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Pod Med > Rearfoot Pathology--------------exam3 > Flashcards

Rearfoot Pathology--------------exam3 Flashcards

1
Q

1st met cuneiform exostosis

Clinical presen

A

Pain w shoe P
Deep aching pain after rest
Palpable mass
Sweelong

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2
Q

Clin

A

Redness, erythema

EHL tendinitis

Burning, tingling, numbness-MDCN neuritis

Ulceration

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3
Q

1st met cunei exostosis

Conservative treatment

A

Padding
Shoe modif- extra depth, lacing
Physical therapy
Injection of corticosteroid

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4
Q

1st met cunei exostosis

Surgical treat

A

Surgical resection (exostectomy)

Arthrodesis- severe DJD

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5
Q

Os trigonum syndrome

A
  • Triangular ossicle located at the posterior aspect of the talus adjacent to the lateral tubercle
  • Ossicle can be united to the posterior aspect of the talus by cartilaginous, fibro- cartilaginous, or fibrous tissue
  • May be caused as a result of a developmental anomaly or pathologic fracture ???
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6
Q

Os Trigonum Syndrome

 Mechanism of fracture is extreme ankle plantarflexion
- Example: ballet dancers

A

Can predispose FHL tendon to chronic inflammation

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7
Q

Os Trigonum Syndrome

Associated terminology. . .

A
  • An enlarged posterior extension of the lateral tubercle of the talus = Steida’s process
  • Fractures of the posterior lateral tubercle = Shepherd’s fracture
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8
Q

Os Trigonum Syndrome

 Treatment

A
  • Immobilization
  • Physical therapy
  • Injection of corticosteroids
  • NSAID’s
  • Excision
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9
Q

Os Tibiale Externum

A

 Ossicle of varying size, shape, and position which may be found adjacent to the navicular tuberosity

 Dwight classification -3 variants

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10
Q

Os Tibiale Externum

Type I

A
  • small ossicle (sesamoid) within posterior tibial tendon
  • sesamoid is characteristically round and small in size
  • located at a distance from the navicular tuberosity
  • usually asymptomatic
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11
Q

Os Tibiale Externum

Type II

  • larger then type 1
  • oval or semi-circular in shape
A
  • accessory navicular proximal to navicular
  • in close apposition to the tuberosity
  • it may be attached by cartilage or fibrocartilage, or it may articulate with the tuberosity containing true synovial tissue
  • usually most symptomatic
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12
Q

Os Tibiale Externum

Type III

  • enlarged tuberosity
A
  • secondary to the accessory ossification center being fused to the tuberosity
  • other names:
    cornuate navicular, gorilliform navicular
  • symptoms related bony prominence
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13
Q

Os Tibiale Externum

Clinical Presentation

A
  • pain to palpation to medial prominence
  • may palpate motion of bone fragment
  • pain upon resistance to supination
  • inflammation over the area
    shoe irritation, adventitious bursa
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14
Q

Os Tibiale Externum

 Treatment

A
  • Padding
  • Orthotics
  • Immobilization
  • Physical therapy

- NSAID’s
- Surgical Excision

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15
Q

Posterior Tibial Tendon Dysfunction (PTTD)

seen in middle-age and elderly females

A

 Painful progressive deformity resulting from a gradual stretch (attenuation) of the PT tendon as well as the ligaments that support the arch of the foot

 Most common cause of adult acquired flatfoot deformity

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16
Q

PTTD

  • Function (posterior tibial tendon)
A
  • Supports medial arch
  • Decelerate STJ pronation(after heel contact)
  • Invert and plantarflex the foot
17
Q

PTTD

 The etiology of PTTD is multifactorial

 Two categories:

A
  1. Traumatic (uncommon)
    ex: laceration and avulsion at navicular tuberosity
  2. Degenerative
    - Often due to an intrinsic abnormality of the tendon itself
  • A chronic inflammatory process, such as tenosynovitis, can cause tendon degeneration, tendon elongation or attenuation, interstitial tearing, and eventually rupture
18
Q

PTTD

Predisposing Factors

A
  • Overuse
  • Pre-existing flatfoot/
    pronation
  • Tenosynovitis
  • Systemic inflammatory disease
  • Accessory ossicle
  • Corticosteroids
  • Tendon hypovascularity
  • Obesity
  • HTN
  • DM
19
Q

PTTD

Clinical presentation

  • Usually no history of trauma
A
  • Patient complains of “fallen arches”
  • Unilateral progressive flatfoot with calcaneal valgus
  • Swelling, warmth and tenderness along tendon
  • Lateral calcaneal fibular impingement pain
  • may see sinus tarsi syndrome
20
Q

PTTD

A

The location of pain can change as the deformity progresses

21
Q

PTTD

 Clinical presentation continued . . .

A
  • “Too many toes sign”
  • Unable to perform a single heel rise
  • unable invert heels
  • Decreased manual muscle testing against resistance
22
Q

PTTD

 “ Too many toes sign”

A
  • forefoot abduction
  • posterior view
  • more toes are visible
    in relation to the lateral surface of the leg on the pathologic side as compared with the normal foot
  • Usually 1 1⁄2 toes is normal
23
Q

PTTD

 Single heel rise test

A
  • Patient asked to rise up on the ball of the affected foot while the non-affected foot is held off the ground
  • Sequence of activation
    1. PT tendon- inverts and locks hindfoot
    2. Gastrocsoleus muscle group- pulls up heel to
    complete heel rise
24
Q

PTTD

Myerson added a 4th stage

A
  • characterized by valgus angulation of the talus and early degeneration of the ankle joint
25
Q

PTTD

Conservative Treatment

A

Immobilization

Physical therapy

NSAID

foot orthoses

Ankle foot orthoses

26
Q

PTTD

 Surgical Treatment
- primary repair

A
  • PT tendon augmentation
  • calcaneal osteotomies
  • fusions
27
Q

Sinus Tarsi Syndrome

 Sinus tarsi definition:

A
  • anatomic space between the inferior neck of the talus and the superior aspect of the distal calcaneus

 Forms part of the subtalar joint

 Contains small vessels and nerves, subtalar
ligaments as well as fat and connective tissue
- Hoke’s tonsil

28
Q

Sinus Tarsi Syndrome

 Chronic pain over the sinus tarsi and lateral foot and ankle

A

 Often associated with a sensation of rearfoot instability

 Often associated with trauma example: ankle sprain

29
Q

Sinus Tarsi Syndrome

 Non-traumatic cases

A
  • Pes planus/Excessive pronation
  • Tarsal Coalition
  • Osteoarthritis
  • Inflammatory arthritis
30
Q

Sinus Tarsi Syndrome

Clinical Presentation

  • Minimal edema
A
  • Pain elicited by supination
  • Pain elicited by direct palpation
  • Rapid relief with sinus tarsi block
  • Aggravated by ambulation
  • Improved with rest
31
Q

Sinus Tarsi Syndrome

 Conservative Treatment

A
  • Physical therapy
  • Injections
  • NSAIDS
  • Orthotics
    – limit pronation
  • Immobilization
32
Q

Sinus Tarsi Syndrome

 Surgical Treatment

A
  • Evacuation of contents of sinus tarsi
  • denervate the sinus tarsi
  • Arthroscopic examination and debridement of the posterior subtalar joint and sinus tarsi
33
Q

1st metatarsal- cuneiform exostosis

Saddle bone deformity

A

Chronic 1st hypermobility- leads to the dorsal jamming at the 1st met-cuneiform joint

Flexible high arched feet- more prone or hypermobile PF 1st ray

Pod Med (8 decks)

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