Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 2 - T3 Theme 2 > L17 Introduction to surgery of the foot and ankle > Flashcards

L17 Introduction to surgery of the foot and ankle Flashcards

1
Q

Why is the foot important

A
  • To ensure that we have a smooth gait cycle

- If foot anatomy is abnormal foot function is compromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Sections of the foot

A
  • Hindfoot
  • Midfoot
  • Forefoot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Basics of foot and ankle

A
  • Have a natural hindfoot valgus

- Further valgus your midfoot and forefoot will compensate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can the natural hindfoot valgus be achieved surgically

A

Tendons

  • Debridement
  • Tenodesis
  • Tendon transfer
  • Direct repair

Ligaments

  • Indirect repair
  • Tendon transfer

Bone

  • Osteotomy
  • Exostectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Aims of treating foot and ankle pathology

A

Is always to achieve a foot which is:

  • Painless
  • Plantigrade
  • Structurally normal
  • Functionally normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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 attaches to the calcaneal tuberosity

  • Largest and strongest tendon
  • Approx 15 cm in length
  • Plantarflexor of the foot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is the achilles heel vulnerable to pathology

A

Unlike other tendons, it has no tendon sheath

It is surrounded by a paratenon

It has a poor blood supply

Blood vascularity weakest at the bone-tendon interface

Blood supply weakest at 2 to 6 cm form the calcaneal attachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Achilles tendon - blood supply

A
  1. posterior tibial artery (proximal and distal section)

2. Peroneal artery (supplies midsection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When might achilles rupture occur

A
  • Occurs after a sudden forced plantarflexion to the foot

- Violent dorsiflexion in a planatar flexed foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where does the achilles rupture occur usually

A
  • Usually ruptures 4 to 6 cm above the calcaneal insertion in the hypovascular region
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Achilles rupture - treatment

A
  • In functional bracing
  • Surgery - end to end repair, VY advancement, failure to heal(tendon transfer)
  • Trendon used is the one closest in proximity - flexor hallucis longus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Surgical approach to the achilles

A
  • Patient is prone 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Structure to avoid during surgery of the achilles

A
  • Sural nerve laterally
  • Avoid going medial to flexor hallucis longus (FHL) (easily identifiable as has muscle fibres at this level) - neurovascular bundle medially
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Location of tibialis posterior tendon

A
  • Posterior aspect of interosseous membrane, fibula and tibia and has 9 insertions in the foot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tibialis posterior tendon - action

A
  • Plantarflexes the ankle joint
  • Principal invertor of the foot
  • Adductus and supinates the foot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tibilalis posterior tendon - arterial supply

A

Arterial supply from the posterior tibial, peroneal and sural

  • Has a watershed area around the medial malleoli
17
Q

Function of tibialis posterior tendon

A
  • Stabilise lower leg
  • Facilitates foot inversion
  • Supports the foot’s medial arch
  • Plays a critical role in hindfoot inversion during the gait cycle
18
Q

Presenting symptoms/signs of tibialis posterior insufficiency

A
  • Post-malleolar pain
  • Arch pain + aching
  • Progressive flat foot deformity
  • Forefoot problems: progressive hallux valgus, metatarsalgia, lesser toe deformities
  • Rarely, tarsal tunnel syndrome
19
Q

How might tibialis posterior insufficiency typically present

A
  1. Valgus hindfoot
  2. Acquired flatfoot
  3. forefoot abduction
20
Q

How might tibialis posterior insufficiency occur

A
  • Either the tendon ruptures or stretches
  • Only normally 1cm excursion so very little lengthening required to dysfunction
  • Tears occur in the hypovascular zone 3-5cm proximal to insertion
21
Q

What is the most common cause of adult acquired flat foot

A
  • Tibialis posterior insufficiency
22
Q

Causes of tibialis posterior insufficiency

A
  • Trauma
  • Chronic flat foot
  • Inflammatory arthropathy
  • Degenerative tendonopathy
23
Q

Two main groups affected by tibialis posterior insufficiency

A
  • younger patients aged 30-40 with inflammatory arthropathy

- Older, typically female patients 50-60 years old with degenerative tears

24
Q

Tibialis posterior insufficiency - complaints

A
  • Post-malleolar pain
  • Arch pain + aching
  • Progressive flat foot
  • Forefoot problems: progressive hallux valgus, metatarsalgia, lesser toe deformities
  • Rarely, tarsal tunnel syndrome
25
Q

Tibialis posterior insufficiency - examination

A
  • Gait
  • Planovalgus foot
  • Heel remains in valgus on double foot tiptoe standing
  • Post-malleolar tenderness/swelling with no palpable tendon on resisted plantar flexion/inversion
26
Q

Single foot tiptoe test

A

Cannot stand on tiptoe on single foot if tibialis posterior not functioning

  • Tight TA in hindfoot neutral
  • Hindfoot/forefoot malalignment and its degree of correctability
27
Q

Tibialis posterior insufficiency - treatment (non-surgical)

A
  • Analgesics
  • Shore wear modification
  • Orthortics - medial arch supports
  • Physiotherapy
28
Q

Tibialis posterior insufficiency treatment (surgery)

A
  • Reconstruction (tendon transfer)

- Fusion(if secondary arthritis)

29
Q

Surgical approach to tibialis posterior tendon

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 - avid damage to the long saphenous vein and nerve
Divide the retinaculum and identify the tibialis posterior tendon by pullling on it

FHL will plantart flex the freat toe and FDL will plantarflex the lesser toes

30
Q

Dangers of surgery on tibialis posterior tendon

A
  • Saphenous nerve and the tibialis posterior tendon are particularly vulnerable

Year 2 - T3 Theme 2 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions