FAnkle Flashcards
bunnionette types
1 - lateral prominence ; 2 - bowed with normal IMA (distal chevron); 3 - wide IMA (most common)
normal 4-5th IMA
6-8 deg; also 5th MT head should be less than 13mm
sx of baxter’s nerve
9-12 months heelpain; unrelated to WB, similar to plantar fascitis
position for ankle fusion
0 DF, 0-5 valgus, 0 ER
floating toe seen with
seen with Weil osteotomy - up to 36%; more common when performed with PIP arthrodesis
Distal MT osteotomy parameters
HVA < 25 and IM < 13
FDL and FHL in plantar mid foot
FHL is DEEP (dorsal) to FDL
what position is hind foot for toe off
inversion, locked for toe off
traits of rigid hammertoe
neutral to slight extension of MTP; fixed PIP, variable DIP - key is that PIP does not correct with foot plantarflexion
criteria for DM ulcer
ABI < 0.45; TcO2 < 30; albumin < 3
which part of plantar fascia to release in PF
medial third ONLY - otherwise you will destabilize the arch
tx of chronic achilles tendinopathy
debridement, exostectomy of calc, and FHL transfer
risk factors for subtalar fusion non-union
smoking, failure of previous union or tibiotalar union, > 2mm of AVN at fusion site
baxter’s nerve innervates
abductor digit quinti, FDB, and quadratus plantae
bracnhes of tibial nerve at medial ankle
Medial Calc nerve; lateral plantar (with baxters) and medial plantar ; medial plantar is more anterior
tx of metatarsal stress fracture
walking boot x 6 weeks;
what position causes peroneal tendon subluxation
resisted dorsiflexion and eversion - due to disrupted SUPERIOR peroneal retinaculum
Peroneus longus injuries a/w
RhA, Varus foot, and large peroneal tubercle - tx is debride and attach to the brevis when chronic
chronic achilles rupture tx
if < 3months old and < 3cm , try for primary repair; if > 3cm gap use FHL transfer
Silfverskiold test
dorsiflexion improves with knee flexion - if DF improves then ONLY Gastroc was involved in contracture
the ONLY oral abx with pseudomonas coverage
fluoroquinolones
% reduction in recurrent sprains after proprioception PT
35% less
Antagonist to Tib Ant and Post Tib.
P Longus and P brevis respectively
what is modified Brostrom
recon of ATFL, CFL, with augment of inferior extensor retinaculum
what is evans procedure for ankle instability
a NON-anatomic recon of lateral support b/w the positions of ATFL and CFL - involves using half or P. brevis and attaching to anterior fibula via a drill bhole
ways to avoid floating toe with Weil
make osteotomy as plantar and paralle to floor as possible to avoid MT head from moving plantar as it is shortened
how to pick up sesamoid fracture
bone scan can help - to determine if source of pain
risk factors for achilles wound issues
tobacco»_space; steroids and female gender; DM also a rf
inversion ankle injury a/w
OCD of talar dome, peroneal tendon split, anterolateral soft tissue impingment
eversion ankle injury a/w
detloid avulsion fleck - anterior colliculus
HO after high ankle sprain develops
6-8months after injury- wait for a negative bone scan
navicular stress fracture tx
NWB x 6week; perc ORIF only after
during heel strike what happens to GSC
dorman, TA Is ECCENTRIC
screw diameter and Jones frx
if < 4.5 then higher rate of delayed or non-union
TAA vs fusion in young patients
Fusion for active young, TAA is for older
consequence of removalof both sesamoids
toe cock-up deformity
treatment of flexible claw toe
based on PIP - if flexible then FDL transfer to extensor surface; if rigid PIP then resection arthroplasty +/- weil if many toes
triad of claw toe
Dorsiflexed MTP; Hyperflex at PIP and DIP
supramalleolar osteotomy for varus ankle
if stage 2 - 3a then good; 3b is not as good
FHL tendonitis sx
posteromedial ankle pain; crepitus, triggering of great toe; decresaed passive extension of the great toe.pain with resisted great toe extension
second tier tx of Plantar fascitis
night splints, steroid shot, and casting
third line tx of Plantar fascititis
surgical release or extracorporal shockwave tx
Sx for cavovarus and lateral ankle instability
recon of lateral ligaments and calc osteotomy
chance of osteoM with ulcer that probes to bone
if probes to bone then 65%
when do diabetic ulcers recurr
1 month after initiall healing in casting - help avoid recurrence with achilles lengthening
which test has most false positive for syndesmosis injury
COTTON test
operative tx for navicular stress
orif WITH bone graft
mechanism of injury for peroneal tendon
DORSIflexion and inversion
ligametnous lisfranc prognosis
poor compared to bony \even with ORIF
how much delay after stroke before surg is doable
for acquired cavovarus - wait 18-24 months
ligament integrity and Total ankle
they must be reconstructed - if not stable then cant do it
medial vs lateral ocd
medial is more common, less traumatic, deeper and more posterior.
what is boutinerre caused by
central slip - PIP flexion; DIP extension
replant of palm amputation
if clean with no avulsion then yes
tendon repair suture principle
10mm from cut edge with 4-6 epitendinous strands
nomral ulnar variance what is load distribution
80 R 20 Ulna; goes to 95 -5
contraindication to ulnar shortening
DRUJ OA
