Foot and Ankle Classifications Flashcards

1
Q

Diabetic foot ulcers

A

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

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2
Q

PTTI

A
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
q	
• 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
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3
Q

Charcot Foot - Eichenholtz Classification

A

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

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4
Q

Low Ankle Sprain

A

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
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5
Q

Hallux Valgus?

A

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
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6
Q

Hallux Rigidus

A

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

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7
Q

Ogden Classification of Superficial Peroneal Retinaculum Tears

A

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

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8
Q

5th MT #

A
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

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9
Q

Ankle OA

A

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

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10
Q

OCD Talus

A

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.

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11
Q

Lesser Toe Deformities

A

Claw Toe
Hammer Toe
Mallet Toe

DIP
flexion
extension
flexion

PIP
flexion
flexion
normal

MTP
hyperextension
normal (slight extension)
normal

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12
Q

Navicular Fractures

A

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.

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