Foot and Ankle List Flashcards
Phases of the gait cycle
- Initial contact (heel strike)
- Limb-loading response
- Midstance
- Terminal stance (toe-off)
- Preswing
- Initial swing
- Midswing
- Terminal swing
Pathologic changes of the foot in rheumatoid arthritis (9)
- Hallux valgus
- Hallux valgus interphalangeus
- Dorsal subluxation of MTP joints
- Varus 5th toe
- Distal migration plantar fat pad
- Extensor subluxation with lesser toe clawing
- 1st metatarsal elevation
- Forefoot supination
- Midfoot abduction
- Valgus hindfoot
Rheumatoid foot non-operative management (6)
- Medical management of RA
- NSAIDs
- Injections
- PT for heel cord stretching/modalities/balancing training/strengthening
- Bracing (UCBL midfoot/hindfoot, Arizona brace ankle)
- Casting for unresponsive synovitis
Classification of achilles tendon disorders (5)
- Acute paratenonitis
- Paratenonitis and tendinosis
- Tendinosis
- Retrocalcaneal bursitis
- Insertional tendinosis
Risk factors for achilles tendinopathy (11)
- Previous achilles tendon injury
- Runners
- Diabetes mellitus
- Obesity
- Hypothyroidism
- Renal insufficiency
- Gout
- Fluoroquinolone antibiotics
- Steroid exposure
- Hormone replacement therapy
- Oral contraceptives
Nonoperative treatment of achilles tendinosis (6)
- Rest/immobilization
- Ice
- NSAIDs
- Physiotherapy (stretching/eccentric strengthening)
- Heel lift
- Iontophoresis
Poor prognostic factors for nonoperative treatment of achilles tendinopathy (3)
- Older patient
- Longer duration
- More severe degenerative changes
Options for surgical treatment of chronic achilles tendon rupture (4)
- V-Y advancement
- Gastrocnemius turndown
- Allograft reconstruction
- FHL transfer
Advantages of FHL transfer for chronic achilles tendon disorders (6)
- Line of pull similar to that of the achilles tendon
- Long tendon
- Strong repair
- In-phase firing
- Close to the achilles tendon for transfer
- Use does not compromise muscle balance of the foot
Classification of peroneal tendon tears (4)
- Type I: both tendons grossly intact
- Type II: one tendon torn, the other “usable”
- Type IIIa: both tendons torn/“unusable” with stiff/fibrotic muscle bellies
- Type IIIb: both tendons torn/ “unusable” with proximal muscle excursion
Factors associated with pathology of the peroneal tendons
- Subluxation/dislocation of the tendons
- Acute change in direction around the fibula
- Diminished blood supply
- Ankle instability
- Compression of peroneus brevis between PL and the posterior fibula
- Low-lying peroneus brevis muscle belly
- Peroneus quartius
Surgical treatment options for peroneal tendon disorders (7)
- core repair and tubularization of the tendon
- Debridement and tenodesis of the brevis tendon to the peroneus longus
- acute repair of superior peroneal retinaculum and Fibular groove deepening (if dislocating)
- Lateral closing wedge calcaneal osteotomy (if hindfoot varus)
- Autograft reconstruction
- Allograft reconstruction
Classification of peroneal tendon dislocation (5)
Acute (Odgen-Eckert-Davis)
- Fibular periosteal elevation with anterior displacement
- Tearing of superior peroneal retinaculum with anterior displacement
- Posterolateral fibular avulsion fracture with anterior displacement
- Calcaneal avulsion fracture with anterior displacement over the peroneal retinaculum
Chronic
Surgical treatment options for chronic peroneal tendon dislocation
- Direct repair of retinaculum
- Superior peroneal retinaculum reconstruction
- Bone block procedures
- Groove deepening procedures
- Tendon rerouting under the calcaneofibular ligament
Variants of os peroneum syndrome (5)
- Acute os peroneum fracture
- Chronic os peroneum fracture
- Attrition/partial rupture of peroneus longus tendon
- Frank peroneus longus rupture
- Hypertrophied peroneal tubercle that entraps the tendon or os peroneum
Surgical options for chronic tibialis anterior tendon rupture (3)
- Primary repair
- Allograft reconstruction (healthy muscle)
- Tendon transfer (EHL)
Differential diagnosis of ankle pain (8)
- Osteochondritis dessicans of the talus
- Peroneal tendonitis
- Occult fracture
- Peroneal tendon subluxation/dislocation
- Ankle instability
- Tarsal tunnel syndrome
- Tarsal coalition
- Bone/soft tissue impingement
Causes of ankle arthritis (9)
- Post-traumatic (#1)
- Instability
- Post-infections
- Inflammatory
- Crystalline
- Neuropathic
- Haemophilic
- Idiopathic/primary degenerative
- Osteonecrosis
Non-operative treatment options for ankle arthritis (8)
- activity modification
- weight loss
- gait aids
- shoe modifications (rocker bottom sole)
- Lace-up gauntlet ankle brace (Arizona)
- AFO
- NSAIDs
- Corticosteroid injections
Surgical treatment options for ankle arthritis (7)
- Debridement (open vs. arthroscopic)
- Osteotomy
- Distraction arthroplasty
- Allograft “resurfacing”
- Arthroplasty
- Arthrodesis (#1 – gold standard)