Foot and Ankle Classifications Flashcards
Diabetic foot ulcers
Brodsky Depth-Ischemia Classification and Treatment
Depth
Classification
Definition Treatment
0 At risk foot, no ulceration Patient education, accommodative footwear, regular clinical examination
1 Superficial ulceration, not infected Off-loading with total contact cast, walking brace or special footwear
2 Deep ulceration, exposing tendons or joints Surgical debridement, wound care, off-loading, culture-specific antibiotics
3 Extensive ulceration or abscess Debridement or partial amputation, off-loading, culture-specific antibiotics
Ischemia
A Not ischemic
B Ischemia without gangrene Non-invasive vascular testing and vascular reconstruction with angioplasty/bypass
C Partial forefoot gangrene Vascular reconstruction and partial foot amputation
D Complete gangrene Complete vascular evaluation and major extremity amputation
PTTI
Stage I • Tenosynovitis • No deformity • (+) single-leg toe raise • Normal Stage IIA • Flatfoot deformity • Flexible hindfoot • Normal forefoot
- (-) single-leg heel raise
- Mild sinus tarsi pain
• Arch collapse deformity
Stage IIB • Flatfoot deformity
• Flexible hindfoot
• Forefoot abduction ("too many toes", >40% talonavicular uncoverage)
Stage III
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• Flatfoot deformity
• Rigid forefoot abduction
• Rigid hindfoot valgus
• (-) single-leg heel raise • Severe sinus tarsi pain • Arch collapse deformity • Subtalar arthritis Stage IV • Flatfoot deformity • Rigid forefoot abduction • Rigid hindfoot valgus • Deltoid ligament compromise • (-) single-leg heel raise • Severe sinus tarsi pain • Ankle pain • Arch collapse deformity • Subtalar arthritis • Talar tilt in ankle mortise
Charcot Foot - Eichenholtz Classification
Stage 0
• Joint edema
• Radiographs are negative
• Bone scan may be positive in all stages
Stage 1 fragmentation • Joint edema
• Radiographs show osseous fragmentation with joint dislocation
Stage 2 coalescence • Decreased local edema
• Radiographs show coalescence of fragments and absorption of fine bone debris
Stage 3 reconstruction • No local edema
• Radiographs show consolidation and remodeling of fracture fragments
Low Ankle Sprain
Classification of Low Ankle Sprains
Ligament disruption Ecchymosis and swelling Pain with weight bearing Grade I none minimal normal Grade II stretch without tear moderate mild Grade III complete tear severe severe
Hallux Valgus?
Surgical Indications for Various Techniques to treat Hallux Valgus
HVA
IMA
Modifier
Procedure
Mild
< 25°
15° usually with mod McBride
Moderate 26-40° 13-15° Proximal osteotomy +/- distal osteotomy Chevron/mod McBride + Akin osteotomy Proximal MT osteotomy and mod McBride Severe 41-50° 16-20° Double osteotomy DMAA > 15° - Proximal MT osteotomy plus biplanar chevron, mod McBride
Lapidus procedure plus Akin Elderly/very low demand patient Keller Juvenile/Adolescent with DMAA > 20 Double osteotomy of first ray
Hallux Rigidus
Coughlin and Shurnas Classification
Exam Findings Radiographic Findings
Grade 0 Stiffness
Normal
Grade 1 mild pain at extremes of motion
mild dorsal osteophyte, normal joint space
Grade 2 moderate pain with range of motion increasingly more constant moderate dorsal osteophyte, 50% joint space narrowing
Grade 4 significant stiffness, pain at extreme ROM, pain at mid-range of motion same as grade III
Ogden Classification of Superficial Peroneal Retinaculum Tears
Grade 1 The SPR is partially elevated off of the fibula allowing for subluxation of both tendons
Grade 2 The SPR is separated from the cartilofibrous ridge of the lateral malleolus, allowing the tendons to sublux between the SPR and the cartilofibrous ridge
Grade 3 There is a cortical avulsion of the SPR off of the fibula, allowing the subluxed tendons to move underneath the cortical fragment
Grade 4 The SPR is torn from the calcaneous, not the fibula
5th MT #
Classification Class Description Images Zone 1 (pseudo Jones fx)
Proximal tubercle (rarely enters 5th tarsometatarsal joint) Due to long plantar ligament, lateral band of the plantar fascia, or contraction of the peroneus brevis Nonunions uncommon
Zone 2
(Jones fx)
Metaphyseal-diaphyseal junction Involvies the 4th-5th metatarsal articulation Vascular watershed area Acute injury Increased risk of nonunion
Zone 3
Proximal diaphyseal fracture
Distal to the 4th-5th metatarsal articulation
Stress fracture in athletes
Associated with cavovarus foot deformities or sensory neuropathies
Increased risk of nonunion
Ankle OA
Takakura Classification
Stage I Early sclerosis and osteophyte formation, no joint space narrowing
Stage II Narrowing of medial joint space (no subchondral bone contact)
Stage IIIA Obliteration of joint space at the medial malleolus, with subchondral bone contact
Stage IIIB Obliteration of joint space over roof of talar dome, with subchondral bone contact
Stage IV Obliteration of joint space with complete bone contact
OCD Talus
Berndt and Harty Radiographic Classification
Stage 1 • Small area of subchondral compression
Stage 2 • Partial fragment detachment.
Stage 3 • Complete fragment detachment but not displaced.
Stage 4 • Displaced fragment.
Lesser Toe Deformities
Claw Toe
Hammer Toe
Mallet Toe
DIP
flexion
extension
flexion
PIP
flexion
flexion
normal
MTP
hyperextension
normal (slight extension)
normal
Navicular Fractures
Sangeorzan Classification of Navicular Body Fractures
(based on plane of fracture and degree of comminution)
Type I Transverse fracture of dorsal fragment that involves < 50% of bone.
No associated deformity
Type II Oblique fracture, usually from dorsal-lateral to plantar-medial.
May have forefoot aDDuction deformity.
Type IIII Central or lateral comminution.
ABDuction deformity.
