Introduction to Surgery of the Foot and Ankle Flashcards

Question 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

Answer

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

Question 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 …

Answer

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

Question 3

Q

Why is the foot so important?

To ensure that we have a smooth … cycle
If foot anatomy is abnormal foot … is compromised

Answer

A

To ensure that we have a smooth gait cycle
If foot anatomy is abnormal foot function is compromised

Question 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

Answer

A

Have a natural hindfoot valgus
Further valgus your midfoot and forefoot will compensate
If you go into varus it will also compensate

Question 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

Answer

A

Have a natural hindfoot valgus
Further valgus your midfoot and forefoot will compensate
If you go into varus it will also compensate

Question 6

Q

How do we achieve this surgically? (natural hindfoot valgus)

Tendons
- Debridement
- Tenodesis
- Tendon …
- … repair
Ligaments
- … repair
- Tendon transfer
Bone
- …tomy
- …stectomy

Answer

A

Tendons
- Debridement
- Tenodesis
- Tendon transfer
- Direct repair
Ligaments
- Indirect repair
- Tendon transfer
Bone
- Osteotomy
- Exostectomy

Question 7

Q

How do we achieve this surgically? (natural hindfoot valgus)

Tendons
- …ment
- …
- … transfer
- Direct repair
Ligaments
- Indirect repair
- Tendon transfer
Bone
- Osteotomy
- Exostectomy

Answer

A

Tendons
- Debridement
- Tenodesis
- Tendon transfer
- Direct repair
Ligaments
- Indirect repair
- Tendon transfer
Bone
- Osteotomy
- Exostectomy

Question 8

Q

Aims of treating Foot and Ankle Pathology

Is always to achieve a foot which is :
- …
- Plantigrade
- … normal
- Functionally normal

Answer

A

Is always to achieve a foot which is :
- Painless
- Plantigrade
- Structurally normal
- Functionally normal

Question 9

Q

Aims of treating Foot and Ankle Pathology

Is always to achieve a foot which is :
- Painless
- …
- Structurally normal
- … normal

Answer

A

Is always to achieve a foot which is :
- Painless
- Plantigrade
- Structurally normal
- Functionally normal

Question 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

Answer

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

Question 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

Answer

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

Question 12

Q

Achilles tendon is approximately … cm in length

Answer

A

Achilles tendon is approximately 15 cm in length

Question 13

Q

Label the diagram

Question 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

Answer

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

Question 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

Answer

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

Question 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

Answer

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

Question 17

Q

Achilles tendon - Blood vascularity weakest at the … –tendon interface
Blood supply weakest at .. to … cm form the calcaneal attachment

Answer

A

Achilles tendon - Blood vascularity weakest at the bone –tendon interface
Blood supply weakest at 2 to 6 cm form the calcaneal attachment

Question 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

Answer

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

Question 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

Answer

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

Question 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

Answer

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

Question 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 … …

Answer

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

Question 22

Q

What is tendon transfer?

Answer

A

This procedure repositions the flexor hallucis longus tendon, (commonly called the “FHL” tendon) to reinforce a diseased Achilles tendon.

Question 23

Q

When is tendon transfer used?

Answer

A

This procedure repositions the flexor hallucis longus tendon, (commonly called the “FHL” tendon) to reinforce a diseased Achilles tendon.

Question 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

Answer

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

Question 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

Answer

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

Question 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

Answer

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

Question 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

Answer

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

Question 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

Answer

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

Question 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 …

Answer

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

Question 30

Q

What tendon is this?

Answer

A

Tibialis posterior tendon

Question 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

Answer

A

Stabilise lower leg
Facilitates foot inversion
Supports the foot’s medial arch
Plays a critical role in hindfoot inversion during the gait cycle

Question 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

Answer

A

Stabilise lower leg
Facilitates foot inversion
Supports the foot’s medial arch
Plays a critical role in hindfoot inversion during the gait cycle

Question 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

Answer

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

Question 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

Answer

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

Question 35

Q

Tibialis Posterior Insufficiency

Question 36

Q

Tibialis Posterior Insufficiency- Treatment

Non-surgical
- …
- … wear modification
- Orthotics- … arch supports
- Physiotherapy
Surgery
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)

Answer

A

Non-surgical
- Analgesics
- Shoe wear modification
- Orthotics - medial arch supports
- Physiotherapy
Surgery
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)

