Brainscape's Knowledge GenomeTM

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


See full index

Biomechanics & Surgery Exam 3 > Metatarsalgia > Flashcards

Metatarsalgia Flashcards

1
Q

what is metatarsalgia?

A

forefoot pain under metatarsal heads

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

what are some bony causes of metatarsalgia?

A
  • long metatarsal
  • plantarflexed met
  • hammertoe
  • enlarged met head
  • arthritis
  • Freiberg’s infarction
  • stress fx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are some soft tissue causes of metatarsalgia?

A
  • calluses
  • neuroma
  • capsulitis
  • plantar plate pathology
  • hypermobile 1st ray
  • equinus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are indications for metatarsal osteotomies?

A
  • long metatarsal
  • plantarflexed metatarsal
  • contracted digit that cannot be reduced w/o dec metatarsal length
  • angular deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are contraindications for metatarsal osteotomies?

A
  • pain of unknown etiology
  • parabola correction w/o underlying pain or sx
  • severe osteopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are contraindications for metatarsal osteotomies?

A
  • pain of unknown etiology
  • parabola correction w/o underlying pain or sx
  • severe osteopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the weil osteotomy?

A

a shortening osteotomy where you make a cut parallel to WB surface at cartilage surface, causing the soft tissue to shrink back

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

when is the plantar condylectomy procedure used?

A
  • used in older patients w/ prominent metatarsal head due to fat pad atrophy
  • used in diabetic patients with chronic callus/ulcer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when is the V metatarsal osteotomy indicated?

A

for a purely plantarflexed metatarsal and you just want to raise it up

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

what are two procedures that correct a plantarflexed metatarsal?

A
  1. V metatarsal osteotomy

2. dorsiflexory wedge osteotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the indications for a weil osteotomy?

A

long metatarsal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

for distal procedures, what is the post-op directions?

A

WB in post-op shoe for 6 weeks if fixated

if not fixated, may consider NWB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

for proximal procedures, what is the post-op directions?

A

NWB for 6-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are complications of metatarsal osteotomy?

A
  • floating toe
  • transfer lesions onto adjacent met heads
  • delayed or nonunions w/o fixation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is freiberg’s ifnarction?

A

avascular necrosis of the 2nd metatarsal head leading to collapses of articuarl sruface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what do late changes of freiberg’s infarction look like on radiographs?

A

flattening of met head, spurring, sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

conservative treatment for freiberg’s infarction?

A
  • initially: immobilization

- chronic tx: steroid injection, rocker bottom shoes, carbon plate for shoes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

surgical treatment for freiberg’s infarction?

A
  • metatarsal head resection
  • graft
  • implant
19
Q

how do you diagnose stress fracture?

A
  • pain with palpation dorsally
  • pain with tuning fork application over the site itself
  • may have edema
  • initial x-rays negative
  • bone scan will have uptake in 3rd phase
20
Q

conservative treatment for stress fx?

A

-immobilize in boot or post-op shoe for 4-6 weeks

21
Q

surgical treatment for stress fx?

A

only done if it goes to full fracture or there is excessive callus formation

22
Q

s/s of neuroma?

A
  • burning pain
  • tingling/numbness
  • wrinkled sock sensation
  • sharp or radiating pain to toes
  • symptoms worse with tight shoes
23
Q

which interspace is commonly affected (aka Morton’s neuroma) and why?

A

3rd interspace

bc of communicating branch btwn medial and lateral plantar nerves

24
Q

what physical exam findings do you expect with morton’s neuroma?

A
  • pain on direct palpation to intersapce
  • Mulder’s sign: a palpable click is heard when you squeeze forefoot while applying plantar and dorsal pressure
  • gauthier test: pain with just squeezing foot
  • usually no edema noted
25
Q

what diagnostic testing do you need for a neuroma?

A

(usually not necessary)

  1. x-rays to rule out stress fx; Sullivan’s sign
  2. ultrasound: ovoid mass with hypoechoic signal
  3. MRI- T1 image is best
26
Q

what is sullivan’s sign?

A

splaying of toes in the involved interspace when WB

27
Q

conservative treatment options on neuroma?

A
  • wider shoes
  • metatarsal pad
  • steroid injection
  • sclerosing injection
28
Q

what are the advatnages of a dorsal incision for a surgical tx for neuroma?

A
  • immediate WB

- no plantar scar or wound dehiscence

29
Q

what are teh disadvantages of a dorsal incision for a surgical treatment for neuroma?

A

need meticulous dissection (can lead to hematoma or hammertoe formation)

30
Q

what is the advantages of plantar incision for surgical tx of neuroma?

A
  • better visualization

- less incidence of hematoma and hamemrtoe formation

31
Q

what are the disadvantages of plantar incision?

A

NWB for 3 weeks

-potential plantar scar

32
Q

plantar plate pathology commonly affects which metatarsal?

A

2nd met (bc it is the longest)

33
Q

s/s of plantar plate pathology?

A
  • pain worse w/ walking
  • feels like walking on a stone bruise
  • change in position of toes (medial deviation is common)
34
Q

etiologies of plantar plate?

A
  • long 2nd met/ short 1st met
  • 1st ray hypermobility
  • overloading due to equinus or high heels
35
Q

what are the physical exam findings of plantar plate pathology?

A
  • pain w/ palpation directily plantar at joint line
  • focal edema over joint
  • possible loss of purchase of toe
  • vertical stress test
36
Q

what is vertical stress test?

A

(for plantar plate pathology)

is (+) with 2mm or more displacement of the toe

37
Q

what is stage 1 of predislocation syndrome (aka plantar plate pathology)?

A
  • mild edema dorsal and plantar
  • very painful
  • joint is still aligned
38
Q

what occurs in stage 2 of predislocation syndrome?

A
  • moderate edema
  • deviaition of digit both clinically and radiographically
  • loss of toe purchase, noticeable in WB
39
Q

what occurs in stage 3 predislcoation syndrome?

A

-moderate edema
-subluxation/ dislocation is pronounced
-

40
Q

how does the bone scan compare between plantar plate tear and stress fx?

A

will be (-) in phase 3 of plantar plate tear but (+) for stress fx bc it of bone involvement

41
Q

conservative tx for plantar plate tears?

A
  • metatarsal pads
  • budin splint
  • crossover taping
  • NSAIDs
  • ice, stiff shoes, CAM boot
42
Q

surgical treatment for plantar plate tear?

A

-direct repair
-indirect stabilization
(in addition, may fuse PIPJ or do metatarsal osteotomy; may even do 2nd MPJ fusion)

43
Q

describe the direct repair for a plantar plate tear.

A

can be a dorsal or plantar incision, although most people approach it from plantar side. The tear is usually on the phalanx side; can suture end-to-end or use anchor in proximal phalanx base. stabilize with K-wire.
*post-op: NWB for 3 wks

44
Q

describe the indirect repair of plantar plate tear.

A
  1. isolate flexor tendon and split in half, bring up over toe and suture to itself and periosteum dorsally
  2. isolate tendon and insert into bone and secure to itself, periosteum, or use anchor

Biomechanics & Surgery Exam 3 (11 decks)

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