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Millers > Foot and Ankle > Flashcards

Foot and Ankle Flashcards

1
Q

Where is the hypovasc zone for PT tendon

A

2-6cm from insertion onto ***

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2
Q

What is the last failure for PTT

A

Spring lig

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3
Q

Why can people with PTT not preform single leg heel rise

A

PT not working - no locking of trans tarsal joints
Foot isn’t rigid - can’t push off
Use to det rigid vs flexible deformity

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4
Q

XR findings PTT

A
  1. Meary angle - goes NEGATIVE
    (1st MT to talus)
  2. Talar head uncoverage
  3. Valgus heel
  4. Valgus tilt on the AP (subfibular impingement) 2/2 deltoid insuff
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5
Q

Nonop PTT

A

MEDIAL post orthotic

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6
Q

Op stages PTT

A

St 1 - NO deformity (just pain), failed non-op 6mo - tenosynovectomy
St 2 - flexible, failed non-op - FDL to navic
2a: hindfoot valgus but forefoot fine (<40% uncoverage) - +med calc slide (increase FDL trsf power)
2b: valgus + forefoot abduction - +” “ AND lat col lengthening
2c: stable medial col (cotton, dorsal opening wedge)
unstable med col (1st TMT arthrodesis)
3 - rigid/OA - triple arthrodesis
4 - valgus tilt b/c deltoid insuff
Flexible - deltoid recon
Rigid - ankle fusion

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7
Q

What procedure do you add for most PTT procedures

A

GR - Silfverskiold
If tight only with knee extension, then gastrocnemius is tight = Strayer
If tight also with knee flexion, then soleus is also tight aka Achilles complex = triple cut

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8
Q

Deformity associated with peroneal tendon pathology

A

Cavovarus (stretch the lateral side)
If see this, need calc osteotomy at time of surg or orthotic for non op

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9
Q

Indications for op treatment of peroneal tendon pathology by surgery type

A

<50% - tenosynovectomy, repair longitudinal tears
>50% - tenodesis

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10
Q

What do you do for peroneal tendon pain if the tendons are absent (aka worn away)

A

FHL trf to 5th MT base

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11
Q

What is foot position for peroneal tendon sublux/dislocation

A

Forced eversion + DF
Rupture SPR
Remember to deepen the bony groove if needed during SPR repair vs recon

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12
Q

Dx: heel pain 1st out of bed in AM or rising from chair

A

Plantar fasciitis
= microtears at origin of PF = inflam
TTP at medial aspect tuberosity

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13
Q

Treat plantar fasciitis nonop vs op

A

Stretch, heel inserts
LIMITED cortisone
Op:
- Release medial 1/4 plantar fascia (dont cause flat foot by full release)
+/- Strayer for GR

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14
Q

What is Baxter’s nerve and what is the EMG finding

A

Medial heel pain
Entrapment of the 1st br of the lateral plantar nerve
EMG: abd dig quinti motor latency

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15
Q

Ddx heel pain (3)

A

Plantar fasciitis
Baxter’s nerve
Calc stress frx
Tarsal tunnel

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16
Q

Diagnose +trt calc stress frx

A

Pain w/ heel compression
Pain w/wo WB (aka all the time!)
Frx line on MRI perpendic to trabecular bone
NWB 6-8wks

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17
Q

Presentation tarsal tunnel

A

Plantar foot / medial heel pain (sensory > motor for EMG)
Flat foot can make worse
+Tinnel

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18
Q

Contents of tarsal tunnel

A

TDavnH
PTT, FDL, tib art/v/n, FHL
Tarsal tunnel syndrome entrapment of the tibial nerve

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19
Q

Causes tarsal tunnel

A

Engorged veins
PVNS
Space occupying lesion - ganglion, nerve sheath tumor - why get MRI!

