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Module 204 MSK & Immune system > T2 L17 Intro to surgery of the foot and ankle > Flashcards

T2 L17 Intro to surgery of the foot and ankle Flashcards

1
Q

What are the 3 sections of the foot?

A

Hindfoot
Midfoot
Forefoot

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2
Q

Give examples of types of tendon repair

A

Debridement
Tenodesis
Tendon transfer
Direct repair

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3
Q

Give examples of types of ligament repair

A

Indirect repair

Tendon transfer

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4
Q

What is the aim when treating foot pathology?

A

Painless
Plantigrade
Structurally normal
Functionally normal

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5
Q

What is the achilles tendon?

A

Heel cord
Formed when gastrocnemius, soles and planters unite
Attaches to calcaneal tuberosity

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6
Q

What is the function of the achilles tendon?

A

Plantarflexion of the foot

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7
Q

Why is the achilles tendon vulnerable to pathology?

A

Has no tendon sheath
Instead surrounded by paratenon
Poor blood supply

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8
Q

What is the blood supply to the achilles tendon?

A

Proximal and distal sections supplied by posterior tibial artery
Midsection supplied by peroneal artery

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9
Q

What can rupture the achilles tendon?

A

Sudden forced plantarflexion to foot - common in tennis players
Violent dorsiflexion in plantar flexed foot

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10
Q

What is the treatment for a ruptured achilles tendon?

A 
In functional bracing
Surgery
 - end to end repair
 - VY advancement
 - tendon transfer if other methods fail
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11
Q

What tendon is used in a tendon transfer to repair a ruptured achilles tendon?

A

Flexor hallucis longus

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12
Q

What is the position, landmarks and incision when surgically repairing Achilles?

A

Patient in prone or lazy lateral position
Landmarks: malleoli and achilles tendon
Incision: longitudinal, slightly medial to avoid rural nerve

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13
Q

What is the tibialis posterior tendon?

A

From posterior aspect of interosseous membrane, fibula and tibia
Has 9 insertions in foot

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14
Q

What are the actions of the tibialis posterior tendon?

A

Plantarflexion ankle joint
Principle invertor of foot
Adducts and supinates foot

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15
Q

What are the functions of the tibialis posterior tendon?

A

Stabilise lower leg
Facilitate foot inversion
Supports foot’s medial arch
Role in hindfoot inversion during gait cycle

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16
Q

What is the arterial supply to the tibialis posterior tendon?

A

Posterior tibial nerve
Peroneal nerve
Sural nerve

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17
Q

How does insufficiency of the tibialis posterior occur?

A

Tendonitis, stiffens up, becomes non-functional and hind foot goes into valgus
Lose arch of midfoot

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18
Q

What are the causes of tibialis posterior insufficiency?

A

Trauma
Chronic flat foot
Inflammatory arthropathy
Degenerative tendinopathy

19
Q

What are the symptoms of tibialis posterior insufficiency?

A 
Post-malleolar pain 
Arch pain & aching
Progressive flat foot deformity
Forefoot problems: progressive hallux valgus, metatarsalgia, lesser toe deformities
Tarsal tunnel syndrome (rare)
20
Q

What are the signs of tibialis posterior insufficiency?

A

Valgus hindfoot
Acquired flatfoot
Forefoot abduction

21
Q

What is the non-surgical treatment for tibialis posterior insufficiency?

A

Analgesics
Shoe wear modification
Orthotics – medial arch supports (stops pressure on medial side of foot)
Physiotherapy

22
Q

What are the surgical treatments for tibialis posterior insufficiency?

A

Reconstruction (tendon transfer)

Fusion (if secondary arthritis)

23
Q

What tendon is used in a tendon transfer for tibialis posterior insufficiency?

A

Flexor digitorum longus as functional loss is minor

24
Q

Describe the surgical approach to tibialis posterior tendon

A

Position: supine
Landmark: tip of medial malleoli & base of navicular
Incision: 10cm longitudinal incision from tip of medial malleolus

25
Q

What can be damaged during surgery to tibialis posterior tendon?

A

Saphenous nerve

Saphenous vein

26
Q

How does ankle arthritis present?

A

Pain
Swelling
Deformity

27
Q

What is the pathology of ankle arthritis?

A 
Fracture – cartilage damage
Malalignment – leads to abnormal loading
Biomechanics altered in ankle joint
Leads to abnormal point loading
Eventual joint space narrowing & pain
28
Q

What is the surgical management of ankle arthritis?

A 
In early disease:
 - arthroscopy 
 - debridement
In late disease:
 - arthrodesis
 - arthroplasty
 - excision arthroplasty
29
Q

When is ankle arthrodesis indicated?

A

Pain relief
Severe deformity
When total ankle replacement isn’t appropriate

30
Q

What is the surgical approach for total ankle replacement?

A

Position: supine
Landmarks: both malleoli which are subcutaneous
Incision: 15cm longitudinal incision, midway between malleoli

31
Q

What can be damaged in total ankle replacement?

A

Superficial peroneal nerve
Deep perineal nerve
Anterior tibial artery

32
Q

When is a tibiotalcocalcaneal arthrodesis indicated?

A

Severe deformity
Osteoporotic ankle fractures
Complex failed ankle fixation
Failed total ankle replacement

33
Q

What is an ankle sprain?

A

Damage to lateral ligament

34
Q

What is the lateral ligament of the ankle?

A 
Passes from anterior margin of fibular malleolus to tallus bone
3 elements:
 - anterior talofibular 
 - calcaneofibular
 - posterior talofibular
35
Q

What is the treatment for an acute lateral ligament sprain?

A 
RICE
Physio directed rehabilitation
 - loading injured ligaments
 - proprioception
 - strength and return to function
36
Q

What are the examination signs of chronic instability?

A

Posterior ankle draw

Sulcus sign

37
Q

What investigations may be done in chronic instability?

A

Stress radiographs

MRI

38
Q

What are the indications for surgery in chronic instability?

A

Acute rupture

Chronic mechanical instability symptoms that aren’t responding to non-operative rehabilitation

39
Q

What are the surgical options for chronic instability?

A

Tendon transfer using peroneal tendon

40
Q

What is hallux valgus?

A

(Bunion)
Deformity away from midline, 1st metatarsal has drifted medially
More common in females

41
Q

What are the presenting symptoms and signs of hallux valgus?

A 
Pain
Deformity
Modification of shoe wear
Nerve irritation
Lesser toe deformity
42
Q

What are the treatment options for hallux valgus?

A 
Non-surgical
Surgical 
 - bunionectomy
 - osteotomy
 - 1st TMT joint fusion
43
Q

What is the surgical approach for hallux valgus repair?

A

Position: supine
Landmarks: easily palpable 1st metatarsal joint
Incision: proximal to IP joint & curve over medial eminence staying medial to extensor hallucis

44
Q

What can be damaged in surgical repair of hallux valgus?

A

Dorsal cutaneous nerve
Extensor hallucis tendon
Flexor hallucis longus

Module 204 MSK & Immune system (44 decks)

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