Introduction to Surgery of the Foot and Ankle Flashcards
1
Q
Basics of Foot & Ankle Pathology
- 3 Sections- …, … and …
- Pathology in any one of these areas has a reciprocating effect in the rest of the foot
- The foot is like a tripod
A
- 3 Sections- hindfoot, midfoot and forefoot
- Pathology in any one of these areas has a reciprocating effect in the rest of the foot
- The foot is like a tripod
2
Q
Basics of Foot & Ankle Pathology
- 3 Sections- hindfoot, midfoot and forefoot
- Pathology in any one of these areas has a reciprocating effect in the rest of the foot
- The foot is like a …
A
- 3 Sections- hindfoot, midfoot and forefoot
- Pathology in any one of these areas has a reciprocating effect in the rest of the foot
- The foot is like a tripod
3
Q
Why is the foot so important?
- To ensure that we have a smooth … cycle
- If foot anatomy is abnormal foot … is compromised
A
- To ensure that we have a smooth gait cycle
- If foot anatomy is abnormal foot function is compromised
4
Q
Basics of Foot and Ankle
- Have a natural … valgus
- Further valgus your … and … will compensate
- If you go into varus it will also compensate
A
- Have a natural hindfoot valgus
- Further valgus your midfoot and forefoot will compensate
- If you go into varus it will also compensate
5
Q
Basics of Foot and Ankle
- Have a natural hindfoot …
- Further … your midfoot and forefoot will compensate
- If you go into … it will also compensate
A
- Have a natural hindfoot valgus
- Further valgus your midfoot and forefoot will compensate
- If you go into varus it will also compensate
6
Q
How do we achieve this surgically? (natural hindfoot valgus)
- Tendons
- Debridement
- Tenodesis
- Tendon …
- … repair
- Ligaments
- … repair
- Tendon transfer
- Bone
- …tomy
- …stectomy
A
- Tendons
- Debridement
- Tenodesis
- Tendon transfer
- Direct repair
- Ligaments
- Indirect repair
- Tendon transfer
- Bone
- Osteotomy
- Exostectomy
7
Q
How do we achieve this surgically? (natural hindfoot valgus)
- Tendons
- …ment
- …
- … transfer
- Direct repair
- Ligaments
- Indirect repair
- Tendon transfer
- Bone
- Osteotomy
- Exostectomy
A
- Tendons
- Debridement
- Tenodesis
- Tendon transfer
- Direct repair
- Ligaments
- Indirect repair
- Tendon transfer
- Bone
- Osteotomy
- Exostectomy
8
Q
Aims of treating Foot and Ankle Pathology
- Is always to achieve a foot which is :
- …
- Plantigrade
- … normal
- Functionally normal
A
- Is always to achieve a foot which is :
- Painless
- Plantigrade
- Structurally normal
- Functionally normal
9
Q
Aims of treating Foot and Ankle Pathology
- Is always to achieve a foot which is :
- Painless
- …
- Structurally normal
- … normal
A
- Is always to achieve a foot which is :
- Painless
- Plantigrade
- Structurally normal
- Functionally normal
10
Q
Achilles Tendon
- Also known as the … cord
- The gastrocnemius, soleus and plantaris muscle unites to form a band of fibrous tissue which becomes the Achilles tendon which attaches to the … tuberosity
- … and … tendon
- Approximately 15 cm in length
- … of the foot
A
- Also known as the heel cord
- The gastrocnemius, soleus and plantaris muscle unites to form a band of fibrous tissue which becomes the Achilles tendon which attaches to the calcaneal tuberosity
- Largest and strongest tendon
- Approximately 15 cm in length
- Plantarflexor of the foot
11
Q
Achilles Tendon
- Also known as the heel cord
- The …, soleus and … muscle unites to form a band of fibrous tissue which becomes the Achilles tendon which attaches to the calcaneal tuberosity
- Largest and strongest tendon
- Approximately … cm in length
- Plantarflexor of the foot
A
- Also known as the heel cord
- The gastrocnemius, soleus and plantaris muscle unites to form a band of fibrous tissue which becomes the Achilles tendon which attaches to the calcaneal tuberosity
- Largest and strongest tendon
- Approximately 15 cm in length
- Plantarflexor of the foot
12
Q
Achilles tendon is approximately … cm in length
A
Achilles tendon is approximately 15 cm in length
13
Q
Label the diagram
A
14
Q
Why is the achilles tendon vulnerable to pathology?
