FAnkle

Question 1

bunnionette types

Answer 1

1 - lateral prominence ; 2 - bowed with normal IMA (distal chevron); 3 - wide IMA (most common)

Question 2

normal 4-5th IMA

Answer 2

6-8 deg; also 5th MT head should be less than 13mm

Question 3

sx of baxter’s nerve

Answer 3

9-12 months heelpain; unrelated to WB, similar to plantar fascitis

Question 4

position for ankle fusion

Answer 4

0 DF, 0-5 valgus, 0 ER

Question 5

floating toe seen with

Answer 5

seen with Weil osteotomy - up to 36%; more common when performed with PIP arthrodesis

Question 6

Distal MT osteotomy parameters

Answer 6

HVA < 25 and IM < 13

Question 7

FDL and FHL in plantar mid foot

Answer 7

FHL is DEEP (dorsal) to FDL

Question 8

what position is hind foot for toe off

Answer 8

inversion, locked for toe off

Question 9

traits of rigid hammertoe

Answer 9

neutral to slight extension of MTP; fixed PIP, variable DIP - key is that PIP does not correct with foot plantarflexion

Question 10

criteria for DM ulcer

Answer 10

ABI < 0.45; TcO2 < 30; albumin < 3

Question 11

which part of plantar fascia to release in PF

Answer 11

medial third ONLY - otherwise you will destabilize the arch

Question 12

tx of chronic achilles tendinopathy

Answer 12

debridement, exostectomy of calc, and FHL transfer

Question 13

risk factors for subtalar fusion non-union

Answer 13

smoking, failure of previous union or tibiotalar union, > 2mm of AVN at fusion site

Question 14

baxter’s nerve innervates

Answer 14

abductor digit quinti, FDB, and quadratus plantae

Question 15

bracnhes of tibial nerve at medial ankle

Answer 15

Medial Calc nerve; lateral plantar (with baxters) and medial plantar ; medial plantar is more anterior

Question 16

tx of metatarsal stress fracture

Answer 16

walking boot x 6 weeks;

Question 17

what position causes peroneal tendon subluxation

Answer 17

resisted dorsiflexion and eversion - due to disrupted SUPERIOR peroneal retinaculum

Question 18

Peroneus longus injuries a/w

Answer 18

RhA, Varus foot, and large peroneal tubercle - tx is debride and attach to the brevis when chronic

Question 19

chronic achilles rupture tx

Answer 19

if < 3months old and < 3cm , try for primary repair; if > 3cm gap use FHL transfer

Question 20

Silfverskiold test

Answer 20

dorsiflexion improves with knee flexion - if DF improves then ONLY Gastroc was involved in contracture

Question 21

the ONLY oral abx with pseudomonas coverage

Answer 21

fluoroquinolones

Question 22

% reduction in recurrent sprains after proprioception PT

Answer 22

35% less

Question 23

Antagonist to Tib Ant and Post Tib.

Answer 23

P Longus and P brevis respectively

Question 24

what is modified Brostrom

Answer 24

recon of ATFL, CFL, with augment of inferior extensor retinaculum

Question 25

what is evans procedure for ankle instability

Answer 25

a NON-anatomic recon of lateral support b/w the positions of ATFL and CFL - involves using half or P. brevis and attaching to anterior fibula via a drill bhole

Question 26

ways to avoid floating toe with Weil

Answer 26

make osteotomy as plantar and paralle to floor as possible to avoid MT head from moving plantar as it is shortened

Question 27

how to pick up sesamoid fracture

Answer 27

bone scan can help - to determine if source of pain

Question 28

risk factors for achilles wound issues

Answer 28

tobacco >> steroids and female gender; DM also a rf

Question 29

inversion ankle injury a/w

Answer 29

OCD of talar dome, peroneal tendon split, anterolateral soft tissue impingment

Question 30

eversion ankle injury a/w

Answer 30

detloid avulsion fleck - anterior colliculus

Question 31

HO after high ankle sprain develops

Answer 31

6-8months after injury- wait for a negative bone scan

Question 32

navicular stress fracture tx

Answer 32

NWB x 6week; perc ORIF only after

Question 33

during heel strike what happens to GSC

Answer 33

dorman, TA Is ECCENTRIC

Question 34

screw diameter and Jones frx

Answer 34

if < 4.5 then higher rate of delayed or non-union

Question 35

TAA vs fusion in young patients

Answer 35

Fusion for active young, TAA is for older

Question 36

consequence of removalof both sesamoids

Answer 36

toe cock-up deformity

Question 37

treatment of flexible claw toe

Answer 37

based on PIP - if flexible then FDL transfer to extensor surface; if rigid PIP then resection arthroplasty +/- weil if many toes

Question 38

triad of claw toe

Answer 38

Dorsiflexed MTP; Hyperflex at PIP and DIP

Question 39

supramalleolar osteotomy for varus ankle

Answer 39

if stage 2 - 3a then good; 3b is not as good

Question 40

FHL tendonitis sx

Answer 40

posteromedial ankle pain; crepitus, triggering of great toe; decresaed passive extension of the great toe.pain with resisted great toe extension

Question 41

second tier tx of Plantar fascitis

Answer 41

night splints, steroid shot, and casting

Question 42

third line tx of Plantar fascititis

Answer 42

surgical release or extracorporal shockwave tx

Question 43

Sx for cavovarus and lateral ankle instability

Answer 43

recon of lateral ligaments and calc osteotomy

Question 44

chance of osteoM with ulcer that probes to bone

Answer 44

if probes to bone then 65%

Question 45

when do diabetic ulcers recurr

Answer 45

1 month after initiall healing in casting - help avoid recurrence with achilles lengthening

Question 46

which test has most false positive for syndesmosis injury

Answer 46

COTTON test

Question 47

operative tx for navicular stress

Answer 47

orif WITH bone graft

Question 48

mechanism of injury for peroneal tendon

Answer 48

DORSIflexion and inversion

Question 49

ligametnous lisfranc prognosis

Answer 49

poor compared to bony \even with ORIF

Question 50

how much delay after stroke before surg is doable

Answer 50

for acquired cavovarus - wait 18-24 months

Question 51

ligament integrity and Total ankle

Answer 51

they must be reconstructed - if not stable then cant do it

Question 52

medial vs lateral ocd

Answer 52

medial is more common, less traumatic, deeper and more posterior.

Question 53

what is boutinerre caused by

Answer 53

central slip - PIP flexion; DIP extension

Question 54

replant of palm amputation

Answer 54

if clean with no avulsion then yes

Question 55

tendon repair suture principle

Answer 55

10mm from cut edge with 4-6 epitendinous strands

Question 56

nomral ulnar variance what is load distribution

Answer 56

80 R 20 Ulna; goes to 95 -5

Question 57

contraindication to ulnar shortening

Answer 57

DRUJ OA