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Foot & Ankle > Miller's Review Foot and Ankle > Flashcards

Miller's Review Foot and Ankle Flashcards

Ortho Foot and Ankle Review

1
Q

Deforming forces in hallux valgus

A

Abductor hallucis migrates plantar to MT head, 1st MT head migrates medial, EHL is now lateral to 1st MT and pronates it and pulls it into more valgus, lateral migration of the sesamoids erode the crista and allow further deformity

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2
Q

HVA

A

<15

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3
Q

IMA

A

<9

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4
Q

HVI

A

<10

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5
Q

DMAA

A

<10

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6
Q

Three types of hallux valgus deformities

A

Congruent = DMAA <10, Incongruent = DMAA >10 and degenerative

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7
Q

Treatment of incongruent bunion with stable 1st MT, IMA <13 and HVA <40

A

Distal metatarsal osteotomy

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8
Q

Treatment of incongruent bunion with stable 1st MT, IMA >13 and HVA >40

A

Proxial 1st MT osteotomy

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9
Q

Treatment of incongruent bunion with unstable 1st MT, IMA >13 and HVA >40

A

Lapidus

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10
Q

Indication for biplanar distal chevron osteotomy

A

Congruent DMAA with IMA <13, HVA<40 and stable 1st MTP joint. Can also consider an Akin.

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11
Q

Indication for double 1st MT osteotomy

A

Congruent DMAA with IMA >13, HVA >40 and stable 1st MTP joint. Can also consider Akin.

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12
Q

Is risk of AVN increased with distal osteotomy and lateral capsule release?

A

No, this was debunked.

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13
Q

Risks for post-bunionectomy hallux valgus

A

Excision of the fibular sesamoid, overcorrection of the IMA or excessive lateral release.

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14
Q

Techniques for correcting hallux varus

A

If it’s flexible can try taping. If that doesn’t work, then can transfer extensor tendon through IM membrane and medial capsule release. It may require distal osteotomy if increased DMAA.

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15
Q

Management of hallux rigidus

A

Non-op = extra depth shoes, Morton extension brace

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16
Q

Position of fusion of 1st MTP joint

A

Neutral rotation, 10-15 dorsiflexed and 5 of valgus

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17
Q

What is a hammertoe

A

MTP extended, PIP flexed, DIP extended

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18
Q

What is a claw toe

A

MTP extended, PIP and DIP flexed. This can start with volar plate laxity, MTP extended by EDL pull and FDL flexes PIP and DIP joints.

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19
Q

What is a mallet toe?

A

Isolated DIP flexion

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20
Q

What causes crossover toe?

A

Plantar plate attenuates, then collateral ligament attenuates

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21
Q

Hammertoe treatment algorithm

A

Fixed = PIP arthroplasty/arthrodesis, EDL lengthening if flexion >15 degrees

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22
Q

Mallet toe treatment algorithm

A

Doesn’t matter fixed or flexible.

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23
Q

Claw toe treatment algorithm

A

Fixed: PIP arthroplasty/arthrodesis, EDL lengthening, MTP capsulotomy +/- Weil shortening osteotomy to address MTP dislocation

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24
Q

Crossover toe treatment

A

EDB transfer to lateral lax MTP capsule and medial capsule release, FDL -> EDL transfer +/- Weil osteotomy

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25
Q

Etiology of Freiberg infraction

A

AVN of 2nd MT head can occur from trauma, long 2nd MT head and overload

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26
Q

Natural history of Freiberg infraction

A

Central subchondral bone resorption, flattening, collapse and arthritis.

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27
Q

Freiberg infraction treatment

A

Rigid Morton extension orthotic. If that fails, can do a dorsal closing wedge osteotomy to remove diseased bone and rotate preserved plantar cartilage into the joint. Cutting out the 2nd MT head isn’t the correct answer because you’ll get transfer metatarsalgia (unless RA).