- Unlike other tendons it has no … …
- It is surrounded by a … (connective tissue sheath to ensure gliding )
- It has a poor blood supply
- i. Posterior tibial artery ( proximal and distal section)
- ii. Peroneal artery ( supplies midsection)
- Blood vascularity weakest at the bone –tendon interface
- Blood supply weakest at 2 to 6 cm form the calcaneal attachment
A
- Unlike other tendons it has no tendon sheath
- It is surrounded by a paratenon ( connective tissue sheath to ensure gliding )
- It has a poor blood supply
- i. Posterior tibial artery ( proximal and distal section)
- ii. Peroneal artery ( supplies midsection)
- Blood vascularity weakest at the bone –tendon interface
- Blood supply weakest at 2 to 6 cm form the calcaneal attachment
15
Q
Why is the achilles tendon vulnerable to pathology?
- Unlike other tendons it has no tendon sheath
- It is surrounded by a paratenon ( connective tissue sheath to ensure …)
- It has a poor … …
- i. Posterior … artery (proximal and distal section)
- ii. … artery ( supplies midsection)
- Blood vascularity weakest at the bone –tendon interface
- Blood supply weakest at 2 to 6 cm form the calcaneal attachment
A
- Unlike other tendons it has no tendon sheath
- It is surrounded by a paratenon ( connective tissue sheath to ensure gliding )
- It has a poor blood supply
- i. Posterior tibial artery ( proximal and distal section)
- ii. Peroneal artery ( supplies midsection)
- Blood vascularity weakest at the bone –tendon interface
- Blood supply weakest at 2 to 6 cm form the calcaneal attachment
16
Q
Why is the achilles tendon vulnerable to pathology?
- Unlike other tendons it has no tendon sheath
- It is surrounded by a paratenon ( connective tissue sheath to ensure gliding )
- It has a poor blood supply
- i. Posterior tibial artery ( proximal and distal section)
- ii. Peroneal artery ( supplies midsection)
- Blood vascularity weakest at the … –… interface
- Blood supply weakest at 2 to 6 cm from the … attachment
A
- Unlike other tendons it has no tendon sheath
- It is surrounded by a paratenon ( connective tissue sheath to ensure gliding )
- It has a poor blood supply
- i. Posterior tibial artery ( proximal and distal section)
- ii. Peroneal artery ( supplies midsection)
- Blood vascularity weakest at the bone –tendon interface
- Blood supply weakest at 2 to 6 cm form the calcaneal attachment
17
Q
- Achilles tendon - Blood vascularity weakest at the … –tendon interface
- Blood supply weakest at .. to … cm form the calcaneal attachment
A
- Achilles tendon - Blood vascularity weakest at the bone –tendon interface
- Blood supply weakest at 2 to 6 cm form the calcaneal attachment
18
Q
Achilles rupture
- Occurs after a sudden forced … to the foot
- Violent … in a planatar flexed foot
- Usually ruptures 4 to 6 cm above the calcaneal insertion in the hypovascular region
A
- Occurs after a sudden forced plantarflexion to the foot
- Violent dorsiflexion in a plantar flexed foot
- Usually ruptures 4 to 6 cm above the calcaneal insertion in the hypovascular region
19
Q
Achilles rupture
- Occurs after a sudden forced … to the foot
- Violent dorsiflexion in a … foot
- Usually ruptures 4 to 6 cm above the … insertion in the hypovascular region
A
- Occurs after a sudden forced plantarflexion to the foot
- Violent dorsiflexion in a plantar flexed foot
- Usually ruptures 4 to 6 cm above the calcaneal insertion in the hypovascular region
20
Q
Achilles Rupture - Treatment
- Most common - In Functional …
- Surgery
- … to … repair
- VY advancement
