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Foot & Ankle > Questions > Flashcards

Questions Flashcards

1
Q

Name characteristics of patients with hallux rigidus

A

Inverted gait, decreased DF, transfer metatarsalgia, decreased push off strength; NOT associated with FHL rupture

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2
Q

what happens with chronic adult flatfoot deformity to the achilles tendon and why?

A

hindfoot valgus that causes the AT to become an evertor which then lends to contracture

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3
Q

what is the preferred treatment for painful os navicular that has failed non-operative tx?

A

split the PT and excise WITHOUT advancement

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4
Q

Optimal positioning of the foot for ankle arthrodesis: ___ rotation, DF/PF, A/P, varus/valgus?

A

10 deg ER, plantigrade, 5 mm posterior on the plafond, 5 deg valgus

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5
Q

what must be repaired to prevent hallux valgus after medial sesmoidectomy?

A

FHB

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6
Q

what is the study of choice for total ankle arthroplasty workup far out from surgery with a patient previously doing well and no concerns for infection?

A

CT with metal artifact reduction; Bone scan could be helpful for aseptic loosening but it would be hard to differentiate with infection

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7
Q

at what % of resection for achilles tendinitis do you need to augment instead of just side to side repairing and closing up?

A

50% or more

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8
Q

what are the classic findings of an atraumatic TA rupture? what is the mechanism?

A
  • decreased DF, excessive toe hyperextension with DA of the ankle, loss of anterior ankle contour, anteromedial pseudotumor
  • eccentric
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9
Q

charcot marie tooth has ___ foot deformity; chromosome ___, the gene is ___, ___ and ___ are weakened but ___ is first

A
  • equinovarus
  • 17
  • PMP 22
  • TA and PB
  • TA
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10
Q 
Plantar plate deficiency leads to what lesser toe deformity? 
What causes claw toe?
What causes curly toe?
What causes mallet toe?
What is hammer toe?
A
  • crossover toe
  • weak intrinsics cause MTP hyperextension and PIP/DIP hyperflexion
  • FDL/FDB contracture with unknown etiology
  • Flexion at DIP; either release of EDL distal to the DIP joint or FDL contracture from wearing a toe box that is too short
  • PIP flexion with DIP extension; most common lesser toe deformity
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11
Q

excision of both sesamoids causes ___, Tibial causes ___ and fibular causes ___

A
  • cock up deformity
  • hallux valgus
  • hallux varus
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12
Q

are positive wound cultures indicative of osteomyelitis in diabetic foot ulcers?

A

no; increase on T2 MRI, exposed bone, periarticular erosions

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13
Q

what is the treatment of a chronic > 7 weeks Anterior tibialis rupture?

A

those that are traumatic would then be candidates for repair with plantaris augmentation prior to have a PT transfer with gastroc recession

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14
Q

what are the 5 grades of hallux rigidus?

A

grade 0: stiffness; no pain; no narrowing
grade 1: mild pain at extremes of motion; mild dorsal osteophytes; no narrowing
grade 2: moderate pain at extremes of motion; less than 50% narrowing
grade 3: pain at extremes; no pain with midrange; > 50% joint space narrowing
grade 4: pain with midrange motion; severe dorsal osteophytes; > 50% joint space narrowing

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15
Q

Bunion deformity is characterized by ____ (varus/valgus) and ____ (supination/pronation)

A
  • valgus

- pronation

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16
Q

Arthrodesis vs fixation in lis franc: which has higher hardware removal? outcomes are ___ between the two options

A
  • fixation

- mixed

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17
Q

what is the conjointed tendon of the foot?

when is it encountered?

A
  • FHB + adductor hallucis
  • lateral release for a bunion you try to preserve this by releasing tissue lateral to the sesamoid but leaving it attached to the proximal phalanx; remember the adductor hallucis has oblique and transverse heads
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18
Q

Lateral OCD on the talus ____

Medial OCD on the talus ____

A
  • anterior, more shallow, worse prognosis, less common than medial, and usually from traumatic etiology
  • posterior, deeper, better prognosis, more common than lateral, and usually without traumatic etiology
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19
Q

what the cutoff for performing a moberg after dorsal cheilectomy for hallux rigidus to achieve more DF?