Question 37

Q

Tibialis Posterior Insufficiency- Treatment

Non-surgical
- Analgesics
- Shoe wear modification
- …- medial arch supports
- …therapy
Surgery
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)

Answer

A

Non-surgical
- Analgesics
- Shoe wear modification
- Orthotics- medial arch supports
- Physiotherapy
Surgery
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)

Question 38

Q

Tibialis Posterior Insufficiency- Treatment

Non-surgical
- Analgesics
- Shoe wear modification
- Orthotics- medial arch supports
- Physiotherapy
Surgery
- … (… transfer)
- … (if secondary arthritis)

Answer

A

Non-surgical
- Analgesics
- Shoe wear modification
- Orthotics- medial arch supports
- Physiotherapy
Surgery
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)

Question 39

Q

Tibialis Posterior Insufficiency- Treatment

Non-…
- Analgesics
- Shoe wear modification
- Orthotics - … arch supports
- Physiotherapy
…
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)

Answer

A

Non-surgical
- Analgesics
- Shoe wear modification
- Orthotics - medial arch supports
- Physiotherapy
Surgery
- Reconstruction (tendon transfer)
- Fusion (if secondary arthritis)

Question 40

Q

What are the two surgical options for tibialis posterior insufficiency?

Answer

A

reconstruction (tendon transfer) or fusion (if secondary arthritis)

Question 41

Q

Tibialis Posterior Dysfunction - Which tendon to use for the transfer?

Answer

A

Tibialis Posterior Dysfunction - Which tendon to use for the transfer? (flexor digitorum)

Question 42

Q

Surgical Approach to Tibialis Posterior tendon

Position: …
Landmark: Tip of medial … and the base of the …
Incision : 10 cm longitudinal incision from tip of MM
Internervous plane : None
Dissection : Avoid damage to the long saphenous vein and nerve
Divide the retinaculum and identify the tibialis posterior tendon by pulling on it
(FHL will plantar flex the great toe and FDL will plantarflex the lesser toes)
Dangers: Saphenous nerve and the tibialis posterior tendon are particularly vulnerable

Answer

A

Position: Supine
Landmark: Tip of medial malleoli and the base of the navicular
Incision : 10 cm longitudinal incision from tip of MM
Internervous plane : None
Dissection : Avoid damage to the long saphenous vein and nerve
Divide the retinaculum and identify the tibialis posterior tendon by pulling on it
(FHL will plantar flex the great toe and FDL will plantarflex the lesser toes)
Dangers: Saphenous nerve and the tibialis posterior tendon are particularly vulnerable

Question 43

Q

Surgical Approach to Tibialis Posterior tendon

Position: Supine
Landmark: Tip of medial malleoli and the base of the navicular
Incision : … cm longitudinal incision from tip of MM
Internervous plane : None
Dissection : Avoid damage to the long … vein and nerve
Divide the retinaculum and identify the tibialis posterior tendon by pulling on it
(FHL will plantar flex the great toe and FDL will plantarflex the lesser toes)
Dangers: Saphenous nerve and the tibialis posterior tendon are particularly vulnerable

Answer

A

Position: Supine
Landmark: Tip of medial malleoli and the base of the navicular
Incision : 10 cm longitudinal incision from tip of MM
Internervous plane : None
Dissection : Avoid damage to the long saphenous vein and nerve
Divide the retinaculum and identify the tibialis posterior tendon by pulling on it
(FHL will plantar flex the great toe and FDL will plantarflex the lesser toes)
Dangers: Saphenous nerve and the tibialis posterior tendon are particularly vulnerable

Question 44

Q

Surgical Approach to Tibialis Posterior tendon

Position: Supine
Landmark: Tip of … malleoli and the base of the navicular
Incision : 10 cm longitudinal incision from tip of MM
Internervous plane : None
Dissection : Avoid damage to the long saphenous vein and nerve
Divide the retinaculum and identify the tibialis posterior tendon by pulling on it
(FHL will plantar flex the … toe and FDL will plantarflex the … toes)
Dangers: Saphenous nerve and the … … tendon are particularly vulnerable

