Foot Disorders Flashcards
2nd MTP Joint Synovitis: - Presentation - Risk factors
PE: appears septic - Dorsal drawer sign for instability - Mortor Neuroma 2/2 to pressure of digital nerve in 2ND webspace Risk Factors: - elongated 2nd toe comp to 1st toe - hallux valgus
2nd MTP Joint Synovitis: - Pathology
Synovitis -> stretch of capsuloligamentous complex of MTP -> frontal and axial plane instability -> Deformity
2nd MTP joint Synovitis: - Deformity
Plantar plate attenuation -> MTP extension and sagittal plane deformity -> leading to: - MTP instability - dorsal d/l - inc risk of hammertoe and toe crossover
2nd MTP joint synovitis - treatment:
1st: Nonop for 8-12 weeks 2nd: Surgery to correct deformity: synovectomy and long 2nd toe joint perservig osteoytomy
Freiburg Infarction - What - Where - Classification - tx
Infarction of 2nd MT head with DORSAL collapse, pain inc with WB Smillie Class: 1. Subchondral fx only on adv imagin 2. Dorsal collapse 3. Entire head collapse, early arthritic signs 4. Severe arthritic signs and no joint space Tx: - early stage 1: NWB with stiff shoe - Sx: dorsal closing wedge osteotomy: excises dz bone, brings unaff. plantar surface up and dec stress with shortening - Sx: duVries Arthroplasty: partial head resection in stage 3/4
Mallet Toe - PE: - Tx
hyperFLEXION of DIP with callouses at tip Tx: - Flexible: perc release of FDL - Fixed: resection of distal condyles of midphalanx, repair of extensors and pinning
Hammer Toe - PE - Tx:
PE: hyperFLEXION of PIP and EXTENSION of MTP and DIP Tx: - No MTP involvement: resection of prox phalanx condyles and cut FDL - MTP Involvement: z-plasty lengthening and MTP capsule release - Girdlestone Taylor: shortening osteotomy and/or FPL and EDL tendons
Cross Over Toe Deformity - Cause? - What happens with weight bearing?
Cause: plantar plate deficiency WB: proximal phalanx displaces DORSALLY - Plantar plate/interossei&lumbricals pull prox phal back to NEURTRAL - No plantar plate: collateral ligaments attenuate -> 2nd toe crosses over