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20
Q

Treat tarsal tunnel

A

SSRI
Medial posting (flat foot)
Op: release better if a mass
Prox 5cm to flexor retinac
Distal to deep fascia abd hall

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21
Q

What tendon trsf might you do during an insertional Achilles repair

A

If need remove >50% of the tendon, consider FHL repair

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22
Q

Treat non-insertional Achilles tendinopathy

A

Eccentric stretching!!
OR:
- Excise diseased tissue
- Tubularize
- >50% involvement FHL trs

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23
Q

Op vs non op Achilles rupture comparison points

A

Equiv PF strength
No diff re rupture
Less comp w/ non op

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24
Q

Options for Achilles rupture repair

A

<6wks (acute) - consider end to end
Chronic <3cm defect - V-Y recon
Chronic >3cm - FHL +/- V-Y (must have functional tibial n)

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25
Biomech heel strike
AT contracts Hindfoot unlocks (valgus)
26
Biomech during flat foot
Achilles eccentric contract Hindfoot stays unlocked
27
Biomech toe off
Achilles concentric contract Hindfoot locks - PF tightens - Windlass causes hindfoot supination
28
Lis Franc lig + mechanism injury
Med cuneiform to base 2nd MT Indirect : axial load on PF foot Direct : crush
29
Imaging LF inj
WB XR Abd stress XR MRI for non displaced inj
30
LF non op vs op
Non op only if lig only and no displacement on WB and stress XR OR: ORIF bony - LF screw (removed) or bridge plating (also removed) Lig only - fusion
31
Deformity of missed LF
Midfoot arthritis Flat foot -> hindfoot valgus
32
Zones for 5th MT base frx
1: avulsion = nonop WBAT 2: at joint = Jones = op for active, NWB others 3: distal to joint = pseudo Jones = fix most Anyone fixing, check hindfoot varus that would overload the site
33
Describe pathophys HV
Prox phal goes lat Medial capsule stretches Lateral capsule scars short EHL only thing that goes medial - pronation Everything else moves lateral (seasmoids, adductor) - Aka abd hal moves plantar
34
Normal HV measurements
IMA < 9 HVA < 15 DMMA < 10
35
Think IMA normal, HVA abnormal
Incongruent joint Distal only - think Chevron, poss lat lig release
36
Think high IMA and HVA
Incongruent joint No OA Proximal MT osteotomy Scarf, Ludloff, etc
37
HV w/ gen lig laxity or 1st MT OA
FUSE! Lapidus
38
If DMMA high, what are you thinking of doing
Biplanar osteotomies Biplanar Chevron
39
Complications HV surgery
AVN Hallux varus - excessive lateral release, removing fib seasmoid If flexible - do a salvage If rigid - fuse
40
3 operative options for HR
If joint space preserved - cheilectomy (up to 30%), +/- Moberg DF osteotomy to change WB joint / improve ROM No joint space - fuse 10DF, 5valgus, neutral rotation Keller resection arthroplasty only in ELDERLY med compromised
41
What is a hammertoe / treat fixed vs flexible
MTP ext PIP flex DIP ext Flexible: FDL to ext transfer Fix: PIP fuse
42
What is a clawtoe / trt fixed vs flexible
MTP fixed ext PIP flex DIP flex Flexible: EDL lengthening, FDL trs Fix: PIP fusion
43
What is a mallet toe / trt
Isolated DIP flex Trt: FDL tenotomy, DIP fusion
44
What is a crossover toe
Plantar plate disrupted LCL stretches (now multiplanar unstable) 2nd toe migrates medial 3ary will get claw toe deformities
45
What is Freiberg infraction?
Trauma -> ischemia -> 2nd MT head AVN Often to a long 2nd MT See central resoprtion -> OA
46
Trt Freiberg infraction
Non-op like OA - carbon fiber Op: move the OA out of articulating w/ DF osteotomy Do NOT excise the MT head
47
3 types of bunionettes
T1: enlarged 5th MT head = hypertrophy T2: shaft bowed = congenital T3: wide angle bet 4/5th MT
48
Trt bunionettes
