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Orthopaedics > Foot And Ankle > Flashcards

Foot And Ankle Flashcards

0
Q

What are the histological findings in a Morton’s neuroma?

A

Perineural fibrosis
Endoneural thickening
Degeneration of nerve fibres

No true neuroma

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1
Q

What are the contents of the tarsal tunnel?

A 
Tibialis posterior tendon
FDL
Posterior Tibial artery & vein
Tibial nerve
FHL
Flexor retinaculum (laciniate ligament) proximally
Fascia of Abductor Hallucia distally
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2
Q

What are the terminal branches of the posterior tibial nerve?

A

Medial plantar
Lateral plantar
Medial calcaneal

Branch in tarsal tunnel
Distal TTS is compression of 1st branch of lateral plantar nerve

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3
Q

What are the causes of tarsal tunnel syndrome?

A

Trauma - soft tissue and osteous
SOL - ganglion, lipoma, neurilemmoma, varicose vein, anomalous muscle - per quart
Biomechanical malalignment of ankle /foot
Tenosynovitis Tib Post, FHL, FDL

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4
Q

Who affected more frequently with CMT - male or female?

A

Male more common

Female more severe

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5
Q

What re the major characteristics of Charcot Marie Tooth?

A

Foot deformities - Cavovarus foot
DDH
Hand weakness - intrinsics
Scoliosis

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6
Q

4 causes of a Cavovarus foot

A

Residual clubfoot
Idiopathic
Neurolomuscular - CMT,
Traumatic - compartment syndrome, TA rupture

Unilateral - Neuro, trauma, reisdual

Bilateral - CMT

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7
Q

Neural pathology & genetics of CMT

A

Motor Nerve root degeneration

CMT1 - Myelin sheath
CMT 2 - Axonal

CMT1A - 70% have PMP22 gene duplication Chromosome 17 (peripheral myelin protein 22)

X-linked - Schwann cells. Connnexin 32 gene mutation
Makes moderately affected. Females no symptoms.

Recessive - early onset and more rapidly progressive

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8
Q

Inheritance pattern of CMT

A

1 AD 50%
2 AD 20-40%
X-linked 10-20%
3&4 AR rare

CMT 3 Dejuerine-Sottas disease

Add spasticity versus falcid in type 1 /2

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9
Q

Radiographic angles for the Cavovarus deformity of CMT

A

LATERAL
Meary’s angle - long axis talus and 1st MT - 0-10•
Hibb’s angle - long axis Calc and 1st MT -

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10
Q

Differential diagnosis for SPN compression neuropathy

A 
Lateral ankle sprain - not healing
Chronic compartment syndrome
Fascial defects
Muscle herniations
Proximal nerve entrapments - similar to L5
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11
Q

Name the AVN conditions of the foot?

A

Kohler’s - Navicular in kids 2-9. Muller-Weiss in adults
Freiburgs - 2nd MT. Smilie classification 1-5. MRI to just dorsal collapse to OA
OT - cheilectomy, dorsal wedge closing, Duvries Arthroplasty

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12
Q

Incidence of Charcot in diabetics?

Time to conte lateral foot involvement?

A
  1. 1-1.5% of all diabetics
  2. 5% in those with a peripheral neuropathy

10-35% have bilateral disease

Average time to second foot is 2 years - usually staged not simultaneous

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13
Q

What is the duration of onset of Charcot in diabetics by type?

A

Type 1 - present younger (5th decade) but later ie 20-25 years after diagnosis

Type 2 - present older (6th decade) but earlier ie 5-10 years after diagnosis

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14
Q

What are the 6 X-ray findings in Charcot?

A 
Disorganisation
Destruction 
Debris
Disuse osteopaenia
Dislocation
Distension of soft tissues

The 6 Ds

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15
Q

7 pathoanatomic components of hallux valgus

A 
Lateral deviation Great toe
Medial deviation MT
Bunion
Pronation great toe
Hallux valgus interphalangeus 
Lesser toe deformities 
Metatarsalgia
16
Q

What are the DDs for heel pain?

17 in JAAOS book

A 
Plantar fasciitis
Plantar fascia rupture
Fat pad atrophy
Fat pad contusion
Calcaneal stress fracture
Baxter's nerve entrapment - 1st branch LPN, between ABd Hallucis and QP
Severs disease
Tumour - OO, chondroblastoma
Tarsal tunnel syndrome
Gout
Inflamm arthropathies
Spondyloarthropathies
Infection
Pagets
Neuropathy
Radiculopathy
Foreign body reactions
17
Q

OCD lesions - where, trauma?

A

Medial are posterior, larger and deeper

Lateral are anterior, more related to trauma and resistant to non-op management

18
Q

Stage Tib post dysfuntion

A

1 - No deformity - Tenosynovectomy
2a - Mild / mod flexible with minimal abduction - 30% - Lat column length or hindfott fusion
3 - Fixed - Hindfoot fusion
4 - Foot and ankle deformity - Complete correction of foot, possible deltoid recon. Severe arthritis - ankle fusion or arthroplasty
4a - Ankle deformity and Flexible foot - Correct foot as per 2b
4b - Ankle deformity and a fixed foot - Correct foot as per stage 3

Orthopaedics (19 decks)

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