Foot & Ankle Flashcards
What is the most common area of rupture for the achilles tendon?
2 to 6 cm proximal to its insertion site
True or False: Functional outcomes of open repair versus nonsurgical management of achilles ruptures have been shown to be similar as early as 1 year after management
True
Percutaneous repair of the achilles has improved cosmesis and irritation but has a high risk of what injury?
Sural nerve injury
Achilles chronic defect 2-5 cm is treated how?
V-Y myotendinous lengthening with augmentation of nerve transfer as necessary
Ankle dorsiflexion results in what kind of movement of the fibula?
External rotation and proximal translation
What originates 1 cm proximal to the fibula tip and extends to the lateral aspect of the talar neck?
Anteror talo fibular ligament (ATFL)
Of the ATFL, PTFL and CFL, what is the weakest talofibular ligament?
ATFL
When do the joints of the foot lock and what tendon locks these joints?
During toe-off stance and the PTT (posterior tibial tendon) locks them
If PTT dysfunction, there is difficulty with heel rise
Where does the Lisfranc ligament travel?
Medial cuneiform to the base of the second metatarsal
(interosseous is the strongest)
During walking, ground reaction forces at what times body weight?
1.5
What part of the gait cycle does the windlass mechanism take place?
Toe off (assists with hind foot supination and heel varus to help lock the foot)
A congruent hallux valgus will have what DMAA?
Higher DMAA
What is the insert for hallux rigidus?
Carbon fiber footplate with morton extension (elimates MTP motion)
If I decided to fix a type 2 5th metatarsal head fracture, when should I use bone graft?
Patient with hindfoot varus
Which food column is the most rigid?
The middle column
I have a navicular fracture that was treated, what do I need prior to returning to sports?
CT scan to confirm union
What orthotic for tarsal tunnel?
Medial post orthotic, flat foot worsens the pain
What are normal toe pressures?
Greater than 40 mm Hg
What nerve innervates the first dorsal web space?
Deep peroneal nerve
Inversion of the ankle in dorsiflexion evaluates what ligament?
CFL
In hallux valgus, where does the abductor hallucis migrate?
Plantar and lateral which caused plantar flexion and pronation of the hallux
What is the normal HVA angle?
Less than 15
What is the normal IMA angle?
Less than 9 degrees
What is a normal DMAA angle?
Less than 10 degrees
What IMA and HVA degrees mean distal metatarsal osteotomy (chevron)?
IMN <13 and HVA <40
What is a lapidus procedure?
TMT fusion
What angle necessitates a distal medial closed wedge metatarsal osteotomy?
DMAA >10 degrees
When is an akin osteotomy indicated?
HVI (hallux valgus interphalangeus) larger angle
What is the most common complication after surgical correction of juvenile hallux valgus?
Recurrence
What is the surgery for a flexible flatfoot?
FDL transfer to navicular and medial side calcaneal osteotomy (adds increased power to the FHL)
What are the three radiographic things I should look for regarding a lisfranc injury?
- On an AP, medial border for 2nd MT inline with medial border of middle cuneiform
- On an oblique, medial border of the 4th MT lines up with medial border of the cuboid
- On a lateral, the dorsal cortex of the 1st MT lines up with medial cuneiform
3 views, 3 things
Return to sport after ORIF Lisfranc?
6-8 months
Percutaneous fixation of achilles raise concern for what nerve injury?
Sural
Treatment for flexible cavovarus with no arthritis?
Lateral reconstruction with peroneal brevis grafting and first metatarsal osteotomy
Spring ligament connects what to what?
Navicular to the calcaneus
What is the minimal ABI for wound healing in the foot?
ABI > 0.45
(toe pressures > 40 mmHg O2, tension most sensitive!)
