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FF summary Flashcards

1
Q

Metatarsalgia

Physical exam

A

Pain on palpation- met heads

Little or no inflam (rare= bursitis)

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2
Q

Metatarsalgia

Pathogenesis

A

Inc pronation

Dec tran. Arc

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3
Q

Metatarsalgia

Diagnosis

A

Rule out everything else

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4
Q

Metatarsalgia

Treatment

A

Rest ,ice
Met pads
Orthotics
Pain meds

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5
Q

Nerve injury

Compression

A
  1. Neuropraxia- most common
    Distal- TIPS compression (casting, shoes)
    Prox- herniated disc
    Reversible ischemia
    Transient dec sensation(d-w): dec conduction until remyelination
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6
Q

Nerve injury

Compression

A 
2. Axonotmesis-severe/crush
Demyelination= dec sensation (wks-m)
Intact basement membrane
Axon regeneration, remyelination
Really severe? Wallerian degen (perm loss)
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7
Q

Nerve injury

Transection

A

Neurotmesis (least common)

  • laceration
  • no basemembrane
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8
Q

Nerve injury

Ischemia/ infarct

A

Caused by vasculitis/ atherosclerosis
Conduction not decreased
Basement membrane intact= can regen , sciatic n most common,
Peroneal/ tibial too

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9
Q

Nerve injury

Radiation-induced

A

Seen w radiation treatment
Delayed presentation
Dec sensation, proprioception
Weakness

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10
Q

Nerve injury

Degeneration (most common cause of injury)

A

Distal: distal->prox deg /longest n first

Most vuln to metabolic/toxic activity

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11
Q

Nerve injury

Inflammation

A

Infections- EBV, HSV, Zoster(most common)
Diabetes- radiculopathy (most common)
Sjogrens(dorsal root ganglion)

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12
Q

Nerve injury

Common symptom

A

Pain, paresthesia, anesthesia,
Pruritis(itching)
Motor function loss

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13
Q

Nerve injury

Autonomic inv

A

Skin changes due to nn injury

Slow wound healing due to poor innervation to sm mm

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14
Q

Nerve injury

Physical exam

A

Valleix- prox+dis

Tinel- distal

Tingling and pain

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15
Q

Common n entraps

Morton

McDonald

A

Common dig n

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16
Q

Joplin

A

Med proper dig n to hallux (1st)

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17
Q

Ant tarsal tunnel

A

Deep fib n

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18
Q

Lemonts

A

Superficial fib n

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19
Q

Tarsal tunnel syndrome

A

Post tib n

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20
Q

Compressed common dig n

A

Morton’s neuroma

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21
Q

Most common:3rd interspace than 2nd (largest)

F>M; shoe choices

A

Morton’s neuroma

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22
Q

Morton’s neuroma

Etiology

A

Compressed by DTIL ( or by bursa from trauma)

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23
Q

Morton’s neuroma

Symptoms

A

Pain, burning, tingling

Pebble in shoe (worse wt bearing)

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24
Q

Morton’s neuroma

Diagnosis

A 
Dec sensation adjacent toes
Mulder's sign
Pencil test
DF= pain
Sullivan's sign (splayed toes near neuroma on x ray)
Lidocaine injection

Ultrasound is best!