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28
Q

Types of bunionette deformity and treatment

A

I) bump, distal chevron osteotomy and lateral capsule release II) congenital lateral bow, oblique diaphyseal MT osteotomy III) IMA > 8 degrees, oblique diaphyseal MT osteotomy. Can’t do proximal osteotomy due to vascular watershed.

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29
Q

Classification and management of turf toe

A

I) Strain, stiff insole, taping and immediate return to play

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30
Q

Complications of hallux sesamoid excision

A

Tibial excision = hallux valgus.

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31
Q

Management of chronic cock up toe deformity from neglected turf toe

A

Fuse the contracted IP joint and transfer FHL to the base of the proximal phalanx to restore push off power

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32
Q

Most common location of Morton’s neuroma

A

3rd webbed space between the rigid and flexible 3rd and 4th MT heads

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33
Q

Management of Morton’s neuroma

A

Injections (only 14% get relief), no high heels, wide toe box, MT pads.

34
Q

How far do you need to resect a Morton’s neuroma to minimize recurrence?

A

3cm proximal to MT heads, must incise transverse metatarsal ligament to visualize and resect. Recurrent or inadequately excised neuromas need to be exposed through a plantar incision.

35
Q

Risk factor for Jones fracture and failure of fixation

A

Hindfoot varus, if supple should do orthotic with lateral post

36
Q

Management of zone III base of 5th MT fractures

A

Typically from stress fracture, higher risk of non-union (33%), treat with IM screw

37
Q

Most and least rigid midfoot columns

A

Most rigid = intermediate (<1mm movement), lease rigid = lateral (13mm), medial column ~ 3mm dorsal plantar translation

38
Q

Best diagnostic test for midfoot arthritis

A

Piano key

39
Q

Management of midfoot arthritis

A

Stiff shank shoe with rocker bottom for push off

40
Q

Non-operative management in Lisfranc injury

A

Only indicated if there is no displacement on weight bearing radiographs, stress radiographs and no bony injury (i.e. likely ligament strain). NWB x 6 weeks, repeat x-rays before return to sport

41
Q

Operative management in bony vs ligamentous Lisfranc

A

Ligamentous Lisfrancs do better with primary arthrodesis. If bony with associated fracture, can do primary ORIF.

42
Q

X-ray needed for accessory navicular

A

External oblique foot x-ray

43
Q

Typical navicular stress fracture orientation

A

Dorsolateral to plantarmedial, screws are placed lateral to medial to capture the best medial bone

44
Q

Non-op management of navicular stress fracture

A

NWB 6-8 weeks, get follow-up CT prior to return to play to ensure it healed

45
Q

Aside from C-sign and anteater sign, what other radiographic clues are there that a patient has a coalition?

A

Talar beaking

46
Q

X-ray needed to assess the facet most commonly involved in subtalar coalition?

A

Harrix axial view will show you the middle facet

47
Q

Etiologies for tarsal tunnel

A

Engorged veins, PVNS, ganglion cysts, nerve sheath tumors, progressive pes planus

48
Q

EMG/NCS in tarsal tunnel

A

Only 50% will be diagnostic, make sure to check MRI for space occupying lesion

49
Q

Tarsal tunnel treatment

A

Nonop: SSRI, antiseizure meds, TCAs and orthotic for hindfoot valgus 3-6 months

50
Q

Best results after tarsal tunnel decompression

A

If there is a space occupying mass

51
Q

Anatomic structure that fails leading to progressive flat foot deformity

A

Calcaneonavicular (spring) ligament no longer supports the talonavicular joint. This can occur after failure of the posterior tibial tendon.

52
Q

Radiographic features of flat foot

A

Negative Meary angle, uncovering of talar head, valgus hindfoot alignment and valgus talar tilt in mortise

53
Q

Conservative management of flat foot

A

Medial post, UCBL brace if flexible. Can use Arizona if rigid. AFO if stage IV and insufficient deltoid.

