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Pod practice > Forefoot Pathology > Flashcards

Forefoot Pathology Flashcards

1
Q

Long flexors and extensors are stabilized by what in the foot?

A

Stabilized by lumbricals

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2
Q

All digital contractures are a result of what?

A

Result of imbalance at MTPJ

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3
Q

What are the etiologies of hammertoes

A
  • Flexor stabiliztion
  • Extensor substitution
  • Flexor substitution
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4
Q

What is flexor stabilization and during what phase of gait does it occur

A
  • Failure of PTT to resupinate the foot results in overpronation.
  • Extrinsics (FHL/FDL) fire earlier/longer/stronger to grasp ground during midstance

Midstance phase of gait

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5
Q

What is extensor substitution and during what phase of gait

A
  • Weak anterior muscles: EDL/EHL overpowers intrinsics during swing phase of gait
  • Cavus foot- EDL in position to overpower lumbricals just by passive stretch
  • Equinus: extensors overworked to prevent tripping on forefoot

During the Swing phase of gait

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6
Q

What is flexor substitution and during what phase of gait?

A

Supinated foot with weak posterior muscle (achilles tendon) unable to PF foot during propulsion.

PT, FHL, FDL overpower to lumbricals

Propulsive phase of gait

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7
Q

Clinical presentation of forefoot pathology (3)

A
  • Heloma molle
  • Heloma durum
  • Congruous, deviated, subluxed
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8
Q

Where is heloma molle found

A
  • At the 4th interspace due to curly toe at 5th digit

- Head of 5th proximal phalanx rubs against the base of 4th proximal phalanx

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9
Q

Where are heloma durum found

A

At the dorsal IPJ

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10
Q

How to test the flexibility of a hammertoe

A

Reducibility determined by Kalikien push up test

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11
Q

Clinical tests used to diagnose hammertoe defermity

A

Lachman test: positive test is > 2 mm of dorsal displacement

Kilikian push up test

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12
Q

Conservative treatment options for hammertoes (4)

A
  • Aperture pad
  • Crest Pad
  • Taping/Strapping
  • Boudin Splint
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13
Q

What is the sequential release of MTPJ for hammertoe repair

A

1) Arthroplasty
2) Extensor tenotomy
3) Extensor hood release
4) Extensor Tendon lengthening
5) Flexor tendon transfer

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14
Q

What are some of the soft tissue procedures that can be done for overlapping 5th toe

A
  • Incision from Distal Medial to Proximal Laterl
  • Z-plasty or V-Y pasty
  • tendon lengthening
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15
Q

What are hammertoe soft tissue procedures (4)

A
  • Flexor or extensor percutaneous tenotomy
  • Extensor tendon lengthening, Z-lengthening
  • Capsulotomy
  • Flexor tendon transfer
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16
Q

What is done with a flexor/extensor percutaneous tenotomy

A
  • For hammertoe: cut @ PIPJ (for release FDL/FDB)

- For Clawtoe: cut @ DIPJ (release FDL)

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17
Q

What are the steps to Capsulotomy

A
  • Includes extensor hood release

- J maneuver to release collaterals

18
Q

What are the three Flexor tendon transfers

A
  • Girdlestone Taylor
  • Kuwada/Dockery
  • Schuberth
19
Q

What is the Girdlestone Taylor procedure

A
  • bisect the tendon

- flexor reattached dorsally and sutured together to make a sling over proximal phalanx

20
Q

What is the Kuwada/Dockery procedure

A

-reroute the tendon through distal drill hole

21
Q

What is the Schuberth procedure

A

re-route tendon through proximal drill hill

22
Q

What are specific procedures for 5th digit hammertoe procedures

A
  • Derotational arthroplasty
  • Ruiz Mora procedure
  • Syndactyly
23
Q

Describe derotational arthroplasty

A

Used for adductovarus of the 5th digit

-PIPJ arthroplasty and oblique removal of skin

24
Q

What is the syndactyly procedure

A

When abnormal digit is fused a a normal adjacent digit to bring it down

Good treatment for flail toe

25
Q

What are the osseous procedures for hammertoe correction (4)

A

Arthroplasty

  • Arthrodesis
  • Implant arhtroplasty
  • Amputation
26
Q

Techniques to be used for arthroplasty

A

Resectional (Keller)

Interpositional- interposition of tissue to keep inflammatory surfaces apart

-Implant

27
Q

What is the anatomy of the plantar plate

A

crimp morphology

chinese finger trap

28
Q

What is the most common etiology of predislocation syndrome

A

-elongated metatarsal or short neighboring metatarsal

29
Q

What is the function of plantar plate and what is its healing potential

A

Plantar plate serves as a stabilizer during WB and has very poor healing potential

30
Q

What is the clinical presentation for predislocation syndrome

A
  • Grape like swelling
  • Painful MT head/callus
  • Crossover toe: rupture of the collateral ligaments
  • Hammertoe:rupture of plantar plate
31
Q

How to diagnose predislocation syndrome clinically

A
  • Modified lachman test
  • Arthrogram: extravasation
  • MRI
  • Ultrasound
32
Q

What are the conservative treatment options

A
  • Offloading
  • Splinting
  • orthosis
  • MT pad
  • Spica taping
33
Q

Ligamentous correction for plantar plate tear

A
  • Flexor tendon transfer: good for transverse plane deformity
  • Capsulotomy or capsulorraphy
  • Plantar plate repair: provides static stability
34
Q

Ossesous correction for plantar plate tear

A
  • IPJ arthrodesis
  • Arthroplasty/arthrodesis
  • Lesser MTPJ arhrodesis
35
Q

What are some distal metatarsal procedures that can be done for metatarsalgia

A

Weil

Weil+plantar plate repair

  • Jacoby
  • Duvries
  • Chevron
  • DFWO
36
Q

Describe the Weil and complications

A

-Cut is made parallel to weight bearing surface but appears to be made Distal- Dorsal to Proximal plantar

  • Complications are:
  • –Transfer lesions
  • –recurrence
  • –floating toe/flail toe
  • –Dorsal contracture
37
Q

Describe the jacoby procedure

A

V-osteotomy that can be PF or DF

38
Q

Describe the Duvries procedure

A

plantar condylectomy on both sides of the MPJ

39
Q

Describe the Chevron

A

Jacoby with removal of bone to shorten MT

40
Q

Describe DFWO

A

same as Waterman procedure

Pod practice (75 decks)

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