Q3: RA, Tarsal/MT Fx, Fusions Flashcards
Definition
RA
chronic, autoimmune disorder affecting synovium of joints
How RA affects the joints
RA
- Immune system attcks synovium
- incresed inflammation
- symptoms
- thickening damages joints
- joint is no longer functional
Etiology
RA
Idiopathic
Risks include age, genetics, smoking, and obesity
Clinical Presentation
RA
- small joints affected first
- bilateral
- warm and swollen joints
- metatarsalgia
- heel pain
- nodules
Toe Deformities
RA
Hammer - flexed PIP, extended DIP
Claw - flexed PIP & DIP
Bunion
Nodule
Clinical Significance
RA
Tender areas (callus and ulcer)
Shoe wear
loss of function (hand)
Other implications: fatigue, fever, and loss of apetite
Diagnostic Techniques
RA
- Blood Test
- X-Ray - track deformity progression
- MRI, Ultrasound - inflammation
Diagnostic Qualifications
RA
4 out of 7 of the chart criteria for at least 3 months
Non-Ox Intervention
RA
Surgery
* synovectomy - remove inflamed lining
* tendon repair
* joint fusion or replacment
* ORIF
Pharmaceuticals, PT/OT, and Assistive devices
Ox Intervention
RA
- Extra D+W shoe wear
- Accommodative FOs
- Compression Therapy
Velcro/Adaptive closure may be helpul for these patients
Etiology
Tarsal & MT Fx
10% of fractures occur in the foot, usually from:
* overuse
* sports/activity
* trauma
* change in activity level
Calcaneus Fx
Tarsal & MT Fx
Usually from trauma/fall;
rare;
can possibly be from avulsion too
Talus Fx
Tarsal & MT Fx
Trauma, MVA, fall; neck more common than body
Snowboarders Fx - lateral process of talus from being “locked in”
Hawkins classification
Tarsal & MT Fx
Measures talus fx; based on amount of displacement and disruption of blood supply
Navicular Fx
Tarsal & MT Fx
- running
- repitition/overuse
- hard to see on imaging
- avulsion is common too
can be associated with ligament injury (tibialis posterior)
Cuboid Fx
Tarsal & MT Fx
AKA Nutcracker Fx; from compression between calcaneus and MTs
Cuneiform Fx
Tarsal & MT Fx
Less common, usually not alone
* axial loading
Metatarsal Fx
Tarsal & MT Fx
Stress Fx’s common; usually 5th MT
* Jones - through base
* Shaft - through shaft
* Dancers - spiral/oblique (art. with cuboid)
Can be avulsion (insertion of fib. brevis)
Diagnostic Techniques - Observation
Tarsal & MT Fx
- Redness
- Hot
- Swollen
- Painful
- Blisters
Diagnostic Techniques - Radiology
Tarsal & MT Fx
- Radiographs - all views and B/L for comparison
- CT - boney details
- MRI - soft tissue
Fx Classification
Tarsal & MT Fx
AO/OTA Classification
based on bone, fx type, and location
Non-Ox Intervention
Tarsal & MT Fx
ORIF if displaced, compound, or comminuted (alignment issues)
External Fixation
Pharmaceuticals
Casting/Splinting
Weightbearing Status
Tarsal & MT Fx
NWB - non weight bearing
TTWB - Toe Touch Weight bearing
PWB - Partial weight bearing
FWB - Full weight bearing
Ox Intervention
Tarsal & MT Fx
Goals - reduce force and motion through joint or bone
FO
Carbon footplate
Post-Op shoe
CAM Walker (short)
PTB or Unloading Ox
Surgical Indications
Fusions
- Painful arthritis
- cancer
- osteomyelitis
- failed Sx
- nuero- arthropathy
- fx malunion
- deformity
Clinical Significance
Fusions
- Loss of ROM
- hardware for modifications
- arthrodesis
Complications: nonunion, infection, nerve damage, OA
Sx: 1st MTP
Fusion
Hallux valgus; bunion
can also fuse 1st ray to reduce hypermobility (Lapidus procedure)
Sx: Midfoot
Fusions
Includes the navicular, cuboid, cuneiform
Min. loss of motion but reduces collapse
Sx: Calcaneocuboid
Fusions
Calcaneus and cuboid
Sx: Talonavicular
Fusions
Talus and navicular to realign pes planus
Sx: Subtalar
Fusions
Talus and calcaneus
loss of inversion/eversion
lack of safety on uneven surfaces
Sx: Triple Athrodesis
Fusions
- Talocalcaneal
- Talonavicular
- Calcaneocuboid
Sx: Pantalar
Fusions
Triple arthrodesis + tibiotalar fusion
2 stage Sx:
first tibiotalar, second triple arthrodesis
