Questions Flashcards
Name characteristics of patients with hallux rigidus
Inverted gait, decreased DF, transfer metatarsalgia, decreased push off strength; NOT associated with FHL rupture
what happens with chronic adult flatfoot deformity to the achilles tendon and why?
hindfoot valgus that causes the AT to become an evertor which then lends to contracture
what is the preferred treatment for painful os navicular that has failed non-operative tx?
split the PT and excise WITHOUT advancement
Optimal positioning of the foot for ankle arthrodesis: ___ rotation, DF/PF, A/P, varus/valgus?
10 deg ER, plantigrade, 5 mm posterior on the plafond, 5 deg valgus
what must be repaired to prevent hallux valgus after medial sesmoidectomy?
FHB
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?
CT with metal artifact reduction; Bone scan could be helpful for aseptic loosening but it would be hard to differentiate with infection
at what % of resection for achilles tendinitis do you need to augment instead of just side to side repairing and closing up?
50% or more
what are the classic findings of an atraumatic TA rupture? what is the mechanism?
- decreased DF, excessive toe hyperextension with DA of the ankle, loss of anterior ankle contour, anteromedial pseudotumor
- eccentric
charcot marie tooth has ___ foot deformity; chromosome ___, the gene is ___, ___ and ___ are weakened but ___ is first
- equinovarus
- 17
- PMP 22
- TA and PB
- TA
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?
- 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
excision of both sesamoids causes ___, Tibial causes ___ and fibular causes ___
- cock up deformity
- hallux valgus
- hallux varus
are positive wound cultures indicative of osteomyelitis in diabetic foot ulcers?
no; increase on T2 MRI, exposed bone, periarticular erosions
what is the treatment of a chronic > 7 weeks Anterior tibialis rupture?
those that are traumatic would then be candidates for repair with plantaris augmentation prior to have a PT transfer with gastroc recession
what are the 5 grades of hallux rigidus?
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
Bunion deformity is characterized by ____ (varus/valgus) and ____ (supination/pronation)
- valgus
- pronation
Arthrodesis vs fixation in lis franc: which has higher hardware removal? outcomes are ___ between the two options
- fixation
- mixed
what is the conjointed tendon of the foot?
when is it encountered?
- 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
Lateral OCD on the talus ____
Medial OCD on the talus ____
- 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
what the cutoff for performing a moberg after dorsal cheilectomy for hallux rigidus to achieve more DF?
30 deg
when do you see the floating toe complication/phenomenon in ortho? commonly seen with what procedure?
- 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
what is the type of boot you put a diabetic with charcot into if they have no ulcerations?
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
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 ___
- 50%
- other procedures
what compresses baxter’s nerve? what would be deinnervated if this happened?
- abductor hallucis
- abductor digiti minimi
what does baxter’s nerve branch off? what does it innervate? what compresses it?
- 1st branch off lateral plantar nerve
- abductor digiti quinti/minimi, FDB, quadratus plantae
- abdcutor hallucis fascia
what is the classification system for bunionette deformities and what are the treatments?
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
at the knot of henry on the plantar aspect of the midfoot, what is the relationship between FHL and FDL?
FHL is deep or dorsal to FDL
pars vs open achilles repair show what in regards to scar formation, rerupture rate, calf circumference, iatrogrenic sural neurotpathy
- decreased
- no difference
- no difference
- no difference
what is the difference between IMA with bunionette treatment for distal vs diaphyseal osteotomies?
- 8-12 deg and > 12
what is the most common complication of a weil osteotomy?
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
what are the 4 components of the mirel system? at what point is PPX fixation recommended?
- location, size, type, pain
- 8 or greater
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?
prevents anterior ankle impingement
what are some risk factors for hallux valgus recurrence?
- increasing HVA
- increasing 1,2 IMA
- round (NOT SQUARED) 1st MT head
- severe lateral displacement of tibial sesamoid
what type of foot deformity would a talocalcaneal or calcaneonavicular coalition cause?
- rigid pes planus
what migrates plantar with hallux valgus that cause the valgus and pronation?
- abductor hallucis
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?
- 40 and 13
- arthrodesis/lapidus; also good for extreme IMA’s
- elevated HVI
Hallux varus after hallux valgus correction: tx if flexible? rigid?
- tendon transfer and tapping
- fusion
Lesser Toe Deformities: hammer toe, claw toe, mallet tow
- MTP ext, PIP flexion, DIP ext
- same as above but DIP flexion
- DiP flexion
sesamoid excision: what happens with both? tibial? fibular? how do you prevent the last 2?
- cock up toe deformity
- hallux valgus
- hallux varus
- FHB repair
with zone 1 5th MT avulsions, what is pulling the bone off primarily?
- lateral band of the plantar fascia
what foot x-ray can help evaluate an accessory navicular? what is the fx plane for stress navicular fx?
- external oblique
- dorsolateral to plantar medial
what is the difference with stage 2 and 3 flatfoot?
- flexible vs rigid and you would do a hindfoot or triple arthrodesis
what x -ray should you get when the normal AP knee x-ray doesn’t look bad?
- WB 45 deg AP
AAOS treatments recommend ___ program, ___ loss, what pharmacologic?
- exercise
- weight
- NSAIDs (topical and PO) and ultram
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?
- glucosomine/chondroitin, acupuncture, lateral wedge insoles for medial compartment
- inconclusive
- no
- inconclusive
- yes
spontaneous onset of pain after UKA with blood on aspiration? what side does implant subsidence occur on and why?
- tibial stress fracture
- tibial and when you overcut, osteoporosis, and undersize implant
Risk factors for TKA: ___ patients have less improvement in outcomes
- obese
want neutral ___ alignment with TKA, what is the valgus cut angle? cut ___ with tall and ___ with short
- mechanical
- difference between the anatomic and mechanical axis
- less
- more
what type of HS is metal allergy and what is the cell that is involved?
- type IV
- T lymphocyte
what is the cause of CAM jump with PS knee? what is patellar clunk? more common with ___ patellas and ___ box height
- 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)
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 ___
- smooth vs scalloping
- osteolysis
- macrophage
- TNF-alpha, IL-6, IL-1
- RANKL
what is the tx for TKA with global instability? always do this with ___ arthropathy
- hinge
- charcot
what are the 2 major criterea for TKA infections?
- sinus tract
2. 2 positive cultures
what is the minimum thickness for wear for the poly with TKA?
6-8 mm thus the smallest are 9 usually
what motion at the 1st MTP joint does a Morton’s extension orthosis limit?
- DF
which supplies the lateral 2/3 of the talar body, the artery of the tarsal canal or sinus?
- canal
what is the hallmark of junvenile hallux valgus compared to adult?
- metatarsus primus varus
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
- equivalent
- higher rate or reruptures
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?
- metarsus primus varus (commonly seen with junveniles)
- hypermobility of the first ray
- anatomic plantarflexion
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?
- deltoid branch from the posterior tibial artery
- deltoid ligament
what is the artery that supplies the lateral flap for a lateral extensile approach to the calcaneus?
lateral calcaneal branch of the peroneal artery
What is a hammer toe? when can you do a girdlestone-taylor flexor to extensor transfer +/- weil osteotomy?
- 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
