FF summary Flashcards Preview

Pod Med > FF summary > Flashcards

Flashcards in FF summary Deck (69):
1

Metatarsalgia

Physical exam

Pain on palpation- met heads

Little or no inflam (rare= bursitis)

2

Metatarsalgia

Pathogenesis

Inc pronation

Dec tran. Arc

3

Metatarsalgia

Diagnosis

Rule out everything else

4

Metatarsalgia

Treatment

Rest ,ice
Met pads
Orthotics
Pain meds

5

Nerve injury

Compression

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

6

Nerve injury

Compression

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

7

Nerve injury

Transection

Neurotmesis (least common)
- laceration
- no basemembrane

8

Nerve injury

Ischemia/ infarct

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

9

Nerve injury

Radiation-induced

Seen w radiation treatment
Delayed presentation
Dec sensation, proprioception
Weakness

10

Nerve injury

Degeneration (most common cause of injury)

Distal: distal->prox deg /longest n first
Most vuln to metabolic/toxic activity

11

Nerve injury

Inflammation

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

12

Nerve injury

Common symptom

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

13

Nerve injury

Autonomic inv

Skin changes due to nn injury
Slow wound healing due to poor innervation to sm mm

14

Nerve injury

Physical exam

Valleix- prox+dis

Tinel- distal

Tingling and pain

15

Common n entraps

Morton

McDonald

Common dig n

16

Joplin

Med proper dig n to hallux (1st)

17

Ant tarsal tunnel

Deep fib n

18

Lemonts

Superficial fib n

19

Tarsal tunnel syndrome

Post tib n

20

Compressed common dig n

Morton's neuroma

21

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

F>M; shoe choices

Morton's neuroma

22

Morton's neuroma

Etiology

Compressed by DTIL ( or by bursa from trauma)

23

Morton's neuroma

Symptoms

Pain, burning, tingling
Pebble in shoe (worse wt bearing)

24

Morton's neuroma

Diagnosis

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!

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