Chpt 13-18: lesser digital deformities

Question 1

what is the most common mechanical etiology for HT

Answer 1

flexor stabilization

Question 2

foot type and causes for flexor stabilization

Answer 2

pronated foot, equinus, peripheral neuropathy, tarsal tunnel

Question 3

Mechanical causes for flexor stabilization

Answer 3

long flexors gain mechanical advantage over interosseous muscles, and quadratus plantae causing adductovarus to 4th and 5th digit

Question 4

Foot type/cause for flexor substitution

Answer 4

weak tricep surae muscles, so flexors gain mechanical advantage over interossei

Question 5

foot type/causes for extensor substitution

Answer 5

pes cavus, anterior cavus, CMT

Question 6

Mechanical advantage of extensor substitution

Answer 6

EDL gain mechanical advantages over lumbricals causing retrograde buckling of digits

Question 7

Hammer toe deformity

Answer 7

MPJ: DF
PIPJ: PF
DIPJ: neutral

Question 8

Claw toe deformity

Answer 8

MPJ: DF

PIPJ and DIPJ: PF

Question 9

Mallet toe deformity

Answer 9

MPJ: neutral
PIPJ: neutral
DIPJ: plantarflexed

Question 10

advantages for peg in hole arthrodesis

Answer 10

avoids excessive shortening

Question 11

Where should the extensor tenotomy be made

Answer 11

stab incision made PROXIMAL to extensor hood (ie at least 2 cm proximal to the MPJ)

Question 12

Where should the flexor tenotomy be made for claw toe?

Answer 12

DIPJ—> only FDL released–> indicated for flexible claw toes

Question 13

where should flexor tenotomy be made for hammer toe

Answer 13

PIPJ–> release long and short flexors DIPJ

Question 14

why is it suggested to fuse toe in mild plantarfleion

Answer 14

to prevent mallet deformity from unstrained flexor pull

Question 15

for an extensor lengthening, where shoudl the EDL and EDB be transected

Answer 15

EDL transected distal to the MPJ and EDB transected proximal to MPJ to complete Z plasty

” cut the longus long and the brevis short”

Question 16

possibel surgical options for flail toe

Answer 16

implant arthroplasty

syndactylization

bone graft

amputation

Question 17

Indication for syndactylization

Answer 17

flail digits, heloma molle

Question 18

syndactylization is performed at well level of soft tissue

Answer 18

dermis

Question 19

for lachmann test, subluxation greater than _______ indicates displacement/rupture

Answer 19

2mm

Question 20

Anatomical relation of lumbricals, interossei and DTML

Answer 20

lumbricals is plantar to DTML and interoseei dorsal to DTML

Question 21

incisional placement for adductovarus 5th digit? how will incision change the position of toe as it gets more vertical

Answer 21

incision with axis of orietnation from proximal lateral to distal medial centered over the PIPJ to allow for bone resection. The more vertical the incision, the more abduction

Question 22

Indications for Weil osteotomy

Answer 22

Metatarsalgia
elongated metatarsal w/ or without transverse plane deformity

crossover toes
subluxed, dislocated MPJ
Rheumatoid

Question 23

avoid weil osteotomy with what procedure? why?

Answer 23

PIPJ artrhodesis to avoid floating toe

Question 24

Osteotomy cut placement for Weil osteotomy on 2nd met

Answer 24

1-2 mm inferior to most dorsal aspect of articular cartilage ad osteotomy is parallel to weight bearing surface

Question 25

how should the osteotomy cut should be on the lesser mets compared to 2nd met

Answer 25

angle of osteotomy decreases on the lateral mets because they are less plantarflexed than 2nd met

Question 26

how long would the weil osteotomy cut be?

Answer 26

2.5- 3 cm long

Question 27

The average amount of metatarsal head shortening of weil osteotomy

Answer 27

3-5 mm normal amount of shortening ( 3 mm preferred)

Question 28

what is the average screw length for weil osteotomy

Answer 28

2.0 or 2.4 x 12 mm screw fits most without penetrating plantar met head

Question 29

post op protocol for weil osteotomy

Answer 29

PWB in surgical shoes for 4-6 weeks, then transfer to shoes

Question 30

what does it indicate when the toe is dorsally subluxed after weil osteotomy

Answer 30

too much shortening, which will weaken flexors an intrinsic muscles

Question 31

most common complication for weil ostoetomy

Answer 31

floating toe `

Question 32

the greater the angle of osteotomy for weil, will have what effect

Answer 32

the greater the osteotomy angle, the greater the plantar displacement

Question 33

for mpj arthroplasty what would you rather resect

Answer 33

met head over the base of roximal phalanx due to floppy toe

Question 34

complications for MPJ arthroplasty

Answer 34

stiffness to MPJ, transfer metatarsalgia, floating toe

Question 35

most common complication for condylectomy for high IM angle

Answer 35

joint subluxation

Question 36

what do you want to avoid when doing a condylectomy

Answer 36

removing lateral and plantar condylectomy as it will weaken met head and lead to fragmentation