A

30 deg

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20
Q

when do you see the floating toe complication/phenomenon in ortho? commonly seen with what procedure?

A
  • it is the result of a shortened metatarsal bone for whatever reason from the decreased tension that causes the affected toe to not reach the floor when standing
  • weil osteotomy
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21
Q

what is the type of boot you put a diabetic with charcot into if they have no ulcerations?

A

CROW: charcot restraint orthotic walker; its basically a double rocket with offset on the plantar midfoot to take pressure away from the area that collapsed

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22
Q

what is the percentage cutoff for isolated resection of talocalcaneal coalition for involvement of ST joint? if other alignment issues are seen in the foot then you must do ___

A
  • 50%

- other procedures

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23
Q

what compresses baxter’s nerve? what would be deinnervated if this happened?

A
  • abductor hallucis

- abductor digiti minimi

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24
Q

what does baxter’s nerve branch off? what does it innervate? what compresses it?

A
  • 1st branch off lateral plantar nerve
  • abductor digiti quinti/minimi, FDB, quadratus plantae
  • abdcutor hallucis fascia
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25
Q

what is the classification system for bunionette deformities and what are the treatments?

A

type 1: lateral exostosis; resection and lateral tightening
type 2: distal osteotomy if IMA < 12
type 3: if IMA > 12 then should do a diaphyseal osteotomy

26
Q

at the knot of henry on the plantar aspect of the midfoot, what is the relationship between FHL and FDL?

A

FHL is deep or dorsal to FDL

27
Q

pars vs open achilles repair show what in regards to scar formation, rerupture rate, calf circumference, iatrogrenic sural neurotpathy

A
  • decreased
  • no difference
  • no difference
  • no difference
28
Q

what is the difference between IMA with bunionette treatment for distal vs diaphyseal osteotomies?

A
  • 8-12 deg and > 12
29
Q

what is the most common complication of a weil osteotomy?

A

floating toe which is caused by DF at the MTP joint as the plantar distal fragment moves the axis of rotation of the interossei muscles dorsally

30
Q

what are the 4 components of the mirel system? at what point is PPX fixation recommended?

A
  • location, size, type, pain

- 8 or greater

31
Q

what does doing a bone block distraction subtalar arthrodesis do for a patient that continues to have complaints after non-op treatment of calc fx?

A

prevents anterior ankle impingement

32
Q

what are some risk factors for hallux valgus recurrence?

A
  • increasing HVA
  • increasing 1,2 IMA
  • round (NOT SQUARED) 1st MT head
  • severe lateral displacement of tibial sesamoid
33
Q

what type of foot deformity would a talocalcaneal or calcaneonavicular coalition cause?

A
  • rigid pes planus
34
Q

what migrates plantar with hallux valgus that cause the valgus and pronation?

A
  • abductor hallucis
35
Q

Hallux valgus: what is the cutoff for HVA and IMA for just a distal osteotomy? what is done for 1st MTC mobility or arthritis? when do you add an akin?

A
  • 40 and 13
  • arthrodesis/lapidus; also good for extreme IMA’s
  • elevated HVI
36
Q

Hallux varus after hallux valgus correction: tx if flexible? rigid?

A
  • tendon transfer and tapping

- fusion

37
Q

Lesser Toe Deformities: hammer toe, claw toe, mallet tow

A
  • MTP ext, PIP flexion, DIP ext
  • same as above but DIP flexion
  • DiP flexion
38
Q

sesamoid excision: what happens with both? tibial? fibular? how do you prevent the last 2?

A
  • cock up toe deformity
  • hallux valgus
  • hallux varus
  • FHB repair
39
Q

with zone 1 5th MT avulsions, what is pulling the bone off primarily?

A
  • lateral band of the plantar fascia
40
Q

what foot x-ray can help evaluate an accessory navicular? what is the fx plane for stress navicular fx?

