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Orthobullets/ FRCSC Canadian Board > Foot and Ankle List > Flashcards

Foot and Ankle List Flashcards

1
Q

Phases of the gait cycle

A
  1. Initial contact (heel strike)
  2. Limb-loading response
  3. Midstance
  4. Terminal stance (toe-off)
  5. Preswing
  6. Initial swing
  7. Midswing
  8. Terminal swing
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2
Q

Pathologic changes of the foot in rheumatoid arthritis (9)

A
  1. Hallux valgus
  2. Hallux valgus interphalangeus
  3. Dorsal subluxation of MTP joints
  4. Varus 5th toe
  5. Distal migration plantar fat pad
  6. Extensor subluxation with lesser toe clawing
  7. 1st metatarsal elevation
  8. Forefoot supination
  9. Midfoot abduction
  10. Valgus hindfoot
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3
Q

Rheumatoid foot non-operative management (6)

A
  1. Medical management of RA
  2. NSAIDs
  3. Injections
  4. PT for heel cord stretching/modalities/balancing training/strengthening
  5. Bracing (UCBL midfoot/hindfoot, Arizona brace ankle)
  6. Casting for unresponsive synovitis
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4
Q

Classification of achilles tendon disorders (5)

A
  1. Acute paratenonitis
  2. Paratenonitis and tendinosis
  3. Tendinosis
  4. Retrocalcaneal bursitis
  5. Insertional tendinosis
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5
Q

Risk factors for achilles tendinopathy (11)

A
  1. Previous achilles tendon injury
  2. Runners
  3. Diabetes mellitus
  4. Obesity
  5. Hypothyroidism
  6. Renal insufficiency
  7. Gout
  8. Fluoroquinolone antibiotics
  9. Steroid exposure
  10. Hormone replacement therapy
  11. Oral contraceptives
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6
Q

Nonoperative treatment of achilles tendinosis (6)

A
  1. Rest/immobilization
  2. Ice
  3. NSAIDs
  4. Physiotherapy (stretching/eccentric strengthening)
  5. Heel lift
  6. Iontophoresis
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7
Q

Poor prognostic factors for nonoperative treatment of achilles tendinopathy (3)

A
  1. Older patient
  2. Longer duration
  3. More severe degenerative changes
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8
Q

Options for surgical treatment of chronic achilles tendon rupture (4)

A
  1. V-Y advancement
  2. Gastrocnemius turndown
  3. Allograft reconstruction
  4. FHL transfer
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9
Q

Advantages of FHL transfer for chronic achilles tendon disorders (6)

A
  1. Line of pull similar to that of the achilles tendon
  2. Long tendon
  3. Strong repair
  4. In-phase firing
  5. Close to the achilles tendon for transfer
  6. Use does not compromise muscle balance of the foot
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10
Q

Classification of peroneal tendon tears (4)

A
  1. Type I: both tendons grossly intact
  2. Type II: one tendon torn, the other “usable”
  3. Type IIIa: both tendons torn/“unusable” with stiff/fibrotic muscle bellies
  4. Type IIIb: both tendons torn/ “unusable” with proximal muscle excursion
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11
Q

Factors associated with pathology of the peroneal tendons

A
  1. Subluxation/dislocation of the tendons
  2. Acute change in direction around the fibula
  3. Diminished blood supply
  4. Ankle instability
  5. Compression of peroneus brevis between PL and the posterior fibula
  6. Low-lying peroneus brevis muscle belly
  7. Peroneus quartius
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12
Q

Surgical treatment options for peroneal tendon disorders (7)

A
  1. core repair and tubularization of the tendon
  2. Debridement and tenodesis of the brevis tendon to the peroneus longus
  3. acute repair of superior peroneal retinaculum and Fibular groove deepening (if dislocating)
  4. Lateral closing wedge calcaneal osteotomy (if hindfoot varus)
  5. Autograft reconstruction
  6. Allograft reconstruction
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13
Q

Classification of peroneal tendon dislocation (5)

A

Acute (Odgen-Eckert-Davis)

  1. Fibular periosteal elevation with anterior displacement
  2. Tearing of superior peroneal retinaculum with anterior displacement
  3. Posterolateral fibular avulsion fracture with anterior displacement
  4. Calcaneal avulsion fracture with anterior displacement over the peroneal retinaculum

Chronic

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14
Q

Surgical treatment options for chronic peroneal tendon dislocation

A
  1. Direct repair of retinaculum
  2. Superior peroneal retinaculum reconstruction
  3. Bone block procedures
  4. Groove deepening procedures
  5. Tendon rerouting under the calcaneofibular ligament
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15
Q

Variants of os peroneum syndrome (5)

A
  1. Acute os peroneum fracture
  2. Chronic os peroneum fracture
  3. Attrition/partial rupture of peroneus longus tendon
  4. Frank peroneus longus rupture
  5. Hypertrophied peroneal tubercle that entraps the tendon or os peroneum
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16
Q

Surgical options for chronic tibialis anterior tendon rupture (3)

A
  1. Primary repair
  2. Allograft reconstruction (healthy muscle)
  3. Tendon transfer (EHL)
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17
Q