- Failure to heal- Tendon …
- Tendon used is the one closest in proximity – FLEXOR HALLUCIS LONGUS
A
- In Functional bracing
- Surgery
- End to end repair
- VY advancement
- Failure to heal- Tendon transfer
- Tendon used is the one closest in proximity – FLEXOR HALLUCIS LONGUS
21
Q
Achilles Rupture - Treatment
- Most common - In Functional bracing
- Surgery
- End to end repair
- … advancement
- Failure to heal- … transfer
- Tendon used is the one closest in proximity – FLEXOR … …
A
- In Functional bracing
- Surgery
- End to end repair
- VY advancement
- Failure to heal- Tendon transfer
- Tendon used is the one closest in proximity – FLEXOR HALLUCIS LONGUS
22
Q
What is tendon transfer?
A
This procedure repositions the flexor hallucis longus tendon, (commonly called the “FHL” tendon) to reinforce a diseased Achilles tendon.
23
Q
When is tendon transfer used?
A
This procedure repositions the flexor hallucis longus tendon, (commonly called the “FHL” tendon) to reinforce a diseased Achilles tendon.
24
Q
Surgical approach to the Achilles
- Patient is … (Requires intubation) or in lazy … position
- Landmarks: The malleoli and the Achilles tendon- which is easily …
- Incision: Longitudinal – slightly medially based ( but can go laterally as well)
- Structure to avoid : … nerve laterally
- Avoid going medial to Flexor hallucis longus (FHL) ( easily identifiable as has muscle fibres at this level ) - NEUROVASCULAR BUNDLE MEDIALLY
A
- Patient is prone (Requires intubation) or in lazy lateral position
- Landmarks: The malleoli and the Achilles tendon- which is easily palpable
- Incision: Longitudinal – slightly medially based ( but can go laterally as well)
- Structure to avoid : Sural nerve laterally
- Avoid going medial to Flexor hallucis longus (FHL) ( easily identifiable as has muscle fibres at this level ) - NEUROVASCULAR BUNDLE MEDIALLY
25
Q
Surgical approach to the Achilles
- Patient is prone (Requires intubation) or in lazy lateral position
- Landmarks: The … and the Achilles tendon- which is easily palpable
- Incision: Longitudinal – slightly … based ( but can go … as well)
- Structure to avoid : Sural nerve laterally
- Avoid going medial to Flexor … … (FHL) ( easily identifiable as has muscle fibres at this level ) - NEUROVASCULAR BUNDLE MEDIALLY
A
- Patient is prone (Requires intubation) or in lazy lateral position
- Landmarks: The malleoli and the Achilles tendon- which is easily palpable
- Incision: Longitudinal – slightly medially based ( but can go laterally as well)
- Structure to avoid : Sural nerve laterally
- Avoid going medial to Flexor hallucis longus (FHL) ( easily identifiable as has muscle fibres at this level ) - NEUROVASCULAR BUNDLE MEDIALLY
26
Q
Surgical approach to the Achilles
- Patient is prone (Requires …) or in lazy lateral position
- Landmarks: The malleoli and the Achilles tendon- which is easily palpable
- Incision: … – slightly medially based ( but can go laterally as well)
- Structure to avoid : Sural nerve laterally
- Avoid going medial to Flexor hallucis longus (FHL) ( easily identifiable as has muscle fibres at this level ) - … BUNDLE MEDIALLY
A
- Patient is prone (Requires intubation) or in lazy lateral position
- Landmarks: The malleoli and the Achilles tendon- which is easily palpable
- Incision: Longitudinal – slightly medially based ( but can go laterally as well)
- Structure to avoid : Sural nerve laterally
- Avoid going medial to Flexor hallucis longus (FHL) ( easily identifiable as has muscle fibres at this level ) - NEUROVASCULAR BUNDLE MEDIALLY
