Clinical Podiatry Flashcards
What is the chronic pattern of tinea pedis and what is the infecting organism?
Mocassin pattern or papulosquamous
Most commonly caused by tricophytum rubrum
What is the acute pattern of tinea infection and what is the infecting organism?
Interdigital or vesicular
Caused by trychophytum mentagrophytes
What organisms typically cause ulcerative tinea pedis?
Trichophytum mentagrophytes with pseudomonas or proteus.
What type of organism causes distal subungual onychomycosis?
Trichophyton rubrum
This is the most common form at 90%
What type of organism causes proximal subungual onychomycosis?
1% of the cases
Caused by trichophytum rubrum just like the distal form but typically only shows up in those with immune disorders.
What organism causes superficial white onychomycosis?
Tricophytum mentagrophytes.
what test confirms tinea pedis?
KOH stain
Looking for septated hyphae.
How does lamosil “terbinafine” work?
Works by inhibiting ergosterol synthesis
What is the brand name for Terbinafine?
Lamosil
What exactly is phenol?
Carbolic acid
During a P&A procedure, why is the wound irrigated with alcohol after phenol exposure?
Carbolic acid (phenol) is soluble in alcohol and washes away with the irrigation.
What are three things that can be done for anesthesia if a patient undergoing a nail avulsion is allergic to all local anesthetics?
Saline block (Pressure induced) Pressure cuff Benadryl block (Blocks histamine release)
In evaluating a bunion why is it the tibial position that is assessed and not the fibular sesamoid?
The tibial sesamoid indicates the abnormal affects of the adductor and flexor 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 the deformity.
What are the three main categories of etiologies for hallux varus?
Iatrogenic
Traumatic
Congenital
What are the congenital causes of hallux varus?
Tallipes equinovarus (clubfoot) Metatarsus adductus
What are the typical traumatic causes for hallux varus?
MPJ dislocation
Fracture of the metatarsal head or phalangeal base.
What are the 5 iatrogenic causes of hallux varus?
Overcorrection of IM angle Excessive resection of the medial eminence "Steaking the head" Fibular sesamoidectomy Overaggressive capsulorraphy Bandaging too far into varus.
What is “Steaking the head”
Excessive resection of the first metatarsal head.
If the sagittal groove of the head is violated, the hallux may drift into varus.
Describe flexor stabilization hammering
Excessive pronation
Over time the deep flexors gain advantage over the interossei.
MOST COMMON
expect to see this initially during stance phase with a pronated foot.
Describe flexor substitution hammering?
What foot type is seen with this deformity.
Flexor substitution occurs when there is a weak posterior flexor group. This is the least common.
The deep flexors take over the interossei and you end up with hammering.
the foot type will be supinated with a high arch foot or weak achilles
Describe extensor substitution hammering
Swing phase hammering seen when the extensors overpower the lumbricals.
Usually results from an anterior cavus/anterior muscle weakness/ or ankle equinus.
What position will the toes be forced into if the QP is accidentally cut?
If the quadratus plantae is accidentally cut the 4th and 5th toes will result in an adductovarus position.
This is because the FDL pull medially is unopposed/not straightened.
What is the difference between a rigid and semirigid hammering deformity?
Semi-rigid is reducible when non-weight bearing only.
rigid is non-reducible.
For completion, flexible hammer toes can be reduced when NWB and when WB.
What X-ray evaluations evaluate a haglund deformity?
Parallel pitch lines
fowler phillip 44-69
Total angle
What is the silfverskiold test?
Determines gastroc vs gastroc-equinus soleus
What is a positive silvferskiold test?
Dorsiflexion of the foot to neutral or beyond with knee flexion
Tells you that there is Gastroc equinus.
What is a negative silvferskiold test?
Lack of dorsiflexion of the foot to neutral with the knee in flexion and in extension.
This tells you the patient has a gastrosoleal equinus present.
What is the Lachmans test?
Determines if there is a plantar plate tear or rupture.
While stabilizing the metatarsal, a dorsal translocation of the proximal phalanx greater than 2mm is suggesstive of a rupture.
What is the mulder sign?
A palpable click when compressing the metatarsal heads and palpating the interspace of pain.
this tests for a mortons neuroma.
What is the Sullivan sign?
Separation of the digits caused by a mass within the innerspace.
Can appreciate this when performing digital blocks!!
What is the Q angle?
The angle between the axis of the femur and the line between the patella and tibial tuberosity.
Normal is: 14 degrees for males and 17 degrees for females.
A high Q angle causes the quads to pull more laterally on the knee cap and results in femoral patellar pain.,
What are the stages of reynauds syndrome?
White to blue to red
Pallor: Spasm of the digital arteries
Blue: Cyanosis/ deoxygenation of blood pools
Rubor: Hyperemia
What are normal, intermittent claudication, rest pain, and ischemic ulceration ABIs?
Normal: 1.0-1.1
Intermittent claudication: 0.6-0.8
Resting pain: 0.4-0.6
Ischemic ulcerations: <0.4
What may falsely elevate an ABI?
Vessel calcifications/non-compressible vessels.
can result in ABI >1.1
What other tests are most commonly done with an ABI?
Segmental pressures: Normal 70-120 mmHg A drop greater than 30 indicates disease in the vessel above.
Pulse volume recordings (PVR) looking for normal triphasic wave forms.
