Forefoot Flashcards
Common forefoot classification systems
4 stages for Hallux Valgus
- Lateral subluxation of proximal phalanx. Will also see excessive pronation. hypermobile 1st ray. stretching of tibial ses. lig. and contraction of fibular ses. lig.
- increased lateral deviation so hallux is now abutting the 2nd digit. FHL and FHB have mechanical advantage. crista begins to erode
- further deviation and increase in IMA. IMA increases due to retrograde forces of abductor hallucis
- hallux is subluxed and dislocated from 1st met.
Hallux limitus classification systems
a. Regnauld
b. Modifed Regnauld/Oloff
c. Drago, Oloff and Jacobs
d. Hanft
e. Ktavitz, Laporta, Lauton
Regnauld Classification system
Used for hallux limitus. Has 3 stages.
- functional hallux limitus with minimal dorsal spurring. joint may appear bigger. no other signs of DJD on radiograph.
- flattening of 1st met head w structural elevates and sig. spurring. Pain at rest. will see joint space narrowing and sesamoid hypertrophy. 75% decrease in ROM.
- ankylosis with extensive periarticular osteophytes. severe joint space narrowing (bone on bone). sig. sesamoid/1st met joint dz.
Modified Regnauld/Oloff
used for hallux limitus. 4 stages.
- functional hallux limitus with no signs of DJD.
- Joint adaptation - flattening of met head with small dorsal exostosis. pain at end ROM.
- joint deterioration - severe flattening of met head with sig. dorsal spurring, uneven joint sace narrowing, osteophytes, and subchondral sclerosis. crepitus noted and pain throughout ROM.
- ankylosis - obliteration of joint space and osteophyte fragmentation. minimal to No ROM.
JAHSS and tx
used for 1st met dislocation (dorsal). 2 stages with the second stage having subtypes A and B
- dorsal dislocation of the prox. phalanx and sesamoids without disruption of intersesamoid lig. or fx.
Tx: ORIF - dorsal dislocation with interruption of the intersesamoid lig.
Tx: closed reduction and x shoe or BK walking cast. - dorsal dislocation with transverse fx of sesamoid and no interruption of the intersesamoid lig.
Tx: Closed reduction with sx shoe, BK walking cast or sesamoidectomy
Stewart Classification system
5 types, used for 5th met base fx.
- extra-articular true jones
- intraarticular avulsion
- extraarticular avulsion
- intraarticular comminuted
- apophysitis
Type 1 Stewart classification.
- where
- common complication
- MOI
- Tx
- transverse fx at metaphyseal-diaphyseal junction apx. 1 cm distal to 5th met/cuboid joint
- Non-union. watershed region between nutrient artery (from 4th plantar met a.) and metaphyseal arteries (DP, PT and peroneal aa.). Periosteum is another blood supply. (15-30% base on orthobullets)
- MOI: internal rotation, PF ankle and adduction of forefoot
- Tx is non-displaced - NWB BK cast 4-6 weeks
- Tx is displaced: ORIF
Type 2 Stewart classification
- MOI
- Tx
- MOI - shear force, resulting from contraction of peroneus brevis
- Tx if reducible: NWB in BK cast for 4-6 weeks
- Tx non-reducible: ORIF
Type 3 Stewart classification
- eponym
- significance?
- MOI
- Tx:
- Tennis fx
- most common 5th met fx
- MOI: contraction of PB with DF of ankle
- Tx if reducible: NWB BK cast for 4-6 weeks
- Tx if non-reducible: ORIF with possible tension band wiring
Type 4 Stewart Classification
- MOI
- Tx
- MOI: Crush
- Tx: NWB BK Cast for 4-6 weeks
- Tx if severely displaced: bone graft and ORIF
Type 5 Stewart Classification
- orientation of line
- whom it’s seen in/Risk
- other name
- Tx
- longitudinal
- Seen in kids with open growth plates (fuses at 9-12 yo). At risk for Iselin AVN
- AKA salter-Harris type 1
- Tx: NWB in BK cast for 4-6 weeks
Torg classification
3 types, Used for Jones fx
- acute jones fx
- delayed union of jones fx or diaphyseal stress fx
- non-union of jones or diaphyseal stress fx
Rosenthal
3 zones used for nail injuries
- distal to bony phalanx. tissue loss of >1cm. acute or delayed grafting
- distal to lunula
Tx: V to Y advancement - proximal to distal end of lunula
tx: if nail bed is lacerated –> considered an open fx
Tx: amputation
http://www.podiatryinstitute.com/pdfs/Update_1993/1993_26.pdf
Freiberg Infarction of metatarsal head
4 types
- met head dies but heals by replacement. articular surface preserved
- collapse of the head but articular surface remains. peripheral osteophytes.
- Collapse of the head with articular cartilage loosening/ joint is destroyed
- multiple heads involved
Quenu and Kuss
3 types for Lisfranc injuries
A. Convergent homolateral - all 5 mets subluxed laterally. (transverse plane only)
B. Isolateral - 1st met subluxed medially or mets 2-5 (usually 1-2 mets) subluxed laterally
C. Divergent - 1st met subluxed medially and mets 2-5 subluxed laterally. (sagittal and transverse planes)
