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
Fusion of the talonavicular joint decreases motion of the hindfoot joints by approximately what percentage of the prearthrodesis range of motion?
90%
WHY if you need a TN fusion just do a triple
What are the options and requirements for cartilage defects (asked in context of talus OCD)
Intact cartilage = retrograde drilling
<1cm diameter, <5mm deep = microfracture
Larger - MACI vs OATS
What cause anterior ankle impingement after calc fracture / treat
Lose height / posterior facet
Distraction subtalar arthrodesis
What is the most common complication of a distal intra artic MT shortening osteotomy
Done with plantar plate repair, translates MT head plantar + proximal
Comp = floating toe = toe is plantar and the lumbricals force extension
What is the Hawkins classification for talar neck fractures and the associated rates of AVN
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
What is the modified Lachman exam
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.
Best tendon transfer for foot drop
PT through IO membrane
For juvenile bunion, what hallux valgus radiograhic angle is most important to correct to prevent recurrence?
DMAA
Reason fusion > ORIF for Lis Franc
Less ROH
LH ankle frx most likely to have “other orthopaedic injury”
SAD
Vertical medial mal = impaction injury talus
Other foot/ankle fracture associated with calc fracture
Distal fibula - look for fleck sign on XR
Check for peroneal retinaculum disruption
Main difference for operative trt Achilles rupture
Faster return to work op > nonop
there was no significant difference in rerupture rate, strength, range of motion, calf circumference
