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Millers > Foot and Ankle Questions > Flashcards

Foot and Ankle Questions Flashcards

1
Q

Presentation of advanced plantar plate tear

A

medially deviated, dorsally dislocated second toe, seen in advanced-stage plantar plate tear

Looks like a cock up toe

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2
Q

4 Risk factors for creating hallux varus as a complication after hallux valgus surgery

A
  1. 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)
  2. fibular sesamoid excision
  3. release of the lateral flexor hallucis brevis
  4. overtightening of the medial capsule
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3
Q

What is Müller-Weiss disease

A

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

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4
Q

RF for open ankle arthrodesis nonunion

A

Prev subtalar fusion
Pre op ankle varus alignment

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5
Q

Treatment algorithm for peroneal tears

A
  1. Both grossly intact - tubularize any partial tears
  2. One >50% torn, other intact - tenodesis
  3. Both >50% torn
    Excursion of the proximal muscle - allograft recon
    No excursion - FHL trf

Remember to address underlying varus hindfoot if present

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6
Q

Complication of repeat plantar fasciitis injections

A

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

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7
Q

Trt non insertional Achilles tendinopathy w/ positive Silfverskiold

A

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.

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8
Q

Treat entire talus AVN

A

TTC fusion
Transfibular approach - gives you large exposure, can use distal fibula as graft

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9
Q

Fusion of the talonavicular joint decreases motion of the hindfoot joints by approximately what percentage of the prearthrodesis range of motion?

A

90%

Aka rare to fuse TN in isolation

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10
Q

Algorithm for Achilles repair techniques

A

<2cm direct repair
2-5cm VY
>5cm FHL trf

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11
Q

Best shoe modification post ankle fusion

A

Rocker bottom

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12
Q

Most common talar coalition

A

Calcaneal navicular
Approach via sinus tarsi

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13
Q

After surgical repair of an Achilles tendon rupture, a protocol that uses early motion has been shown to decrease which postoperative complication?

A

Rerupture

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14
Q

Approach for talocalcaneal coalition

A

Medial between FHL/FDL

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15
Q

Nerve most at risk TTC nailing

A

Lateral plantar

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16
Q

Correct hallux varus as a sequelae after hallux valgus surgery

Correctable vs noncorrectable varus

A

Correctable: Metatarsal osteotomy, medial capsule release, and split extensor hallucis longus tendon transfer

Not correctable: fusion

17
Q

Describe the complication of removing the seasmoids

A

Remove medial -> hallux valgus
(Nothing to strut out the medial column)

Remove lateral / fibular -> hallux varus

18
Q

What is the traditional surgical correction for a cavus foot

A

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

19
Q

Describe the causes of the deforming forces in a cavus foot

A

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

20
Q

What is the cause of subfibular pain with chronic flatfoot?

A

Hindfoot VALGUS

21
Q

Orthotic for hindfoot valgus

A

MEDIAL wedge

22
Q

What is Bassett’s ligament?

A

Distal fascicle of the anterior inferior tibiofibular ligament

AITFL

23
Q

What is more common in kids: SH 1 distal fibula vs lateral lig sprain

A

Lig sprain (80%) > SH T1 frx (3%)

24
Q

What lig does ant drawer test?

A

Ant drawer
- DF = calcaneofib lig
- PF = ATFL

25
Q

Fusion of the talonavicular joint decreases motion of the hindfoot joints by approximately what percentage of the prearthrodesis range of motion?

A

90%
WHY if you need a TN fusion just do a triple

26
Q

What are the options and requirements for cartilage defects (asked in context of talus OCD)

A

Intact cartilage = retrograde drilling
<1cm diameter, <5mm deep = microfracture
Larger - MACI vs OATS

27
Q

What cause anterior ankle impingement after calc fracture / treat

A

Lose height / posterior facet
Distraction subtalar arthrodesis

28
Q

What is the most common complication of a distal intra artic MT shortening osteotomy

A

Done with plantar plate repair, translates MT head plantar + proximal
Comp = floating toe = toe is plantar and the lumbricals force extension

29
Q

What is the Hawkins classification for talar neck fractures and the associated rates of AVN

A

T1 = nondisplaced
<15% AVN

T2 = displaced but not dislocated
20-50% AVN

T3 = displaced + subtalar and tibiotalar dislocations
75-100% AVN

T4 = “ “ + talonavic dislocation
100% AVN

30
Q

What is the modified Lachman exam

A

The modified Lachman examination is a dorsal subluxation of the phalanx base while stabilizing the metatarsal. If relative motion is detected, instability from a plantar plate rupture is diagnosed.

31
Q

Best tendon transfer for foot drop

A

PT through IO membrane

32
Q

For juvenile bunion, what hallux valgus radiograhic angle is most important to correct to prevent recurrence?

A

DMAA

33
Q

Reason fusion > ORIF for Lis Franc

A

Less ROH

34
Q

LH ankle frx most likely to have “other orthopaedic injury”

A

SAD
Vertical medial mal = impaction injury talus

35
Q

Other foot/ankle fracture associated with calc fracture

A

Distal fibula - look for fleck sign on XR
Check for peroneal retinaculum disruption

36
Q

Main difference for operative trt Achilles rupture

A

Faster return to work op > nonop

there was no significant difference in rerupture rate, strength, range of motion, calf circumference

Millers (29 decks)

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