesis

A

avoids excessive shortening

40
Q

how should the osteotomy cut should be on the lesser mets compared to 2nd met

A

angle of osteotomy decreases on the lateral mets because they are less plantarflexed than 2nd met

41
Q

Osteotomy cut placement for Weil osteotomy on 2nd met

A

1-2 mm inferior to most dorsal aspect of articular cartilage ad osteotomy is parallel to weight bearing surface

42
Q

what heart condition is associated with polydactyly

A

atrial septal defect

43
Q

Foot type/cause for flexor substitution

A

weak tricep surae; the deep posterior and lateral leg muscles try to compensate for lack of plantarflexion–> create high arch supinated foot and contract digits

usually no adductovarus deformity in digits

44
Q

reverse wilson osteotomy

A

displacement osteotomy or oblique osteotomy from distal lateral to proximal medial

45
Q

avoid weil osteotomy with what procedure? why?

A

PIPJ artrhodesis to avoid floating toe

**Forefoot (4 decks)

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