27
Q
Surgical approach to the Achilles
- Patient is prone (Requires intubation) or in lazy lateral position
- Landmarks: The … and the Achilles tendon- which is easily palpable
- Incision: Longitudinal – slightly medially based ( but can go laterally as well)
- Structure to avoid : Sural nerve laterally
- Avoid going …. to Flexor hallucis longus (FHL) ( easily identifiable as has muscle fibres at this level ) - NEUROVASCULAR BUNDLE MEDIALLY
A
- Patient is prone (Requires intubation) or in lazy lateral position
- Landmarks: The malleoli and the Achilles tendon- which is easily palpable
- Incision: Longitudinal – slightly medially based ( but can go laterally as well)
- Structure to avoid : Sural nerve laterally
- Avoid going medial to Flexor hallucis longus (FHL) ( easily identifiable as has muscle fibres at this level ) - NEUROVASCULAR BUNDLE MEDIALLY
28
Q
Tibialis Posterior Tendon
- … aspect of …. membrane, fibula and tibia and has … insertions in the foot
- Action-
- Plantarflexes the … joint
- Principal invertor of the foot
- Adducts and supinates the foot
- Arterial supply form the Posterior tibial, peroneal and sural nerve
- Has a watershed area around the medial malleoli
A
- Posterior aspect of interosseous membrane, fibula and tibia and has 9 insertions in the foot
- Action-
- Plantarflexes the ankle joint
- Principal invertor of the foot
- Adducts and supinates the foot
- Arterial supply form the Posterior tibial, peroneal and sural nerve
- Has a watershed area around the medial malleoli
29
Q
Tibialis Posterior Tendon
- Posterior aspect of interosseous membrane, fibula and tibia and has 9 insertions in the foot
- Action-
- …. the ankle joint
- Principal … of the foot
- Adducts and … the foot
- … supply form the Posterior tibial, peroneal and sural nerve
- Has a watershed area around the medial …
A
- Posterior aspect of interosseous membrane, fibula and tibia and has 9 insertions in the foot
- Action-
- Plantarflexes the ankle joint
- Principal invertor of the foot
- Adducts and supinates the foot
- Arterial supply form the Posterior tibial, peroneal and sural nerve
- Has a watershed area around the medial malleoli
30
Q
What tendon is this?
A
Tibialis posterior tendon
31
Q
Function of Tibialis Posterior Tendon
- … lower leg
- Facilitates foot …
- Supports the foot’s … arch
- Plays a critical role in hindfoot inversion during the gait cycle
A
- Stabilise lower leg
- Facilitates foot inversion
- Supports the foot’s medial arch
- Plays a critical role in hindfoot inversion during the gait cycle
32
Q
Function of Tibialis Posterior Tendon
- Stabilise … leg
- Facilitates foot inversion
- Supports the foot’s medial arch
- Plays a critical role in … inversion during the … cycle
A
- Stabilise lower leg
- Facilitates foot inversion
- Supports the foot’s medial arch
- Plays a critical role in hindfoot inversion during the gait cycle
33
Q
Tibialis Posterior Insufficiency
- Presenting symptoms/signs
- Post-… pain
- … pain + aching
- Progressive … foot deformity
- Forefoot problems: progressive hallux valgus, metatarsalgia, lesser toe deformities
- Rarely, tarsal tunnel syndrome
A
- Presenting symptoms/signs
- Post-malleolar pain
- Arch pain + aching
- Progressive flat foot deformity
- Forefoot problems: progressive hallux valgus, metatarsalgia, lesser toe deformities
- Rarely, tarsal tunnel syndrome
34
Q
Tibialis Posterior Insufficiency
- Presenting symptoms/signs
- Post-malleolar pain
- Arch pain + aching
- Progressive flat foot deformity
- … problems: progressive hallux …, metatarsalgia, … toe deformities
