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Pod Med > FF summary > Flashcards

FF summary Flashcards

1
Q

Metatarsalgia

Physical exam

A

Pain on palpation- met heads

Little or no inflam (rare= bursitis)

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2
Q

Metatarsalgia

Pathogenesis

A

Inc pronation

Dec tran. Arc

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3
Q

Metatarsalgia

Diagnosis

A

Rule out everything else

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4
Q

Metatarsalgia

Treatment

A

Rest ,ice
Met pads
Orthotics
Pain meds

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5
Q

Nerve injury

Compression

A
  1. Neuropraxia- most common
    Distal- TIPS compression (casting, shoes)
    Prox- herniated disc
    Reversible ischemia
    Transient dec sensation(d-w): dec conduction until remyelination
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6
Q

Nerve injury

Compression

A 
2. Axonotmesis-severe/crush
Demyelination= dec sensation (wks-m)
Intact basement membrane
Axon regeneration, remyelination
Really severe? Wallerian degen (perm loss)
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7
Q

Nerve injury

Transection

A

Neurotmesis (least common)

  • laceration
  • no basemembrane
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8
Q

Nerve injury

Ischemia/ infarct

A

Caused by vasculitis/ atherosclerosis
Conduction not decreased
Basement membrane intact= can regen , sciatic n most common,
Peroneal/ tibial too

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9
Q

Nerve injury

Radiation-induced

A

Seen w radiation treatment
Delayed presentation
Dec sensation, proprioception
Weakness

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10
Q

Nerve injury

Degeneration (most common cause of injury)

A

Distal: distal->prox deg /longest n first

Most vuln to metabolic/toxic activity

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11
Q

Nerve injury

Inflammation

A

Infections- EBV, HSV, Zoster(most common)
Diabetes- radiculopathy (most common)
Sjogrens(dorsal root ganglion)

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12
Q

Nerve injury

Common symptom

A

Pain, paresthesia, anesthesia,
Pruritis(itching)
Motor function loss

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13
Q

Nerve injury

Autonomic inv

A

Skin changes due to nn injury

Slow wound healing due to poor innervation to sm mm

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14
Q

Nerve injury

Physical exam

A

Valleix- prox+dis

Tinel- distal

Tingling and pain

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15
Q

Common n entraps

Morton

McDonald

A

Common dig n

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16
Q

Joplin

A

Med proper dig n to hallux (1st)

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17
Q

Ant tarsal tunnel

A

Deep fib n

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18
Q

Lemonts

A

Superficial fib n

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19
Q

Tarsal tunnel syndrome

A

Post tib n

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20
Q

Compressed common dig n

A

Morton’s neuroma

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21
Q

Most common:3rd interspace than 2nd (largest)

F>M; shoe choices

A

Morton’s neuroma

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22
Q

Morton’s neuroma

Etiology

A

Compressed by DTIL ( or by bursa from trauma)

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23
Q

Morton’s neuroma

Symptoms

A

Pain, burning, tingling

Pebble in shoe (worse wt bearing)

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24
Q

Morton’s neuroma

Diagnosis

A 
Dec sensation adjacent toes
Mulder's sign
Pencil test
DF= pain
Sullivan's sign (splayed toes near neuroma on x ray)
Lidocaine injection

Ultrasound is best!

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25
Q

Morton’s neuroma

Differential

A 
Friedberg
RA
Callus
Bursitis
Tarsal tunnel, tumor
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26
Q

Entrapment neuropathy of plantar proper digital n to hallux( due to trauma from shoe gear)

Associate w HAV

A

Joplin’s neuroma

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27
Q

Joplin’s neuroma

Treatment

A

Orthotics, pedding, taping

Injections

  • corticosteroids: avoid acetate = avoid fat atrophy
  • sclerosing alcohol(hardening n): 7-10, 1-2wks apart

Surgical removal, or cut DTIL

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28
Q

Joplin’s neuroma

Complication

A

Comes back-stump neuroma
CRPS- symp pain msg doesnt turn off
Digital deformity- lumbrical, interossei mremoved=claw/hammer toes

29
Q

Nerve entrapment

Ant. Tarsal tunnel (deep peroneal n)

A

Pain at ant ankle
Dec sensation 1st interrspace

*physical exam
Lag time to distal mm
Abnormal extensor digitorum brevis m

30
Q

Nerve entrapment

Lemont (superficial peroneal n, INTERME, MEDIAL dorsal cutaneus n)

A

Tight shoes

31
Q

Nerve entrapment

Sural n

A

Int compress- peroneal tendon path, lipomas, cysts

Ext compress- shoe pressure

Trapped at 5th met and CC joint

32
Q

Nerve entrapment

Common fibular n

A

Compressed at

  • peroneal longus m belly
  • neck of fibula

Ext pressure: casts, long surgery, crossing legs, squatting
Lead foot drop(-> steppage gait), dec sensation,

