Foot & Ankle Flashcards
Classification and treatment of diabetic foot ulcers?
Wagner Classification
Grade 0 - skin intact, but at risk due to bony prominences - shoe wear mods with serial exams.
Grade 1 - superficial ulcer - office debridement and contact casting
Grade 2 - full thickness skin ulcer - formal operative debridement and contact casting
Grade 3 - deep abscess or osteomyelitis - formal operative debridement and contact casting
Grade 4 - partial gangrene - local vs. larger amputation
Grade 5 - extensive gangrene - amputation
What is Keller arthroplasty and when is it indicated?
Resection of the proximal end of the proximal phalanx. Indicated for interphalangeal joint neuropathic ulcer with hypermobile/stiff MPT joint that has failed total contact casting
The most predictive markers for diabetic wound
healing are…
– serum albumin >3.0 g/dL – total lymphocyte count (TLC) >1500/mm3 – ABI >0.45 – Toe pressures >40 mm Hg – Transcutaneous oxygen pressures (TcPO2) >30 mm Hg (at the level of the ulcer)
Chopart amputation is what? Indications?
Amputation of forefoot and midfoot, leaving the talus and calcaneus. Indicated in less active patients and allows for some weight bearing, however equinus can be an issue.
Syme amputation is what? Indications?
Ankle disarticulation at tibiotalar joint, then square off the distal tibia and fibula. Allows for some weight bearing but requires healthy intact heel pad and prosthetic/shoe fitting can be challenging.
What is the primary risk factor for development of diabetic foot ulcer?
Loss of protective sensation from peripheral neuropathy
Indications for total ankle arthroplasty?
Tibiotalar arthritis Age >65 Low demand Has some preserved motion Minimal to no deformity <10 deg No neuropathy or diabetes No obesity No hx of infx No talar osteonecrosis
Indications for total ankle arthroplasty?
Tibiotalar arthritis and pain Age >65 Low demand Has some preserved motion Minimal to no deformity <10 deg No neuropathy or diabetes No obesity No hx of infx No talar osteonecrosis
Operative decision for hallux valgus is based on what HVA and IMA measures?
HVA >20 deg
IMA >10
Operative indication for hallux valgus with IMA <13 and HVA <40
DISTAL metatarsal osteotomy (Chevron, Biplanar Chevron, Mitchell, Akin)
***If DMAA >15 deg consider Biplanar Chevron Osteotomy
Operative indication for hallux valgus with IMA >13, or HVA >40
Proximal metatarsal osteotomy (Crescentic, Broomstick, Ludloff, Scarf)
***If DMAA >15 deg consider proximal AND distal osteotomy of 1st metatarsal (proximal osteotomy addresses the high IMA and distal addresses the high DMA)
What is an Akin osteotomy?
Akin osteotomy is a medial closing wedge osteotomy of the PROXIMAL PHALANX of the great toe
Functions of posterior tibial tendon?
Primary dynamic support of foot arch.
Inverts hindfoot, adducts and supinates forefoot “locking in the transverse tarsal joints” to create a longer rigid moment arm for gastroc fxn and powered push-off during the gait cycle.
Antagonizes peroneus brevis.
The IV stages in the development of flat foot deformity/posterior tibial tendon insufficiency…
Stage 1 = Tenosynovitis
Stage 2A= Flatfoot deformity, flexible hindfoot, normal forefoot [sinus tarsi pain]
STage 2B= Flatfoot deformity, flexible hindfoot, forefoot abduction “too many toes” (>40% talonavicular uncoverage) [sinus tarsi pain]
Stage 3 = Flatfoot deformity, rigid forefoot abduction, rigid hindfoot valgus [sinus tarsi pain, severe]
Stage 4=Flatfoot deformity, rigid forefoot abduction, rigid hindfoot valgus, deltoid ligament compromise [ankle pain]
What strengthening exercise is most effective in treating achilles tendinopathy
Eccentric closed chain exercise (controlled eccentric dorsiflexion while standing on step after plantarflexion)