- Rarely, … tunnel syndrome
A
- Presenting symptoms/signs
- Post-malleolar pain
- Arch pain + aching
- Progressive flat foot deformity
- Forefoot problems: progressive hallux valgus, metatarsalgia, lesser toe deformities
- Rarely, tarsal tunnel syndrome
35
Q
Tibialis Posterior Insufficiency
A
36
Q
Tibialis Posterior Insufficiency- Treatment
- Non-surgical
- …
- … wear modification
- Orthotics- … arch supports
- Physiotherapy
- Surgery
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)
A
- Non-surgical
- Analgesics
- Shoe wear modification
- Orthotics - medial arch supports
- Physiotherapy
- Surgery
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)
37
Q
Tibialis Posterior Insufficiency- Treatment
- Non-surgical
- Analgesics
- Shoe wear modification
- …- medial arch supports
- …therapy
- Surgery
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)
A
- Non-surgical
- Analgesics
- Shoe wear modification
- Orthotics- medial arch supports
- Physiotherapy
- Surgery
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)
38
Q
Tibialis Posterior Insufficiency- Treatment
- Non-surgical
- Analgesics
- Shoe wear modification
- Orthotics- medial arch supports
- Physiotherapy
- Surgery
- … (… transfer)
- … (if secondary arthritis)
A
- Non-surgical
- Analgesics
- Shoe wear modification
- Orthotics- medial arch supports
- Physiotherapy
- Surgery
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)
41
Q
Tibialis Posterior Dysfunction - Which tendon to use for the transfer?
A
Tibialis Posterior Dysfunction - Which tendon to use for the transfer? (flexor digitorum)
46
Q
Tibialis Posterior Dysfunction
- Identifying it
A
58
Q
Ankle Fusion/ Arthrodesis
- Indications
- … Relief
- Severe …
- TAR not appropriate
A
- Indications
- Pain Relief
- Severe Deformity
- TAR not appropriate
59
Q
Ankle Fusion/ Arthrodesis
- Indications
- Pain Relief
- Severe Deformity
- … not appropriate
A
- Indications
- Pain Relief
- Severe Deformity
- TAR not appropriate
64
Q
Tibiotalocalcaneal Arthrodesis (TTC)
- Severe …
- … ankle fractures
- Complex failed ankle fixation
- Failed TAR
- * If TNJ / CCJ involved – consider pantalar arthrodesis
A
- Severe deformity
- Osteoporotic ankle fractures
- Complex failed ankle fixation
- Failed TAR
- * If TNJ / CCJ involved – consider pantalar arthrodesis
65
Q
Tibiotalocalcaneal Arthrodesis (TTC)
- Severe deformity
- Osteoporotic ankle fractures
- Complex failed ankle …
- Failed TAR
- * If TNJ / CCJ involved – consider pantalar …
A
- Severe deformity
- Osteoporotic ankle fractures
- Complex failed ankle fixation
- Failed TAR
- * If TNJ / CCJ involved – consider pantalar arthrodesis
66
Q
Tibiotalocalcaneal Arthrodesis (TTC)
- Severe deformity
- Osteoporotic ankle fractures
- Complex … ankle fixation
- Failed …
- * If TNJ / CCJ involved – consider pantalar arthrodesis
A
- Severe deformity
- Osteoporotic ankle fractures
- Complex failed ankle fixation
- Failed TAR
- * If TNJ / CCJ involved – consider pantalar arthrodesis
67
Q
Ankle “Sprains”
- … ligament
- Passes form anterior margin of the fibular malleolus, to the talus bone
A
- Lateral ligament
- Passes form anterior margin of the fibular malleolus, to the talus bone
68
Q
Ankle “Sprains”
- Lateral ligament
- Passes from anterior margin of the … malleolus, to the … bone
A
- Lateral ligament
- Passes form anterior margin of the fibular malleolus, to the talus bone
76
Q
After ankle sprain - may get Diagnosis of Chronic …
A
After ankle sprain, may be left with chronic instability - may get a diagnosis: Chronic Instability