Treatment: remove compression, AFO, PT

33
Q

Ant tarsal tunnel

Diagnostic testing

A 
EMG, 
NCS, NCV
MRI
CT
Serologic- HbA1C, lyme titers
LP- unusual
34
Q

Lemont

Diagnostic testing

A 
EMG, 
NCS, NCV
MRI
CT
Serologic- HbA1C, lyme titers
LP- unusual
35
Q

Sural n

Diagnostic testing

A 
EMG, 
NCS, NCV
MRI
CT
Serologic- HbA1C, lyme titers
LP- unusual
36
Q

Only a little broken

A

Metatarsal stress fracture

37
Q

2nd met most common

A

Metatarsal stress fracture

38
Q

Normal bone w inc pressures

A

Stress/fatigue

Metatarsal stress fracture

39
Q

Normal pressure w weak bone

A

Insufficiency

Metatarsal stress fracture

40
Q

Metatarsal stress fracture

Wolf law

A

March fracture- military

41
Q

Metatarsal stress fracture

Risk factors-anatomic

A

Biomechanically related

42
Q

Metatarsal stress fracture

Risk factors-physiologically

A

Age, wt, osteopenia

43
Q

Metatarsal stress fracture

Risk factors- external

(5th met non-union due to disrupted nutrient a)

A

Shoes, training intensity or surface, post-op

44
Q

Metatarsal stress fracture

Symptoms

A

Sharp pain, pain on palpation w wt

-> get x ray/MRI

45
Q

Metatarsal stress fracture

Treatment

A

RICE + restrict activity

Surgical shoes/ supportive shoes

46
Q

Incomplete fracture leading to avasculaization w necrosis
See osteochondritis of 2,3,4 th met heads
Flat, widen

A

Frieberg’s infarction

47
Q

F>m

Occurs after 11-13 yrs

A

Frieberg’s infarction

48
Q

Frieberg’s infarction

Presentation

A

Dull/aching FF -> worse at end ROM (w wt bearing)

Subchondral fracture, resorption of necrotic bone

49
Q

Frieberg’s infarction

Treatment

A

Early- immobilize
Late- met bar/ pad
NSAIDs

Surgery if doesnt work

50
Q

Inflamed sesamoid apparatus

A

Sesamoiditis

51
Q

Sesamoiditis

Symptoms

A

Insidious- worse w activity
Mild ache -> throbbing
Local edema sometimes

52
Q

Sesamoiditis

Examination

A

Pain on palpation
Hallux DF= worse
Xray rule out fracture

53
Q

Sesamoiditis

Treatment

A

Dancer’s pad(cut out at 1st met head)

NSAIDs, BK Fiberglass cast, corticosteroid inj, surgery

54
Q

Swelling, bruising

A

Sesamoid fracture

55
Q

Sesamoid fracture

X rays

A

AP, MO, FFA
25% bipartite; 85% b/l
Bipartite, 2 pieces together larger than other sesamoid

NSAIDS
BK casting > 8wks

56
Q

Hallux limitus/rigidus

Types

(Normal- DF 1st MPJ 65)

A
  • structural: dec 1st MPJ in gen

- func: dec ROM w closed -normal w open

57
Q

Hallux limitus/rigidus

Symptoms

A

Discomfort-> pain, immobility, joint destruction,

58
Q

Hallux limitus/rigidus

Etiology

I SO GOT

A

-structural: met primus elevatus, long/short 1st ray, hypermobile 1st ray

  • trauma
  • surgical complication
  • gout, OA
  • infection
  • osteochondritis dessicans
59
Q

Hallux limitus/rigidus

Radiograph (think OA)

A

Dec joint space
Subchon sclerosis , cysts
Osteophyte
Joint mouse-> detached osteophyte

60
Q

Hallux limitus/rigidus

Treatment

A

Padding
Stiff sole
Morton’s extension
Surgery( joint fusion)

61
Q

Digital deformities

Hammertoes (E-F-E)

Causes

A
  1. Flexor stabilization (most common): late stance

Pronated foot
AductoVarus 4,5th- loss mech adv of quad plantae
Asso w weak interossei mm
Treatment: artheroplasty

62
Q

Digital deformities

Hammertoes (E-F-E)

Causes

A
  1. Flexor substitute (least common): late stance

Supinated foot type
Flexors> triceps surae m
Treatment: arthrodesis, tendon transfer

63
Q

Digital deformities

Hammertoes (E-F-E)

Causes

A
  1. Extensor substitution: swing

Ext> lumbricals
MPJ ext >90: due to pes cavus, ankle equinus, lumbrical weak, TA weak, EDL splasticity & pain

Treatment: arthrodesis

64
Q

Hammertoes (E-F-E)

Etiology

A 
Idiopathic
Inc PF mets
Shoe p
Intrinsic m imbalance
L/S ext dysfunction
MPJ instability from inc fluid (injection)
Loss of FHB 2ndary to HAV
65
Q

Claw toe

A

E-F F

66
Q

Mallet toe

A

DIP = F

Etiology= imbalance mm

67
Q

Adductovarus digital rotation

A

Severity=5>4>3

Etiology= pronated foot-> abd twist-> dist ph pull med/post
Pathology= HI BUS
(Heloma dura, infection, bursa, ulcer, submet pain)

68
Q

Lesions

A

HT- PIP, TUFT, SUBMET H
CT- PIP, DIP, TUFT, SUBMET H
MT- DIP, TUFT
ADDUCTOVARUS- (5th)PIP, (4th)DIGIT, WEBSPACE

Treatment- palliative, surgical

69
Q

Painful FF

A

Metatarsalgia

Pod Med (8 decks)

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