What are normal segmental pressures?
Measured at the high thigh, above the knee, below the knee, ankle, midfoot, and toe.
Normal is 70-120 mmHg
Drop between segments >30 mmHg indicates disease in a vessel above.
What do pulse volume recordings check?
These are used with abnormal ABI’s
Check the waveforms of occluded vessels.
Normal should be triphasic.
Waveforms are widened and blunted with severe disease.
What is the most common type of skin cancer?
Basal cell carcinoma found on sun exposed parts of the body.
What skin cancer may appear cauliflower like?
Squamous cell carcinoma
What is the most common type of melanoma?
superficial spreading melanoma which can be found on any part of the body.
What is the most malignant form of melanoma?>
Nodular melanoma
Often misdiagnosed with pyogenic granuloma
What is the most benign form of melanoma?
Lentigo melanoma most commonly found of the back, arms, neck, and scalp.
What type of melanoma is most commonly found on the palms, soles, and nails?
Acral lentiginous melanoma.
What is hutchinsons sign?
This is a change in the eponychium seen with subungual melanoma.
What is the most common nodule formed by vascular proliferation?
Hemangioma!
Which vascular malignancy appears as red-blue plaques or nodules and has a high incidence in AIDS?
Kaposi Sarcoma
What three conditions may be associated with plantar fibromatosis?
Ledderhose disease
Duputyren contracture
Peyronie disease
Congenital convex pes valgus (CCPV) is also known as.,…
Vertical talus disorder
What are the radiographic findings of congenital convex pes valgus (CCPV)?
Calcaneus is in equinus
Plantarflexed talus
Dorsally dislocated navicular
Increased talo-calc angle (Kites angle norm is 25-40 degrees)
What additional study should be obtained for neonates with congenital convex pes valgus disorder (CCPV)?
Lumbosacral films
What are the three coalitions of the rearfoot?
Talocalcaneal
Calcaneonavicular
Talonavicular
What percentage of tarsal coalitions are bilateral?
50%
Which coalition of the rearfoot is most symptomatic
CN
Locks up a ton of movement!
What coalition is typically asymptomatic?
Talonavicular coalition
List the order of occurence of the three rearfoot tarsal coalitions
Talocalcaneal
Calcaneonavicular
Talonavicular
Which talocalcaneal facet is most common fused in TC coalitions?
Medial > Anterior > Posterior
At what age to TN coalitions fuse?
3-5 years
At what age do C-N coalitions fuse?
8-12 years
At what age do T-C coalitions fuse?
12-16 years
what occurs radiographically at the lateral process of the talus in tarsal coalition disorders?
Becomes rounded
What causes talar beaking with tarsal coalition radiographically?
Talar beaking is a result of increased stress on the talonavicular ligament with coalitions.
What can be seen as a change radiographically at the anterior subtalar facet with tarsal coalition?
Assymetry of the anterior subtalar facet occurs.
What is the radiographic “Halo sign”?
A circular ring of increased trabecular pattern due to altered compressive forces.
This is seen with rearfoot tarsal coalations.
What is the radiographic ant-eater sign?
C-N coalition in which the calcaneus has an elongated process on the lateral view.
consistant with a C-N coalation.,
What is putter sign?
A radiographic sign in which a T-N coalation has occured and the neck of talus unites with broad expansion of the navicular.
Which radiograpic view is ordered to evaluate the anterior facet of the talus?
Medial oblique!
Also known as the Ischerwood view
Which radiographic view is best for the evaluation of the posterior and medial facets of the talus?
Harrus-Beath view
What is the Badgley procedure?
A procedure for tarsal coalation.
Surgical resection of the coalation or bar with interposition of a muscle belly (Usually the EDB).
What are the three components of club foot?
FF adductus
Rearfoot Varus
Calcaneal equinus
“Tallipes adducto equino varus”
What posterior ligaments are contracted in club foot disorders?
Posterior tib fib
Posterior talo fib
Lateral calcaneofibular
Syndesmosis
What medial ligaments are contracted in club foot disorders?
Superficial deltoid Tibionavicular Calcaneonavicular Talo-navic, navic-cunei, cunei-1st MT joints Spring ligament
What posterior muscles are most commonly contracted in club foot?
Achilles tendon
Plantaris tendon
What medial muscles are most commonly contracted in club foot?
PT
FDL
FHL
Abductor hallucis
What anterior muscles are most commonly contracted in club foot?
Tibialis anterior (rearfoot Varus)
What is the name of the technique to treat club foot?
The Ponsetti technique
What is the Ponsetti technique?
Serial casting used to treat club foot.
first correct the FF and RF deformities, and then correct the ankle equinus.
Where is pressure applied in the Ponsetti technique?
Pressur is applied to the head of the talus (not the calcaneus)
Correct the FF and RF problems first then the equinus.
What is the time frame for the ponsetti technique?
4-8 casts
Percutaneous achilles tenotomy during the last cast for 3 weeks
Ocassionally can do a TA transfer to get some of the RF varus down.
D-B (Denis-Brown) bar brace until age of 3 to prevent relapse.
What is the most accepted theory about club foot?
Germ plasma defect resulting in malpositioning of the head and neck of the talus.
What is the Simon rule of 15?
For clubfoot children <3 years of age one may have talo-navicular subluxation.
T-C angle is<15 degrees and Talo-first met angle is <15.
