MIDTERM Classifications

Question 1

PHASE 1 of Luck classification

Answer 1

PROLIFERATIVE phase

fibroblasts, cellular activity

Question 2

PHASE 2 of Luck classification

Answer 2

ACTIVE phase

nodules form

Question 3

PHASE 3 of Luck classification

Answer 3

RESIDUAL phase

collagen maturation

Question 4

plantar fasciitis versus fasciosis

Answer 4

• fasciitis: more acute, INFLAMMATORY process
• fasciosis: more chronic, DEGENERATION of the fascia

Question 5

pirani classification:

purpose and total possible score

Answer 5

• assesses the severity by using a 6-point scoring system and 6 different physical exam findings.
• 3 points assess the midfoot deformity and 3 points assess the hindfoot deformity

Question 6

when performing the 6 Pirani physical exam findings,

what would be 0 points?

Answer 6

no abnormality

Question 7

when performing the 6 Pirani physical exam findings,

what would be 0.5 points?

Answer 7

moderate abnormality

Question 8

when performing the 6 Pirani physical exam findings,

what would be 1 point?

Answer 8

severe abnormality

Question 9

Tx for Pirani hindfoot score > 2

Answer 9

>83% requiring Achilles tenotomy

Question 10

Treatment for total Pirani score: 2-4

Answer 10

required a mean of 4 biweekly casts

Question 11

Treatment for total Pirani score of 4-6

Answer 11

required a mean of 7 biweekly casts

Question 12

dimeglio classification:

purpose and scoring system

Answer 12

• significant equinus indicates significant deformity/pathology,
  
  • more equinus = more points,
  • more plantarflexion of medial column = more points,
  • more varus = more points,
  • more internally rotated = more points
• 20-point scoring system after applying gentle corrective maneuver
• Rated I - IV based on total points

Question 13

dimeglio stage I

Answer 13

benign (<5 points),

soft-soft, resolving

Question 14

dimeglio stage II

Answer 14

moderate (5-9 points)

soft-stiff, reducible, partly resistant

Question 15

dimeglio stage III

Answer 15

severe (10-14 points), stiff-soft, resistant, partly reducible

Question 16

dimeglio stage IV

Answer 16

very severe (15-19 points),

stiff-stiff, resistant

Question 17

seddon classification: overview

Answer 17

• classification of nerve injury
• describes into:
  
  1. Neurapraxia
  2. Axonotmesis
  3. Neurotmesis

Question 18

neurapraxia

(seddon)

Answer 18

• conduction deficit without damage to the axon
• Least severe (contusion/compression)

Question 19

axonotmesis

(seddon)

Answer 19

• axon damage without endoneurial tube damage
  
  • Wallerian degeneration – degeneration of the axon distal to the injury
  • May cause muscle atrophy

Question 20

neurotmesis

(seddon)

Answer 20

• nerve severance with complete disruption of the endoneurial tube
• Most severe – irreversible with muscle atrophy

Question 21

sunderland classification:

purpose and overview

Answer 21

• classify peripheral nerve injuries PRODUCING LOSS OF FUNCTION
• 1st Degree - 5th Degree

Question 22

1st degree

(sunderland)

Answer 22

axon is preserved with temporary conduction block

Question 23

2nd degree

(sunderland)

Answer 23

axon is (reversibly) damaged,

but the endoneurial sheath is preserved

Question 24

3rd degree

(sunderland)

Answer 24

axon and endoneurial sheath are damaged,

but fasciculi (perineurium) are intact

Question 25

4th degree ## Footnote *(sunderland)*

Answer 25

nerve fascicule is destroyed and **only** held together by connective tissue

Question 26

5th degree ## Footnote *(sunderland)*

Answer 26

complete loss of nerve trunk continuity

Question 27

Johnson & Strom/Myerson Classification: purpose and scale

Answer 27

* classify severity of Tibialis Posterior Dysfunction (adult acquired flatfoot) * levels of severity * stage I * stage II * **IIa - IIe** * stage III * stage IV (added by myerson)

Question 28

stage 1 ## Footnote *(Johnson & Strom/Myerson)*

Answer 28

* **tenosynovitis with mild tendon degeneration** (normal length and function) * without osseous deformity and with flexible rearfoot, * **mild weakness of single heel raise**

Question 29

stage II ## Footnote *(Johnson & Strom/Myerson)*

Answer 29

* **tendonitis** (elongated with degeneration), * flexible rearfoot, * weak heel rise + too many toes sign

Question 30

stage III ## Footnote *(Johnson & Strom/Myerson)*

Answer 30

* longstanding deformity, * **_elongated and ruptured tendon,_** * rigid valgus rearfoot, * **marked weakness of single heel raise + too many toes sign**

Question 31

stage IV (*Johnson & Strom/Myerson)*

Answer 31

* same as **_stage III + rigid ankle valgus,_** * rigid deformity of the hindfoot with valgus tilt secondary to **deltoid insufficiency and spring ligament attenuation**

Question 32

stage IIA ## Footnote *(Johnson & Strom/Myerson)*

Answer 32

stage II tendonitis + **hindfoot valgus**

Question 33

stage IIB ## Footnote *(Johnson & Strom/Myerson)*

Answer 33

stage II tendonitis + **_flexible forefoot supination_**

Question 34

stage IIC ## Footnote *(Johnson & Strom/Myerson)*

Answer 34

stage II tendonitis + *_fixed_ forefoot supination*

Question 35

stage IID ## Footnote *(Johnson & Strom/Myerson)*

Answer 35

stage II tendonitis + **_forefoot abduction_**

Question 36

stage IIE ## Footnote *(Johnson & Strom/Myerson)*

Answer 36

stage II tendonitis + **_medial ray instability_**

Question 37

type I ## Footnote *(MRI classification of TP Dysfunction)*

Answer 37

**hypertrophic,** as tendon responds to injury

Question 38

type II ## Footnote *(MRI classification of TP Dysfunction)*

Answer 38

**candle wicking,** **_narrowing_** at point of injury as tendon stretches

Question 39

type III ## Footnote *(MRI classification of TP Dysfunction)*

Answer 39

full rupture (less common)

Question 40

**Stage I** * (Johnson & Strom/Myerson)* * Recommended Tx*

Answer 40

* **conservative treatment,** tenosynovectomy, tendon debridement * Generally wouldn’t inject tendon with steroids

Question 41

**Stage II** * (Johnson & Strom/Myerson)* * Recommended Tx*

Answer 41

* **tendon transfer, calcaneal osteotomies,** arthroeresis, medial column procedures, isolated rearfoot fusions * MC tx: _medial calcaneal slide (Kouts) and either a FDL transfer_ (or some other type of medial procedure, ex: Hoke)

Question 42

**Stage III** * (Johnson & Strom/Myerson)* * Recommended Tx*

Answer 42

* **isolated rearfoot arthrodesis, double arthrodesis, triple arthrodesis**

Question 43

**Stage IV** * (Johnson & Strom/Myerson)* * Recommended Tx*

Answer 43

**TTC arthrodesis, pantalar arthrodesis**