T1: distal chevron T2: oblique shaft osteotomy T3: unclear Beware proximal osteotomy in the 5th MT shaft bc BS - high nonunion rate
49
What tendons are the seasmoids in? What is the function of the seasmoids?
In FHB tendon Increased pulley/power of FHB
50
What is turf toe
Forced DF Avulse plantar plate Seasmoids migrate proximal
51
Trt turf toe
Strain - toe taping, stiff insole, OK for immediate return to play Partial tear - no sports 2 wks Complete tear - OR for repair if >3mm prox retraction
52
Treat a seasmoid nonunion
Resect Complication of resection: Hallux varus or valgus If you take both out - cock up deformity of the toe (aka need an IP fusion)
53
Treat Morton's neuroma
Cortisone inj can relieve all sx Resect by incising the transverse MT lig 1ary = dorsal approach Revision = plantar approach
54
How does an accessory navic form / best XR to see
From 2ary ossification center XR = external oblique
55
Treat accessory navic
Immobilize first Mod Kidner = excise, advance PTT
56
Traditional fracture pattern for navic stress fracture
Dorsolat to plantar med
57
Trt navic stress frx
Nondisplaced - NWB Any displacement - ORIF screw
58
Embryonic cause of tarsal coalition
Failure of differentiation
59
What are the deformities of cavovarus foot
Cavus = high arch Varus heel Forefoot in equinus + pronation 1st MT PF
60
Associations for unilateral cavovarus - what should you check for
Spina bifida Compartment syndrome Polio
61
Association for bilateral cavovarus
CMT
62
How do you determine if cavovarus is flexible or not
Hindfoot block Place lateral - does the 1sst ray come down and does the hindfoot correct to at least neural If corrects, then the forefoot is driving the hindfoot and can leave alone
63
Trt cavovarus foot
Nonop: lat heel wedge Op: Forefoot driven - 1st MT DF osteotomy Rigid hindfoot - calc osteotomy vs subtalar arthrodesis Also consider - Plantar fascia release - PL to PB trsf to eliminate the deforming force on the 1st ray
64
Indications for ankle instability surgery
Instability despite 3mo of rehab
65
Surg treatment ankle instability
Anatomic repair = mod Brostrom w/ reinforcement from the inf peroneal retinac - Lower risk nerve damage Non-anatomic repair = sacrifice the tendons (think large athletes, revision surg, hypermobility) Make sure check hindfoot varus (+/- calc osteotomy)
66
2 locations for ankle OCD
Post-med : congenital, avascular lesion Ant-lat : post trauma
67
Treat ankle OCD
<1cm - microfrx OATS - better w/o a mal osteotomy at the same time
68
What motor loss is most common in DM
Common peroneal n first Then ant tib, intrinsitics (claw toe)
69
What is the minimum ABI and transcut O2 pressure predictive for healing
ABI min 0.45 (normal 1) Transcut O2 >40 = predictive of healing
70
What test to order for diabetic foot patient if you suspect: Abscess Osteomyelitis
Abscess - MRI Osteo - WBC labeled scan If probe to bone, high likelihood for osteo
71
What tendon transfers do you need if doing a Lis Franc amp
PB to 5th met base Extensors to dorsum of residual foot Achilles lengthening
72
What is a Syme amp
Ankle disartic - take the talus off Requires intact heel pad MOST FUNCTIONAL!
73
What is a Chopart? A good or bad idea?
Take midfoot off - leave the calc/talus
74
What is the ideal length of a BKA? What is an Ertl?
@myotendinous jxn 15cm below knee joint - aka enough soft tissue to cover the stump Ertl - bone bridging for better stability but must lean on bony union (time)
75
Increase in metabolic expenditure for each amp 1. Syme 2. Trauma vs vascular transtib 3. Trauma vs vascular transfem
Generally vascular amps (think diabetics) spend more energy with their amps (unhealthier at baseline) 1. Syme - 15% 2. Trauma transtib - 25% Vasc transtib - 40% 3. Trauma transfem - 70% Vasc transfem - 100%

Millers (29 decks)

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