Foot and Ankle Flashcards
The spring ligament origin and insertion?
Medial aspect of the foot originating from the sustentaculum tail and inserts on the navicular
Is the plantar or dorsal lisfranc ligament the primary stabilizer?
Plantar
Blood supply to the talus?
Artery of tarsal canal
Pathophysiology of acquired hallux valgus
-Proximal phalanx drifts lateral
-medial MTP joint capsule attenuates
-abductor hallucis migrates plantar to metatarsal head which acted as medial restraint
-EHL migrates laterally and acts as deforming force
-hallux pronates
- Sesamoids migrate laterally and erode crusts to allow further progression
Normal hallux valgus angle
<15 deg
Normal intermetatarsal angle
<9 deg
Normal Hallux valgus inter phalange is angle
<10 deg
Normal distal metatarsal articular angle (DMAA)?
<10 deg
Measures joint congruency
Bunion correction for low IMA and HVA? Joint is incongruent
Distal metatarsal osteotomy
(Can make osteotomy biplanar to correct incongruity)
Bunion correction for high IMA and high HVA? Joint is incongruent
Proximal (more powerful) metatarsal osteotomy to correct IMA and HVA
Distal metatarsal osteotomy to correct joint incongruity
Indications for lapidus (1st metatarsal cuneiform arthrodesis)?
Generalizes ligamentous laxity
Degenerative 1st metatarsal cuneiform arthritis
Treatment of arthritic 1st MTP Bunnion?
MTP fusion
Footwear insert for hallux rigidis
Carbon fiber foot plate with Morton’s extension to eliminate 1St MTP motion
Sideline criteria for return to play for turf toe?
Can return to play if can dorsi flex toe 60 deg without pain.
Use stiff insole to help with sx
Indications for turf toe surgery?
Complete tear of hallux MTP plantar plate with >3 mm proximal retraction of sesamoids
On imaging the sesamoids contract and do not dynamically move with the FHB during MTP motion.
Reason for this deformity ?
Cock up deformity
Unrecognized and unrepaires grade 3 turf toe injury (complete tear of plantar plate)
Most common location of Morton’s neuroma?
3rd interspace
Note injx don’t work, need to excise nerve proximal to metatarsal heads
Orthotics for midfoot arthritis
Plastazote orthotic (soft)
Do this in combination with stiff shoe
Treatment of pure ligamentous injury of lis franc injury?
PrimRy arthrodesis of 2nd MTC
Vague dorsal foot pain in an athlete
Diagnosis?
Imaging test?
Navicular stress fracture
CT is needed to assess if fracture displacement and assess the plane of the fracture
If any displacement do surgery, if not conservative treatment NWB x6-8 weeks, then repeat CT prior to reinitiating return to play
Injury to this structure is responsible for flat foot deformity?
Spring ligament
Conservative treatment of flat foot deformity….
Flat foot: medial wedge/post insole to correct flexible hindfoot valgus to varus
Subfibular impingement: UCBL orthosis to better correct heel valgus
Arthritic hindfoot: custom molded lace up Arizona brace
AFO: when ankle becomes involved and there is incompetency of deltoid ligament
Flat foot deformity operative treatments
FLEXIBLE DEFORMITY
Tenosynovectomy of post tib: only if no structural problems with tendon.
FDL transfer to navicular: once structural issues to the post tib are seen and there’s still flexibility of the deformity
Medial slide calcaneal osteotomy recruits achilles to use as inverter (<40% talonavicular uncoverage) to help create mechanical advantage and maintain heel varus position
Evans procedure/lateral column lengthening (>40% talonavicular uncoverage)
Medial column dorsal opening osteotomy to create plantarflexed position of medial column to correct supination deformity
RIGID DEFORMITY
triple arthrodesis + medial column procedure if needed
RIGID DEFORMITY + DELTOID INCOMPETENCE
TTC fusion
***Likely add gastroc recession
Cavovarus foot orthotic?
Lateral heel and sole wedge (like correction with Coleman block test)