Differential diagnosis of ankle pain (8)

A
  1. Osteochondritis dessicans of the talus
  2. Peroneal tendonitis
  3. Occult fracture
  4. Peroneal tendon subluxation/dislocation
  5. Ankle instability
  6. Tarsal tunnel syndrome
  7. Tarsal coalition
  8. Bone/soft tissue impingement
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18
Q

Causes of ankle arthritis (9)

A
  1. Post-traumatic (#1)
  2. Instability
  3. Post-infections
  4. Inflammatory
  5. Crystalline
  6. Neuropathic
  7. Haemophilic
  8. Idiopathic/primary degenerative
  9. Osteonecrosis
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19
Q

Non-operative treatment options for ankle arthritis (8)

A
  1. activity modification
  2. weight loss
  3. gait aids
  4. shoe modifications (rocker bottom sole)
  5. Lace-up gauntlet ankle brace (Arizona)
  6. AFO
  7. NSAIDs
  8. Corticosteroid injections
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20
Q

Surgical treatment options for ankle arthritis (7)

A
  1. Debridement (open vs. arthroscopic)
  2. Osteotomy
  3. Distraction arthroplasty
  4. Allograft “resurfacing”
  5. Arthroplasty
  6. Arthrodesis (#1 – gold standard)
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21
Q

Indications for ankle arthroscopy (10)

A
  1. Hypertrophic synovium/synovitis
  2. Osteochondral lesions of the talus
  3. Loose bodies
  4. Osteophytes with well-preserved joint space
  5. Bone Impingement
  6. Arthrofibrosis
  7. Ankle Fractures
  8. Arthrodesis
  9. Ankle Stabilization Procedures
  10. I&D for Septic Arthritis
22
Q

Contraindications to ankle arthroscopy (4)

A
  1. Poor vascular status
  2. Minimal remaining joint space
  3. CRPS
  4. Soft tissue infection
23
Q

Contraindications to ankle allograft “resurfacing” (5)

A
  1. Age > 55 years
  2. Obesity
  3. Active infection
  4. Severe bone loss
  5. Angular deformity
24
Q

Principles of ankle arthrodesis (4)

A
  1. Large bed of cancellous bone for healing
  2. Stable internal fixation
  3. Interfragmentary compression
  4. Bone grafting of defects
25
Q

Position of ankle fusion (4)

A
  1. Neutral dorsiflexion
  2. 5° valgus
  3. 10° external rotation (symmetric to other side)
  4. Slightly posteriorize talus
26
Q

Complications of ankle arthrodesis (8)

A
  1. Neurovascular injury
  2. Infection
  3. Wound healing complications
  4. Non-union (< 10%)
  5. Malunion
  6. Tibial stress fracture
  7. Medial malleolus fracture
  8. Adjacent joint degeneration

(Early → late)

27
Q

Risk factors for nonunion of ankle arthrodesis (10)

A
  1. Smoking
  2. Non-compliance with weight bearing status
  3. Impaired vascularity
  4. Diabetes
  5. Neuropathic joint
  6. Previous open fracture
  7. Severe ankle fracture
  8. Previous plafond/talus fracture
  9. AVN of the talus
  10. Prior/current infection

(Patient, local)

28
Q

Contraindications to ankle arthroplasty (10)

A
  1. Age < 60
  2. High activity level
  3. Osteoporosis
  4. Obesity
  5. Poor soft tissue envelope
  6. Past or present infection
  7. Severe deformity (varus/valgus > 15°)
  8. Neuropathic joint/peripheral neuropathy
  9. Talar AVN
  10. Medial malleolus absence/deltoid incompetence – have to position in a bit of valgus – won’t be stable

(Patient, disease)

29
Q

Complications of ankle arthroplasty (7)

A
  1. Wound complications
  2. Infection
  3. Aseptic loosening
  4. Subsidence
  5. Osteolysis
  6. Bearing dislocation
  7. Medial malleolus fracture
30
Q

Grading of anterior ankle impingement (4)

A

Grade I: synovial impingement, tibial spur ≤ 3 mm

Grade II: tibial spur > 3 mm

Grade III: significant tibial exostosis ± fragmentation and talar spur

Grade Iv: pantalocrural arthritis

31
Q

Injuries associated with ankle sprains (3)

A
  1. Osteochondral lesions (15-25%)
  2. Peroneal tendon pathology (25%)
  3. Intraarticular loose bodies (20%)
32
Q

Grading of acute lateral ankle instability (3)

A

Grade I: no ligamentous disruption, minimal swelling/ecchymosis/tenderness, no pain on WB

Grade II: ligament stretch, moderate swelling/ecchymosis/tenderness, mild pain with WB

Grade II: complete rupture, severe swelling/ecchymosis/tenderness, severe pain on WB

33
Q

Components of functional treatment of ankle sprains (7)

A
  1. Rest
  2. Ice
  3. Compression/bracing
  4. Elevation
  5. NSAIDs/analgesics
  6. WBAT
  7. Early rehabilitation:
  • Modalities
  • ROM
  • Strengthening
  • Gait training
  • Proprioception
34
Q

