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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
Q

Biomech heel strike

A

AT contracts
Hindfoot unlocks (valgus)

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26
Q

Biomech during flat foot

A

Achilles eccentric contract
Hindfoot stays unlocked

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27
Q

Biomech toe off

A

Achilles concentric contract
Hindfoot locks
- PF tightens
- Windlass causes hindfoot supination

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28
Q

Lis Franc lig + mechanism injury

A

Med cuneiform to base 2nd MT
Indirect : axial load on PF foot
Direct : crush

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29
Q

Imaging LF inj

A

WB XR
Abd stress XR
MRI for non displaced inj

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30
Q

LF non op vs op

A

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

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31
Q

Deformity of missed LF

A

Midfoot arthritis
Flat foot -> hindfoot valgus

32
Q

Zones for 5th MT base frx

A

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
Q

Describe pathophys HV

A

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
Q

Normal HV measurements

A

IMA < 9
HVA < 15
DMMA < 10

35
Q

Think IMA normal, HVA abnormal

A

Incongruent joint
Distal only - think Chevron, poss lat lig release

36
Q

Think high IMA and HVA

A

Incongruent joint
No OA
Proximal MT osteotomy
Scarf, Ludloff, etc

37
Q

HV w/ gen lig laxity or 1st MT OA

A

FUSE!
Lapidus

38
Q

If DMMA high, what are you thinking of doing

A

Biplanar osteotomies
Biplanar Chevron

39
Q

Complications HV surgery

A

AVN
Hallux varus - excessive lateral release, removing fib seasmoid
If flexible - do a salvage
If rigid - fuse

40
Q

3 operative options for HR

A

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
Q

What is a hammertoe / treat fixed vs flexible

A

MTP ext
PIP flex
DIP ext
Flexible: FDL to ext transfer
Fix: PIP fuse

42
Q

What is a clawtoe / trt fixed vs flexible

A

MTP fixed ext
PIP flex
DIP flex
Flexible: EDL lengthening, FDL trs
Fix: PIP fusion

43
Q

What is a mallet toe / trt

A

Isolated DIP flex
Trt: FDL tenotomy, DIP fusion

44
Q

What is a crossover toe

A

Plantar plate disrupted
LCL stretches (now multiplanar unstable)
2nd toe migrates medial
3ary will get claw toe deformities

45
Q

What is Freiberg infraction?

A

Trauma -> ischemia -> 2nd MT head AVN
Often to a long 2nd MT
See central resoprtion -> OA

46
Q

Trt Freiberg infraction

A

Non-op like OA - carbon fiber
Op: move the OA out of articulating w/ DF osteotomy
Do NOT excise the MT head

47
Q

3 types of bunionettes

A

T1: enlarged 5th MT head = hypertrophy
T2: shaft bowed = congenital
T3: wide angle bet 4/5th MT

48
Q

Trt bunionettes

A

T1: distal chevron
T2: oblique shaft osteotomy
T3: unclear
Beware proximal osteotomy in the 5th MT shaft bc BS - high nonunion rate

49
Q

What tendons are the seasmoids in? What is the function of the seasmoids?

A

In FHB tendon
Increased pulley/power of FHB

50
Q

What is turf toe

A

Forced DF
Avulse plantar plate
Seasmoids migrate proximal

51
Q

Trt turf toe

A

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
Q

Treat a seasmoid nonunion

A

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
Q

Treat Morton’s neuroma

A

Cortisone inj can relieve all sx
Resect by incising the transverse MT lig
1ary = dorsal approach
Revision = plantar approach

54
Q

How does an accessory navic form / best XR to see

A

From 2ary ossification center
XR = external oblique

55
Q

Treat accessory navic

A

Immobilize first
Mod Kidner = excise, advance PTT

56
Q

Traditional fracture pattern for navic stress fracture

A

Dorsolat to plantar med

57
Q

Trt navic stress frx

A

Nondisplaced - NWB
Any displacement - ORIF screw

58
Q

Embryonic cause of tarsal coalition

A

Failure of differentiation

59
Q

What are the deformities of cavovarus foot

A

Cavus = high arch
Varus heel
Forefoot in equinus + pronation
1st MT PF

60
Q

Associations for unilateral cavovarus - what should you check for

A

Spina bifida
Compartment syndrome
Polio

61
Q

Association for bilateral cavovarus

A

CMT

62
Q

How do you determine if cavovarus is flexible or not

A

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
Q

Trt cavovarus foot

A

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
Q

Indications for ankle instability surgery

A

Instability despite 3mo of rehab

65
Q

Surg treatment ankle instability

A

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
Q

2 locations for ankle OCD

A

Post-med : congenital, avascular lesion
Ant-lat : post trauma

67
Q

Treat ankle OCD

A

<1cm - microfrx
OATS - better w/o a mal osteotomy at the same time

68
Q

What motor loss is most common in DM

A

Common peroneal n first
Then ant tib, intrinsitics (claw toe)

69
Q

What is the minimum ABI and transcut O2 pressure predictive for healing

A

ABI min 0.45 (normal 1)
Transcut O2 >40 = predictive of healing

70
Q

What test to order for diabetic foot patient if you suspect:
Abscess
Osteomyelitis

A

Abscess - MRI
Osteo - WBC labeled scan
If probe to bone, high likelihood for osteo

71
Q

What tendon transfers do you need if doing a Lis Franc amp

A

PB to 5th met base
Extensors to dorsum of residual foot
Achilles lengthening

72
Q

What is a Syme amp

A

Ankle disartic - take the talus off
Requires intact heel pad
MOST FUNCTIONAL!

73
Q

What is a Chopart? A good or bad idea?

A

Take midfoot off - leave the calc/talus

74
Q

What is the ideal length of a BKA? What is an Ertl?

A

@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
Q

Increase in metabolic expenditure for each amp
1. Syme
2. Trauma vs vascular transtib
3. Trauma vs vascular transfem

A

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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