Foot and Ankle Questions Flashcards
Presentation of advanced plantar plate tear
medially deviated, dorsally dislocated second toe, seen in advanced-stage plantar plate tear
Looks like a cock up toe
4 Risk factors for creating hallux varus as a complication after hallux valgus surgery
- Excessive resection of the medial eminence, usually due to lateral misplacement of the sagittal saw blade (think of as an easy way to think overtighten the medial capsule repair)
- fibular sesamoid excision
- release of the lateral flexor hallucis brevis
- overtightening of the medial capsule
What is Müller-Weiss disease
AVN navicular
radiographs reveal fragmentation and collapse of the lateral aspect of the navicular, causing the talar head to move laterally and appear to contact the cuneiforms
Surgical treatment typically involves medial column arthrodesis
RF for open ankle arthrodesis nonunion
Prev subtalar fusion
Pre op ankle varus alignment
Treatment algorithm for peroneal tears
- Both grossly intact - tubularize any partial tears
- One >50% torn, other intact - tenodesis
- Both >50% torn
Excursion of the proximal muscle - allograft recon
No excursion - FHL trf
Remember to address underlying varus hindfoot if present
Complication of repeat plantar fasciitis injections
Fat pad atrophy
pain with walking, tenderness to the central aspect of the heel pad, and a history of multiple previous injections
trt: shoe modifications
Trt non insertional Achilles tendinopathy w/ positive Silfverskiold
The role of isolated gastrocnemius contracture in noninsertional Achilles tendinosis has spurred interest in treatment of this problem by unloading the Achilles tendon through a gastrocnemius recession as opposed to direct debridement of the Achilles.
Treat entire talus AVN
TTC fusion
Transfibular approach - gives you large exposure, can use distal fibula as graft
Fusion of the talonavicular joint decreases motion of the hindfoot joints by approximately what percentage of the prearthrodesis range of motion?
90%
Aka rare to fuse TN in isolation
Algorithm for Achilles repair techniques
<2cm direct repair
2-5cm VY
>5cm FHL trf
Best shoe modification post ankle fusion
Rocker bottom
Most common talar coalition
Calcaneal navicular
Approach via sinus tarsi
After surgical repair of an Achilles tendon rupture, a protocol that uses early motion has been shown to decrease which postoperative complication?
Rerupture
Approach for talocalcaneal coalition
Medial between FHL/FDL
Nerve most at risk TTC nailing
Lateral plantar
Correct hallux varus as a sequelae after hallux valgus surgery
Correctable vs noncorrectable varus
Correctable: Metatarsal osteotomy, medial capsule release, and split extensor hallucis longus tendon transfer
Not correctable: fusion
Describe the complication of removing the seasmoids
Remove medial -> hallux valgus
(Nothing to strut out the medial column)
Remove lateral / fibular -> hallux varus
What is the traditional surgical correction for a cavus foot
Plantar fascial release
Peroneus longus to brevis transfer
Dorsiflexion osteotomy of the first metatarsal
Dwyer osteotomy (calc slide)
If 1st MTP joint hyperextended, add IP fusion with EHL transfer
Describe the causes of the deforming forces in a cavus foot
Peroneus longus overpowers the anterior tibial tendon, causing plantarflexion of the first ray
Posterior tibial tendon overpowers the peroneus brevis, contributing to the adduction at the hindfoot and midfoot
What is the cause of subfibular pain with chronic flatfoot?
Hindfoot VALGUS
Orthotic for hindfoot valgus
MEDIAL wedge
What is Bassett’s ligament?
Distal fascicle of the anterior inferior tibiofibular ligament
AITFL
What is more common in kids: SH 1 distal fibula vs lateral lig sprain
Lig sprain (80%) > SH T1 frx (3%)
What lig does ant drawer test?
Ant drawer
- DF = calcaneofib lig
- PF = ATFL