Possible indications for acute repair of ruptured lateral ankle ligaments (3)

A
  1. Acute rupture in a patient with recurrent injuries
  2. Associated ankle pathology requiring surgical intervention
  3. Complete rupture in a high performance athlete
35
Q

Indications for nonanatomic graft reconstruction of ankle ligaments (7)

A
  1. Insufficient tissue to perform anatomic repair
  2. Failure of prior anatomic repair
  3. Generalized ligamentous laxity
  4. Obesity
  5. Neuromuscular disease
  6. Connective tissue disorder
36
Q

Advantages of anatomic lateral ankle ligament reconstruction (modified Brostrom procedure) (5)

A
  1. No donor site morbidity
  2. Lower risk of wound problems/nerve injury
  3. No risk of disease transmission
  4. Decreased operative time
  5. Decreased risk of iatrogenic subtalar stiffness
37
Q

Complications of ankle sprains (4)

A
  1. Chronic instability (40%)
  2. Anteroinferior tibiofibular ligament thickening/impingement
  3. Post-traumatic arthritis
  4. Chronic swelling
38
Q

Classification of syndesmosis injury (4)

A

Type I: straight lateral talar subluxation

Type II: type I with plastic deformation of the fibula

Type III: posterior rotary displacement of the fibula and talus

Type IV: complete diastasis with proximal migration of the talus

39
Q

MRI findings of sinus tarsi syndrome (6)

A
  1. Non-specific inflammation
  2. Sinus tarsi fat alteration
  3. Chronic synovitis/synovial thickening
  4. Interosseous talocalcaneal ligament tears
  5. Cervical ligament tears
  6. Ganglion cysts
40
Q

Classification of osteochondral lesions of the talus (Berndt & Harty) (4)

A

Stage I: small region of subchondral compression

Stage II: partial fragment detachment

Stage III: complete fragment detachment without displacement

Stage IV: complete fragment detachment with displacement (loose body)

41
Q

Radiographic criteria for chronic subtalar instability (stress Broden’s view) (4)

A
  1. Loss of subtalar joint parallelism
  2. More than 5°of talocalcaneal tilt
  3. > 7 mm lateral talocalcaneal gap
  4. > 5 mm medial calcaneal displacement
42
Q

Differential diagnosis of midfoot pain (8)

A
  1. Lisfranc joint sprain
  2. Tarsal coalition
  3. Stress fracture (navicular)
  4. Accessory navicular
  5. Flexor tendinopathy
  6. Tarsal tunnel syndrome
  7. Plantar fasciitis
  8. Plantar nerve impingement
43
Q

Risk factors for hallux valgus (9)

A
  1. Family history
  2. Female sex
  3. Metatarsus primus varus
  4. Pes planus
  5. Inflammatory disorders/rheumatoid arthritis
  6. Connective tissue disorders/GLL
  7. Cerebral palsy/NM disorders
  8. 1st TMT instability
  9. Trauma
44
Q

Components of hallux valgus pathoanatomy (9)

A
  1. Valgus MTP joint
  2. Medial capsule attenuation
  3. Lateral capsule contracture
  4. unopposed adductor/becomes deforming force (contracture develops)
  5. Attenuation of the extensor hood
  6. Varus 1st metatarsal
  7. 1st metatarsal pronation
  8. Lateral subluxation of the sesamoids
  9. Lateral deviation of EHL/FHL
  10. Plantar-lateral migration of abductor hallucis
45
Q

Hallux valgus classification:

A
  1. Mild: IM < 15° HVA < 30°
  2. Moderate: IM > 15°, HVA < 40°
  3. Severe: IM > 15°, HVA > 40°
46
Q

Clues to the presence of first ray hypermobility (5)

A
  1. Callus under the 2nd metatarsal head
  2. 2nd metatarsal stress fracture
  3. 2nd metatarsal shaft hypertrophy
  4. Rounding/OA of the 1st metatarsocuneiform joint
  5. Plantar gapping of the 1st metatarsocuneiform joint
47
Q

Options for nonoperative treatment of hallux valgus (6)

A
  1. Shoe wear modifications
  2. Toe spacer
  3. Activity modification
  4. Orthosis with medial arch support
  5. NSAIDs
48
Q

Surgical options for treatment of hallux valgus (8)

A
  1. Simple bunionectomy
  2. Distal 1st metatarsal osteotomy
  3. Proximal 1st metatarsal osteotomy
  4. double proximal and distal 1st MT osteotomy
  5. Aiken osteotomy
  6. 1st MTP arthrodesis
  7. 1st TMT arthrodesis
  8. 1st MTP resection arthroplasty
49
Q

Contraindications to surgical treatment of hallux valgus (5)

A
  1. Infection
  2. Vascular compromise
  3. asymptomatic
  4. Non-compliant patient
  5. Unrealistic expectations
50
Q

Complications of a distal 1st metatarsal osteotomy (5)

A
  1. Incomplete correction
  2. Loss of position
  3. Avascular necrosis of the metatarsal head
  4. Non-union
  5. Recurrence

Orthobullets/ FRCSC Canadian Board (121 decks)

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