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25
Morton's neuroma Differential
``` Friedberg RA Callus Bursitis Tarsal tunnel, tumor ```
26
Entrapment neuropathy of plantar proper digital n to hallux( due to trauma from shoe gear) Associate w HAV
Joplin's neuroma
27
Joplin's neuroma Treatment
Orthotics, pedding, taping Injections - corticosteroids: avoid acetate = avoid fat atrophy - sclerosing alcohol(hardening n): 7-10, 1-2wks apart Surgical removal, or cut DTIL
28
Joplin's neuroma Complication
Comes back-stump neuroma CRPS- symp pain msg doesnt turn off Digital deformity- lumbrical, interossei mremoved=claw/hammer toes
29
Nerve entrapment Ant. Tarsal tunnel (deep peroneal n)
Pain at ant ankle Dec sensation 1st interrspace *physical exam Lag time to distal mm Abnormal extensor digitorum brevis m
30
Nerve entrapment Lemont (superficial peroneal n, INTERME, MEDIAL dorsal cutaneus n)
Tight shoes
31
Nerve entrapment Sural n
Int compress- peroneal tendon path, lipomas, cysts Ext compress- shoe pressure Trapped at 5th met and CC joint
32
Nerve entrapment Common fibular n
Compressed at - peroneal longus m belly - neck of fibula Ext pressure: casts, long surgery, crossing legs, squatting Lead foot drop(-> steppage gait), dec sensation, Treatment: remove compression, AFO, PT
33
Ant tarsal tunnel | Diagnostic testing
``` EMG, NCS, NCV MRI CT Serologic- HbA1C, lyme titers LP- unusual ```
34
Lemont | Diagnostic testing
``` EMG, NCS, NCV MRI CT Serologic- HbA1C, lyme titers LP- unusual ```
35
Sural n | Diagnostic testing
``` EMG, NCS, NCV MRI CT Serologic- HbA1C, lyme titers LP- unusual ```
36
Only a little broken
Metatarsal stress fracture
37
2nd met most common
Metatarsal stress fracture
38
Normal bone w inc pressures
Stress/fatigue Metatarsal stress fracture
39
Normal pressure w weak bone
Insufficiency Metatarsal stress fracture
40
Metatarsal stress fracture Wolf law
March fracture- military
41
Metatarsal stress fracture Risk factors-anatomic
Biomechanically related
42
Metatarsal stress fracture Risk factors-physiologically
Age, wt, osteopenia
43
Metatarsal stress fracture Risk factors- external (5th met non-union due to disrupted nutrient a)
Shoes, training intensity or surface, post-op
44
Metatarsal stress fracture Symptoms
Sharp pain, pain on palpation w wt | -> get x ray/MRI
45
Metatarsal stress fracture Treatment
RICE + restrict activity | Surgical shoes/ supportive shoes
46
Incomplete fracture leading to avasculaization w necrosis See osteochondritis of 2,3,4 th met heads Flat, widen
Frieberg's infarction
47
F>m Occurs after 11-13 yrs
Frieberg's infarction
48
Frieberg's infarction Presentation
Dull/aching FF -> worse at end ROM (w wt bearing) | Subchondral fracture, resorption of necrotic bone
49
Frieberg's infarction Treatment
Early- immobilize Late- met bar/ pad NSAIDs Surgery if doesnt work
50
Inflamed sesamoid apparatus
Sesamoiditis
51
Sesamoiditis Symptoms
Insidious- worse w activity Mild ache -> throbbing Local edema sometimes
52
Sesamoiditis Examination
Pain on palpation Hallux DF= worse Xray rule out fracture
53
Sesamoiditis Treatment
Dancer's pad(cut out at 1st met head) | NSAIDs, BK Fiberglass cast, corticosteroid inj, surgery
54
Swelling, bruising
Sesamoid fracture
55
Sesamoid fracture X rays
AP, MO, FFA 25% bipartite; 85% b/l Bipartite, 2 pieces together larger than other sesamoid NSAIDS BK casting > 8wks
56
Hallux limitus/rigidus Types (Normal- DF 1st MPJ 65)
- structural: dec 1st MPJ in gen | - func: dec ROM w closed -normal w open
57
Hallux limitus/rigidus Symptoms
Discomfort-> pain, immobility, joint destruction,
58
Hallux limitus/rigidus Etiology I SO GOT
-structural: met primus elevatus, long/short 1st ray, hypermobile 1st ray - trauma - surgical complication - gout, OA - infection - osteochondritis dessicans
59
Hallux limitus/rigidus Radiograph (think OA)
Dec joint space Subchon sclerosis , cysts Osteophyte Joint mouse-> detached osteophyte
60
Hallux limitus/rigidus Treatment
Padding Stiff sole Morton's extension Surgery( joint fusion)
61
Digital deformities Hammertoes (E-F-E) Causes
1. Flexor stabilization (most common): late stance Pronated foot AductoVarus 4,5th- loss mech adv of quad plantae Asso w weak interossei mm Treatment: artheroplasty
62
Digital deformities Hammertoes (E-F-E) Causes
2. Flexor substitute (least common): late stance Supinated foot type Flexors> triceps surae m Treatment: arthrodesis, tendon transfer
63
Digital deformities Hammertoes (E-F-E) Causes
3. Extensor substitution: swing Ext> lumbricals MPJ ext >90: due to pes cavus, ankle equinus, lumbrical weak, TA weak, EDL splasticity & pain Treatment: arthrodesis
64
Hammertoes (E-F-E) Etiology
``` Idiopathic Inc PF mets Shoe p Intrinsic m imbalance L/S ext dysfunction MPJ instability from inc fluid (injection) Loss of FHB 2ndary to HAV ```
65
Claw toe
E-F F
66
Mallet toe
DIP = F Etiology= imbalance mm
67
Adductovarus digital rotation
Severity=5>4>3 Etiology= pronated foot-> abd twist-> dist ph pull med/post Pathology= HI BUS (Heloma dura, infection, bursa, ulcer, submet pain)
68
Lesions
HT- PIP, TUFT, SUBMET H CT- PIP, DIP, TUFT, SUBMET H MT- DIP, TUFT ADDUCTOVARUS- (5th)PIP, (4th)DIGIT, WEBSPACE Treatment- palliative, surgical
69
Painful FF
Metatarsalgia

Pod Med (8 decks)

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