54
Q

Operative management in flatfoot

A

1) no deformity, flexible = tenosynovectomy

55
Q

Deformities that make up a cavovarus foot

A

Forefoot equinus relative to hindfoot and forefoot pronation from plantarflexed 1st ray

56
Q

Diseases to think about with unilateral cavovarus foot

A

Tethered cord (spina bifida), compartment syndrome and polio

57
Q

Diseases to think about with progressive bilateral cavovarus foot

A

Hereditary sensory motor neuropathies in 2/3…1/2 of these will be CMT

58
Q

Orthotic for cavovarus foot

A

Lateral post without arch support, arch will worsen deformity

59
Q

Surgical treatment of cavovarus foot that completely corrects after Coleman block testing

A

1st MT dorsiflexion osteotomy +/- plantarfascia release (sometimes PF is so tight it won’t allow dorsiflexion of the 1st MT)

60
Q

Surgical treatment of cavovarus foot that has incomplete correction of varus with Coleman block testing.

A

Must add a lateral closing wedge calc osteotomy to take the hindfoot out of varus (or subtalar arthrodesis if arthritic)

61
Q

Tendon transfer to consider in cavovarus foot

A

Peroneus longus to brevis transfer, removed force on 1st ray plantarflexion and strengthens weakened everters

62
Q

Best test to diagnose peroneal tendon tears

A

u/s. MRI has lots of false positives

63
Q

Surgical management of peroneal tendon tears

A

If <50% tear, tenosynovectomy, repair +/- tubularization.

64
Q

Management of plantar fasciitis

A

Night splints and stretching, almost never need surgery

65
Q

How to differentiate plantar fasciitis from calcaneal stress fracture.

A

Calc stress fx will have pain with medial/lateral calcaneal squeeze test

66
Q

Management of retrocalcaneal bursitis with no tendinopathy and +Haglund deformity.

A

Don’t inject steroids because risk of Achilles rupture. Can perform isolated Haglund excision.

67
Q

Management of Achilles tendinopathy with <50% repairable tendon.

A

Add FHL transfer

68
Q

Indications for non-anatomic lateral ligament reconstruction for chronic ankle instability

A

Large athletes, ligamentously lax and hypermobility syndrome

69
Q

Posteromedial vs anterolateral talar dome lesion

A

Posteromedial = congenital avascular lesion

70
Q

Indications for microfracture in talus OCD

A

Good results if lesion <1cm

71
Q

Rheumatoid forefoot findings and management.

A

MTP joints incompetent -> crossing toes

72
Q

Rheumatoid hindfoot findings and management

A

Hindfoot valgus, treat with bracing, then triple arthrodesis if refractory. If ankle is involved, they do better with total ankle than a pantalar fusion (some evidence suggests they do better with BKA than pantalar fusion)

73
Q

Define loss of foot protective sensation

A

Inability to detect 5.07 Semmes-Weinstein monofilimaent

74
Q

Most common diabetic foot motor neuropathy

A

Common peroneal nerve -> foot drop and intrinsic weakness leading to claw toes

75
Q

TBIs and toe pressures that are thresholds for being able to heal a diabetic foot ulcer

A

TBI > 0.45, toe pressure >40mmHg and TcO2 >40mmHg

76
Q

Labs in diabetics that indicate ability to heal a foot ulcer

A

Total protein >6, WBC > 1500, albumin >2.5

77
Q

Best test to diagnose a diabetic foot ulcer involving bone vs not involving bone

A

Tagged WBC scan. High false positive rate with MRI with Charcot foot. 67% have osteo if ulceration probes to bone.

78
Q

Eichenholtz stages of Charcot arthropathy

A

Warmth/swelling/erythema -> bone resorption and fragmentation over 6-18 month time period. Don’t operate until in the consolidation phase.

79
Q

Differentiating Charcot from osteo on exam

A

Redness improves with elevation in Charcot

80
Q

Surgical principles for Charcot foot

A

Remove bony prominences, fuse unstable joints and lengthen the Achilles

Foot & Ankle (1 decks)

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