77
Q
Diagnosis: Chronic Instability (ankle)
- Examine - … … draw (sulcus sign)
- Diagnose - further investigations - used to do stress …
but MRI more common now (very useful to demonstrate related pathology)
A
- Examine - positive anterior draw (sulcus sign)
- Diagnose - further investigations - used to do stress radiographs
but MRI more common now (very useful to demonstrate related pathology)
78
Q
Diagnosis: Chronic Instability (ankle)
- Examine - positive anterior draw (… sign)
- Diagnose - further investigations - used to do stress radiographs
but … more common now (very useful to demonstrate related pathology)
A
- Examine - positive anterior draw (sulcus sign)
- Diagnose - further investigations - used to do stress radiographs
but MRI more common now (very useful to demonstrate related pathology)
79
Q
Indications For Surgery - ankle sprain
- Do we in acute rupture?
- In chronic mechanical instability symptoms not responding to non operative rehabilitation?
A
- Do we in acute rupture? - no
- In chronic mechanical instability symptoms not responding to non operative rehabilitation? - yes
80
Q
Surgical Options - Ankle sprain
- … … tissue over eachother with … to tighten - sometimes tissue too flimsy = use anchors within bone to gain strength
- Can use … also - adjunct
- If fail - tendon transfer (peroneus brevis tendon)
A
- Double breast tissue over eachother with sutures to tighten - sometimes tissue too flimsy = use anchors within bone to gain strength
- Can use tapes also - adjunct
- If fail - tendon transfer (peroneus brevis tendon)
81
Q
Surgical Options - Ankle sprain
- Double breast tissue over eachother with sutures to tighten - sometimes tissue too flimsy = use … within bone to gain strength
- Can use tapes also - adjunct
- If fail - tendon transfer (… … tendon)
A
- Double breast tissue over eachother with sutures to tighten - sometimes tissue too flimsy = use anchors within bone to gain strength
- Can use tapes also - adjunct
- If fail - tendon transfer (peroneus brevis tendon)
82
Q
Hallux Valgus
- Hallux valgus - deformity - big toe into valgus
- Often called … - which is the prominent median eminence
- Commonly … finding
- Occur in females more than males
- Family history +/- …
- No symptom = no surgery
A
- Hallux valgus - deformity - big toe into valgus
- Often called bunion - prominent median eminence is the bunion
- Commonly incidental finding
- Occur in females more than males
- Family history +/- footwear
- No symptom = no surgery
83
Q
Hallux Valgus
- Hallux valgus - deformity - big toe into valgus
- Often called bunion - prominent median eminence is the bunion
- Commonly incidental finding
- Occur in … more than …
- … history +/- footwear
- No … = no surgery
A
- Hallux valgus - deformity - big toe into valgus
- Often called bunion - prominent median eminence is the bunion
- Commonly incidental finding
- Occur in females more than males
- Family history +/- footwear
- No symptom = no surgery
88
Q
Biomechanics - Hallux Valgus Deformity
- … deviation of the 1st ray (The first ray is the segment of the foot composed of the first metatarsal and first cuneiform bones)
A
- Medial deviation of the 1st ray (The first ray is the segment of the foot composed of the first metatarsal and first cuneiform bones)
89
Q
Dorsomedial Approach to the Great Toe (hallux valgus deformity)
- Position: …
- Landmarks: easily palpable 1st … joint
- Incision: Proximal to the IP joint and curve over the medial eminence staying medial to EHL
