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BSMS 204- Theme 2 > L12- Introduction to surgery of foot and ankle > Flashcards

L12- Introduction to surgery of foot and ankle Flashcards

1
Q

What are the aims of treating foot and ankle patholgy?

A

Is always to achieve a foot which is:

  • Painless
  • Plantigrade
  • Structurally normal
  • Functionally normal
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2
Q

What is achilles tendon?

A
  • Aka heel cord
  • the gastrocnemius, soleus and plantaris muscle unites to form a band of fibrous tissue which becomes the achilles tendon which attached to the calcaneal tuberosity
  • Largest and strongest tendon
  • Approximately 15cm in length
  • Plantarflexor of the foot
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3
Q

Why is the achilles tendon more prone to damage?

A
  • Unlike other tendons it has no sheath
  • it is surrounded by paratenon
  • poor blood supply
  • Blood vascularity weakest at the bone
  • Blood supply weakest at 2 to 6 cm form the calcaneal attachment
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4
Q

Why does the achilles tendon rupture?

A
  • Occurs after a sudden forced plantarflexion to the foot
  • Violent dorsiflexion in a plantar flexed foot
  • Usually ruptures 4-6 cm above the calcaneal insertion in the hypovascular region
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5
Q

What are the achilles rupture treatment?

A
  • In functional bracing
  • surgery: end to end repair
  • VY advancement
  • Failure to heal- tendon transfer
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6
Q

Which tendon is used for repair?

A

Tendon that is used is one closest in proximity- Flexor hallucis longus

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7
Q

What are the surgical approaches to the achilles?

A
  • Patient is prone or in lazy lateral position
  • Landmarks: the malleoli and the achillies tendon- which is easily palpable
  • Incision: Longitudinal- slightly medially based (but can go laterally as well)
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8
Q

Which structures are the to avoid during the achillies surgery?

A
  • Sural nerve laterally
  • avoid going medial to flexor hallucis longus
  • Neurovascular bundle medially
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9
Q

Describe the position of tibialis posterior tendon?

A

-Posterior aspect of interosseous membrane, fibula, and tibia and has 9 insertions in the foot

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10
Q

Describe the actions of Tibialis posterior tendon?

A
  • Plantarflexes the ankle joint
  • principle invertor of the foot
  • adducts and suppinates the foot
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11
Q

Describe the arterial supply to the tibialis posterior tendon?

A
  • Arterial supply from the posterior tibial, peroneal

- Nerve supply from sural nerve

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12
Q

What are the functions of tibialis posterior tendon?

A
  • Stabilise lower leg
  • facilitates foot inversion
  • supports the foot’s medial arch
  • plays a critical in hindfoot
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13
Q

What are the signs and symptoms of tibialis posterior insufficiency?

A
  • Post malleolar pain
  • arch pain + aching
  • Progressive flat foot deformity
  • progressive flat foot deformity
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14
Q

What are the forefoot problems?

A
  • Progressive hallux valgus, metatarsalgia, lesser toe deformaties
  • Rarely tarsal tunnel syndrome
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15
Q

What are the treatment options for tibialis posterior insufficiency?

A

1) Non surgical:
- Analgesics
- Shoe wear modification
- Orthotics: medial arch support
- Physiotherapy
2) Surgery
- Reconstruction
- Fusion (if secondary arthritis)

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16
Q

What is the reason ankle arthritis?

A

-Usually post traumatic

17
Q

Describe the typical presentation of ankle arthritis?

A
  • pain
  • swelling
  • deformity
18
Q

Describe the typical pathology of ankle arthiritis?

A
  • Nasty fracture: cartilage damage
  • Malalighnment- leads to abnormal loading
  • Biomechanics: altered in the ankle joint
  • Leads to abnormal point loading
  • Eventual joint space narrowing and pain
19
Q

What are the surgical management of ankle arthiritis?

A
  • Failed medical/non-operative control
    1) Early disease: joint preservation
  • Arthroscopy (open procedure)
  • Debridement/synovectomy
    2) Late disease: Joint abolition or replacement
  • Arthrodesis (fusion)
  • Arthroplasty (replacement)
  • Excision arthroplasty (excision joint)
20
Q

What are the purpose of the ankle arthroplasty?

A
  • Pain relief
  • Preservation of joint mobility
  • Preservation of function
  • Polyarthropathy; subtalar/triple complex
21
Q

What are the indication for ankle fusion?

A
  • Pain relief
  • Severe deformity
  • TAR not appropriate
22
Q

What are the indications of tibiotalocalcaneal arthrodesis (TTC)?

A
  • Severe deformity
  • Osteoporotic ankle fracture
  • Complex failed ankle fixation
  • Failed TAR
23
Q

What is the main ligament that may be responsible for ankle sprain?

A
  • Lateral ligament
  • Passed from anterior margin of the fibular melleolus to the talus bone.
  • Includes 3 ligaments:
  • Anterior talofibular (ATFL)
  • Calcaneofibular (CFL)
  • Posterior talofibular
24
Q

What are the roles of ATFL/CFL in ankle sprains?

A
  • Weakest/commonly injured

- commonly gets bruised and stretched during inversion injuries

25
Q

What happens when ATFL/CFL are weak?

A
  • Prevents talar tilt

- If weak then the ankle feels unstable

26
Q

What are the tests to check the integrity of ATFl/CFL?

A
  • Positive anterior drawer test

- positive talar tilt test

27
Q

What is the prognosis of ankle sprains?

A
  • Majority sprains recover within 3 months

- Beware the sprain that persists

28
Q

Describe the treatment options for acute lateral ligament sprain?

A
  • RICE
  • Physiotherapy directed rehab
  • Loading injured ligaments
  • proprioception
  • Strength and return to function
29
Q

How is the diagnosis of chronic instability diagnosed?

A
  • Via examination

- Positive anterior draw

30
Q

What are the further investigations required to confirm the diagnosis of chronic instability?

A
  • Stress radiographs

- MRI- very useful to demonstrate related pathology

31
Q

when is the surgery considered for chronic instabilty?

A
  • Acute rupture

- Chronic mechanical instability symptoms not responding to non-operative rehab

32
Q

Which surgery is the most suitable?

A

-Tendon transfer

33
Q

describe the presentation of hallux valgus?

A
  • common incidental finding
  • female>male
  • Family history +/- footwear
  • If no symptoms then no surgery
34
Q

What are the preseting symptom/signs of hallux valgus?

A
  • Pain
  • Defority
  • Modification of shoe wear
  • Nerve irritation
  • Lesser toe deformity
35
Q

What are the treatment options for hallux valgus?

A

1) Non surgical
2) Surgical
- bunionectomy
- osteotomy

36
Q

Which surgical techniques are used for osteotomy?

A

-proximal
-metatarsal shaft
-distal
-1st TMT joint fusion
Techniques depend on the cause and the amount of correction required

BSMS 204- Theme 2 (5 decks)

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