A
  • external oblique

- dorsolateral to plantar medial

41
Q

what is the difference with stage 2 and 3 flatfoot?

A
  • flexible vs rigid and you would do a hindfoot or triple arthrodesis
42
Q

what x -ray should you get when the normal AP knee x-ray doesn’t look bad?

A
  • WB 45 deg AP
43
Q

AAOS treatments recommend ___ program, ___ loss, what pharmacologic?

A
  • exercise
  • weight
  • NSAIDs (topical and PO) and ultram
44
Q

AAOS doesn’t recommend ____ for knee OA, steroid injections? arthroscopic lavage and chondroplasty? arthroscopic lavage and partial menisectomy with OA? HTO with medial joint space narrowing?

A
  • glucosomine/chondroitin, acupuncture, lateral wedge insoles for medial compartment
  • inconclusive
  • no
  • inconclusive
  • yes
45
Q

spontaneous onset of pain after UKA with blood on aspiration? what side does implant subsidence occur on and why?

A
  • tibial stress fracture

- tibial and when you overcut, osteoporosis, and undersize implant

46
Q

Risk factors for TKA: ___ patients have less improvement in outcomes

A
  • obese
47
Q

want neutral ___ alignment with TKA, what is the valgus cut angle? cut ___ with tall and ___ with short

A
  • mechanical
  • difference between the anatomic and mechanical axis
  • less
  • more
48
Q

what type of HS is metal allergy and what is the cell that is involved?

A
  • type IV

- T lymphocyte

49
Q

what is the cause of CAM jump with PS knee? what is patellar clunk? more common with ___ patellas and ___ box height

A
  • flexion instability
  • Synovium superior to the patella that gets caught in the box around 30-45 degrees of flexion
  • small
  • large (shorter boxes means it is lower and has less chance of getting caught)
50
Q

what is the difference with radiolucent lines for aseptic loosening vs infection? round lytic lesions behind implants are ___ and the cell involved is ___ with release of ___ which all upregulate ___

A
  • smooth vs scalloping
  • osteolysis
  • macrophage
  • TNF-alpha, IL-6, IL-1
  • RANKL
51
Q

what is the tx for TKA with global instability? always do this with ___ arthropathy

A
  • hinge

- charcot

52
Q

what are the 2 major criterea for TKA infections?

A
  1. sinus tract

2. 2 positive cultures

53
Q

what is the minimum thickness for wear for the poly with TKA?

A

6-8 mm thus the smallest are 9 usually

54
Q

what motion at the 1st MTP joint does a Morton’s extension orthosis limit?

A
  • DF
55
Q

which supplies the lateral 2/3 of the talar body, the artery of the tarsal canal or sinus?

A
  • canal
56
Q

what is the hallmark of junvenile hallux valgus compared to adult?

A
  • metatarsus primus varus
57
Q

Operative vs Non-operative treatment of achilles tendon ruptures: what in regards to patient satisfaction, return to sport, and ultimate strength? what was higher in the non-op group

A
  • equivalent

- higher rate or reruptures

58
Q

what are the 2 indications for 1st TMT arthrodesis in the treatment of hallux valgus? what is key to the first ray to prevent overloading of the lesser metatarsals?

A
  1. metarsus primus varus (commonly seen with junveniles)
  2. hypermobility of the first ray
    - anatomic plantarflexion
59
Q

with a hawkins 3 or 4 fx dislocation of the talar neck what is often the only remaining blood supply? what must you leave intact to help protect this?

A
  • deltoid branch from the posterior tibial artery

- deltoid ligament

60
Q

what is the artery that supplies the lateral flap for a lateral extensile approach to the calcaneus?

A

lateral calcaneal branch of the peroneal artery

61
Q

What is a hammer toe? when can you do a girdlestone-taylor flexor to extensor transfer +/- weil osteotomy?

A
  • hyperextension at MTP with hyperflexion and at PIP and DIP

- if the deformity is flexible then you can transfer the FDL to the extensor surface

Foot & Ankle (1 decks)

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