Answer

A

Position: Supine
Landmark: Tip of medial malleoli and the base of the navicular
Incision : 10 cm longitudinal incision from tip of MM
Internervous plane : None
Dissection : Avoid damage to the long saphenous vein and nerve
Divide the retinaculum and identify the tibialis posterior tendon by pulling on it
(FHL will plantar flex the great toe and FDL will plantarflex the lesser toes)
Dangers: Saphenous nerve and the tibialis posterior tendon are particularly vulnerable

Question 45

Q

Danger of surgical approach to tibialis posterior tendon - … nerve and the tibialis posterior tendon are particularly vulnerable

Answer

A

Danger of surgical approach to tibialis posterior tendon - Saphenous nerve and the tibialis posterior tendon are particularly vulnerable

Question 46

Q

Tibialis Posterior Dysfunction

Identifying it

Question 47

Q

Ankle Arthritis

Usually post-…
Presentation:
- Pain
- …
- Deformity

Answer

A

Usually post-traumatic
Presentation:
- Pain
- Swelling
- Deformity

Question 48

Q

Ankle Arthritis

Usually post-traumatic
Presentation:
- …
- Swelling
- …

Answer

A

Usually post-traumatic
Presentation:
- Pain
- Swelling
- Deformity

Question 49

Q

Pathology - Ankle Arthritis

Nasty … – cartilage damage
Malalignment – leads to abnormal loading
… altered in the ankle joint
Leads to abnormal point loading
Eventual joint space narrowing and pain

Answer

A

Nasty fracture – cartilage damage
Malalignment – leads to abnormal loading
Biomechanics altered in the ankle joint
Leads to abnormal point loading
Eventual joint space narrowing and pain

Question 50

Q

Pathology - Ankle Arthritis

Nasty fracture – cartilage damage
… – leads to abnormal loading
Biomechanics altered in the ankle joint
Leads to abnormal … loading
Eventual joint space narrowing and pain

Answer

A

Nasty fracture – cartilage damage
Malalignment – leads to abnormal loading
Biomechanics altered in the ankle joint
Leads to abnormal point loading
Eventual joint space narrowing and pain

Question 51

Q

Pathology - Ankle Arthritis

Nasty fracture – cartilage damage
Malalignment – leads to abnormal …
Biomechanics altered in the ankle joint
Leads to abnormal point loading
Eventual joint space … and pain

Answer

A

Nasty fracture – cartilage damage
Malalignment – leads to abnormal loading
Biomechanics altered in the ankle joint
Leads to abnormal point loading
Eventual joint space narrowing and pain

Question 52

Q

Pathology - Ankle Arthritis

Nasty fracture – cartilage …
… – leads to abnormal loading
Biomechanics altered in the ankle joint
Leads to abnormal point loading
Eventual joint space narrowing and pain

Answer

A

Nasty fracture – cartilage damage
Malalignment – leads to abnormal loading
Biomechanics altered in the ankle joint
Leads to abnormal point loading
Eventual joint space narrowing and pain

Question 53

Q

Surgical Management of Ankle Arthritis

Failed medical / non-operative control…………
“Early” disease - joint …
- Arthroscopy (or open procedure)
  - Debridement / synovectomy
“Late” disease – joint … or replacement
- Arthrodesis (fusion)
- Arthroplasty (replacement)
- Excision Arthroplasty (excision joint)

Answer

A

Failed medical / non-operative control…………
“Early” disease - joint preservation
- Arthroscopy (or open procedure)
  - Debridement / synovectomy
“Late” disease – joint abolition or replacement
- Arthrodesis (fusion)
- Arthroplasty (replacement)
- Excision Arthroplasty (excision joint)

Question 54

Q

Surgical Management of Ankle Arthritis

Failed medical / non-operative control…………
“…” disease - joint preservation
- Arthroscopy (or open procedure)
  - Debridement / synovectomy
“…” disease – joint abolition or …
- Arthrodesis (…)
- Arthroplasty (replacement)
- Excision Arthroplasty (excision joint)

Answer

A

Failed medical / non-operative control…………
“Early” disease - joint preservation
- Arthroscopy (or open procedure)
  - Debridement / synovectomy
“Late” disease – joint abolition or replacement
- Arthrodesis (fusion)
- Arthroplasty (replacement)
- Excision Arthroplasty (excision joint)

Question 55

Q

Surgical Management of Ankle Arthritis

Failed medical / non-operative control…………
“Early” disease - joint preservation
- Arthroscopy (or open procedure)
  - … / synovectomy
“Late” disease – joint abolition or replacement
- Arthrodesis (fusion)
- … (replacement)
- Excision … (excision joint)