- Internervous Plane : none
- Dissection: divide fascia and then periosteum
- Dangers: i. Dorsal cutanous nerve ii. Extensor hallucis tendon iii, Flexor hallucis longus
A
- Position: Supine
- Landmarks: easily palpable 1st MTP joint
- Incision: Proximal to the IP joint and curve over the medial eminence staying medial to EHL
- Internervous Plane : none
- Dissection: divide fascia and then periosteum
- Dangers: i. Dorsal cutanous nerve ii. Extensor hallucis tendon iii, Flexor hallucis longus
90
Q
Dorsomedial Approach to the Great Toe (hallux valgus deformity)
- Position: Supine
- Landmarks: easily palpable 1st MTP joint
- Incision: … to the IP joint and curve over the … eminence staying medial to EHL
- Internervous Plane : none
- Dissection: divide fascia and then periosteum
- Dangers: i. Dorsal cutanous nerve ii. Extensor hallucis tendon iii, Flexor hallucis longus
A
- Position: Supine
- Landmarks: easily palpable 1st MTP joint
- Incision: Proximal to the IP joint and curve over the medial eminence staying medial to EHL
- Internervous Plane : none
- Dissection: divide fascia and then periosteum
- Dangers: i. Dorsal cutanous nerve ii. Extensor hallucis tendon iii, Flexor hallucis longus
91
Q
Dorsomedial Approach to the Great Toe (hallux valgus deformity)
- Position: Supine
- Landmarks: easily … 1st MTP joint
- Incision: Proximal to the IP joint and curve over the medial eminence staying medial to EHL
- Internervous Plane : none
- Dissection: divide … and then periosteum
- Dangers: i. Dorsal cutanous nerve ii. Extensor hallucis tendon iii, Flexor hallucis longus
A
- Position: Supine
- Landmarks: easily palpable 1st MTP joint
- Incision: Proximal to the IP joint and curve over the medial eminence staying medial to EHL
- Internervous Plane : none
- Dissection: divide fascia and then periosteum
- Dangers: i. Dorsal cutanous nerve ii. Extensor hallucis tendon iii, Flexor hallucis longus
92
Q
Dorsomedial Approach to the Great Toe (hallux valgus deformity)
- Position: Supine
- Landmarks: easily palpable … MTP joint
- Incision: Proximal to the IP joint and curve over the medial eminence staying medial to EHL
- Internervous Plane : none
- Dissection: divide fascia and then periosteum
- Dangers: i. Dorsal … nerve ii. Extensor … tendon iii, Flexor … longus
A
- Position: Supine
- Landmarks: easily palpable 1st MTP joint
- Incision: Proximal to the IP joint and curve over the medial eminence staying medial to EHL
- Internervous Plane : none
- Dissection: divide fascia and then periosteum
- Dangers: i. Dorsal cutanous nerve ii. Extensor hallucis tendon iii, Flexor hallucis longus
93
Q
Dorsomedial Approach to the Great Toe (hallux valgus deformity) - Dangers
- i. … … nerve ii. … hallucis tendon iii, … hallucis longus
A
- i. Dorsal cutanous nerve ii. Extensor hallucis tendon iii, Flexor hallucis longus
94
Q
Dorsomedial Approach to the Great Toe (hallux valgus deformity)
- Position: Supine
- Landmarks: easily palpable 1st MTP joint
- Incision: Proximal to the IP joint and curve over the medial eminence staying … to EHL
- Internervous Plane : …
- Dissection: divide fascia and then periosteum
- Dangers: i. Dorsal cutanous nerve ii. Extensor hallucis tendon iii, Flexor hallucis longus
A
- Position: Supine
- Landmarks: easily palpable 1st MTP joint
- Incision: Proximal to the IP joint and curve over the medial eminence staying medial to EHL
- Internervous Plane : none
- Dissection: divide fascia and then periosteum
- Dangers: i. Dorsal cutanous nerve ii. Extensor hallucis tendon iii, Flexor hallucis longus