Answer

A

Failed medical / non-operative control…………
“Early” disease - joint preservation
- Arthroscopy (or open procedure)
  - Debridement / synovectomy
“Late” disease – joint abolition or replacement
- Arthrodesis (fusion)
- Arthroplasty (replacement)
- Excision Arthroplasty (excision joint)

Question 56

Q

Ankle Arthroplasty

… relief
Preservation of joint …
Preservation of function
Polyarthropathy; Subtalar / Triple complex
- Compare with ankle arthrodesis

Answer

A

Pain relief
Preservation of joint mobility
Preservation of function
Polyarthropathy; Subtalar / Triple complex
- Compare with ankle arthrodesis

Question 57

Q

Ankle Arthroplasty

Pain relief
Preservation of joint mobility
Preservation of …
…; Subtalar / Triple complex
- Compare with ankle …

Answer

A

Pain relief
Preservation of joint mobility
Preservation of function
Polyarthropathy; Subtalar / Triple complex
- Compare with ankle arthrodesis

Question 58

Q

Ankle Fusion/ Arthrodesis

Indications
- … Relief
- Severe …
- TAR not appropriate

Answer

A

Indications
- Pain Relief
- Severe Deformity
- TAR not appropriate

Question 59

Q

Ankle Fusion/ Arthrodesis

Indications
- Pain Relief
- Severe Deformity
- … not appropriate

Answer

A

Indications
- Pain Relief
- Severe Deformity
- TAR not appropriate

Question 60

Q

Anterior Approach to the Ankle for TAR

Position : …
Landmarks: Both the … which are subcutaneous
Incision : 15 cm longitudinal incision midway between the malleoli
Internervous Plane: None
Intermuscular plane : Between EHL and EDL ( both supplied by deep peroneal but receive their supply proximal to the incision)
Dissection : Find the … bundle and mobilise laterally
Dangers: i. Superficial peroneal nerve ii. Deep peroneal nerve iii. Anterior tibial artery

Answer

A

Position : Supine
Landmarks: Both the malleoli which are subcutaneous
Incision : 15 cm longitudinal incision midway between the malleoli
Internervous Plane: None
Intermuscular plane : Between EHL and EDL ( both supplied by deep peroneal but receive their supply proximal to the incision)
Dissection : Find the neurovascular bundle and mobilise laterally
Dangers: i. Superficial peroneal nerve ii. Deep peroneal nerve iii. Anterior tibial artery

Question 61

Q

Anterior Approach to the Ankle for TAR

Position : Supine
Landmarks: Both the malleoli which are sub…
Incision : … cm longitudinal incision midway between the malleoli
Internervous Plane: None
Intermuscular plane : Between EHL and EDL ( both supplied by deep peroneal but receive their supply proximal to the incision)
Dissection : Find the neurovascular bundle and mobilise …
Dangers: i. Superficial peroneal nerve ii. Deep peroneal nerve iii. Anterior tibial artery

Answer

A

Position : Supine
Landmarks: Both the malleoli which are subcutaneous
Incision : 15 cm longitudinal incision midway between the malleoli
Internervous Plane: None
Intermuscular plane : Between EHL and EDL ( both supplied by deep peroneal but receive their supply proximal to the incision)
Dissection : Find the neurovascular bundle and mobilise laterally
Dangers: i. Superficial peroneal nerve ii. Deep peroneal nerve iii. Anterior tibial artery

Question 62

Q

Anterior Approach to the Ankle for TAR

Position : Supine
Landmarks: Both the malleoli which are subcutaneous
Incision : 15 cm longitudinal incision midway between the malleoli
… Plane: None
… plane : Between EHL and EDL (both supplied by deep peroneal but receive their supply proximal to the incision)
Dissection : Find the neurovascular bundle and mobilise laterally
Dangers: i. Superficial … nerve ii. Deep … nerve iii. Anterior tibial artery

Answer

A

Position : Supine
Landmarks: Both the malleoli which are subcutaneous
Incision : 15 cm longitudinal incision midway between the malleoli
Internervous Plane: None
Intermuscular plane : Between EHL and EDL ( both supplied by deep peroneal but receive their supply proximal to the incision)
Dissection : Find the neurovascular bundle and mobilise laterally
Dangers: i. Superficial peroneal nerve ii. Deep peroneal nerve iii. Anterior tibial artery

Question 63

Q

Anterior Approach to the Ankle for TAR - dangers (Which nerves (2) and artery)

Answer

A

Dangers: i. Superficial peroneal nerve ii. Deep peroneal nerve iii. Anterior tibial artery

Question 64

Q

Tibiotalocalcaneal Arthrodesis (TTC)

Severe …
… ankle fractures
Complex failed ankle fixation
Failed TAR
* If TNJ / CCJ involved – consider pantalar arthrodesis

Answer

A

Severe deformity
Osteoporotic ankle fractures
Complex failed ankle fixation
Failed TAR
* If TNJ / CCJ involved – consider pantalar arthrodesis

Answer 62

A

Severe deformity
Osteoporotic ankle fractures
Complex failed ankle fixation
Failed TAR
* If TNJ / CCJ involved – consider pantalar arthrodesis

Answer 63

A

Severe deformity
Osteoporotic ankle fractures
Complex failed ankle fixation
Failed TAR
* If TNJ / CCJ involved – consider pantalar arthrodesis

Answer 64

A

Lateral ligament
Passes form anterior margin of the fibular malleolus, to the talus bone

Answer 65

A

Lateral ligament
Passes form anterior margin of the fibular malleolus, to the talus bone

Answer 66

A

In ankle ‘sprain’ ligaments affected (+posterior talofibular)
- Weakest and commonly injured
- Commonly gets bruised and stretched during inversion injuries
- Prevents talar tilt
- If weak then the ankle feels unstable
- Positive anterior drawer test
- Positive talar tilt test

Answer 67

A

In ankle ‘sprain’ ligaments affected (+posterior talofibular)
- Weakest and commonly injured
- Commonly gets bruised and stretched during inversion injuries
- Prevents talar tilt
- If weak then the ankle feels unstable
- Positive anterior drawer test
- Positive talar tilt test

Answer 68

A

In ankle ‘sprain’ ligaments affected (+posterior talofibular)
- Weakest and commonly injured
- Commonly gets bruised and stretched during inversion injuries
- Prevents talar tilt
- If weak then the ankle feels unstable
- Positive anterior drawer test
- Positive talar tilt test

Answer 69

A

Majority sprains recover within 3 months
Beware the sprain that persists…..
Back to basics – clinical reassessment

Answer 70

A

RICE (REST ICE COMPRESSION ELEVATION)
Physiotherapy directed rehabilitation
- Loading injured ligaments
- Proprioception
- Strength and return to function

Answer 71

A

RICE (REST ICE COMPRESSION ELEVATION)
Physiotherapy directed rehabilitation
- Loading injured ligaments
- Proprioception
- Strength and return to function

Answer 72

A

After ankle sprain, may be left with chronic instability - may get a diagnosis: Chronic Instability

Answer 73

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)

Answer 74

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)

Answer 75

A

Do we in acute rupture? - no
In chronic mechanical instability symptoms not responding to non operative rehabilitation? - yes

Answer 76

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)

Answer 77

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)

Answer 78

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

Answer 79

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

Answer 80

A

Pain
Deformity
Modification of shoe wear
Nerve irritation
Lesser toe deformity

Answer 81

A

Pain
Deformity
Modification of shoe wear
Nerve irritation
Lesser toe deformity

Answer 82

A

Non- Surgical
Surgical
Bunionectomy
Osteotomy
- Proximal
- Metatarsal shaft
- Distal
Ist TMT joint fusion
Technique used depends on the cause and the amount of correction required

Answer 83

A

Non- Surgical
Surgical
Bunionectomy
Osteotomy
- Proximal
- Metatarsal shaft
- Distal
Ist TMT joint fusion
Technique used depends on the cause and the amount of correction required

Answer 84

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)

Answer 85

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

Answer 86

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

Answer 87

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

Answer 88

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

Answer 89

A

i. Dorsal cutanous nerve ii. Extensor hallucis tendon iii, Flexor hallucis longus

Answer 90

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

Answer 91

A

Do not rely on x rays to define the injury
History taking and examination is the key to an accurate diagnosis
Think of the anatomy to understand the pathology
Exhaust non-surgical options first before considering surgical intervention
Before you operate : think of using the best surgical approach for that case