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Flashcards in Foot & Ankle Deck (228)
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1

Name and describe 2 classifications for charcot foot

Eichenholtz:

 Stage 0: joint edema, x-rays negative

Stage 1: fragmentation

  • Local edema
  • osseous fragmentation with joint dislocation

Stage 2: coalescence:

  • decreased local edema
  • x-rays show coalescence of fragments and absorption of fine bone debris

Stage 3: Reconstruction

  • no local edema
  • x-rays show consolidation and remodeling of fracture fragments

 

Brodsky

Type 1: (midfoot)

  • TMT and naviculocuneiform joints (60%)

Type 2 (Hindfoot):

  • subtalar, TN, CC joints

Type 3: Ankle of calcaneus

  • A: tibiotalar joint
  • B: Follows fracture of calcaneal tuberosity

Type 4: Combination of areas

Type 5: solely in forefoot

 

2

 

How many people get subtalar arthritis 10 years post tibiotalar arthrodesis?

 

50%

3

Syndesmosis screw technique

Be specific

2 x 3.5 or 4.5mm syndesmotic screws

Through 3-4 cortices

2-5cm above plafond

Screw material:

No difference between types of metal or bioabsorbable

Cortices:

No difference between 3-4

Number of screws:

2 is better

Position of foot

Recent studies challenge the principle of holding the ankle in maximal dorsiflexion to avoid over tightening

Post-operative care:

Typically non-weight bearing 6-12 weeks

May prolong if screw breakage is a concern

4

Name 3 gait advantages of total ankle replacement vs. arthrodesis

Increased stride length

 Improved cadence

Increased stride velocity

5

4 common technical errors in Total ankle arthroplasty

Prosthesis is too lateral

Prosthesis is too small - will subside

Failing to solve preoperative varus/valgus malalignment

Attempting to replace an ankle that is too anteriorly subluxed

6

os trigonum syndrome is associated with pathology in what structure?

FHL

7

 

What are Scarf and Ludloff osteotomies used for? Differentiate them in one sentence.

 

Promixal metatarsal osteotomies for the treatment of moderate hallux valgus, usually in combination with a modified McBride distally.

 

See picture for differences.

8

Recalcitrant forefoot plantar ulcers

What is an important aspect of treatment

TAL vs. gastrocs lengthening

Decreaes plantarflexion and decreases pressure on forefoot

9

Neuropathic joint

Technetium bone scan will be

Indium WBC scan will be

Tc: ± positive in charcot (positive for OM)

indium WBC scan: negative in charcot (+OM)

10

Sectioning of which collateral ligament leads to more instability?

Accessory

B/c it attaches directly to the plantar plate

(vs. proper collateral, attaches to the proximal aspect of the phalanx)

11

 

Three differentials for posterior ankle pain not involving the Achilles.

 

  1. Os Trigonum Syndrome
  2. Posterior impingement
  3. FHL Tendonitis

12

Describe ankle arthroscopy portals

Anteromedial

  • Primary viewing portal
  • Established 1st
  • medial to tib ant & lateral to medial malleolus
  • Danger: saphenous nerve & vein

Anterolateral:

  • Primary viewing portal
  • Lateral to peroneus tertius & superficial peroneal nerve & medial to lateral malleolus
  • Danger: Dorsal cutaneous branch of SPN

Anterocentral

  • Anterior viewing portal
  • Medial to EDC and lateral to EHL
  • Not commonly used due to risk to DP artery

Posterolateral

  • Posterior viewing portal
  • 2cm proximal to tip of lateral malleolus
  • Between peroneal tendons and achilles tendon
  • Danger: sural nerve and small saphenous vein

Posteromedial

  • posterior viewing portal
  • just medial to achilles
  • Risks: posterior tibial artery

 

13

Diagnosis & Treatment (chronic)

Ankle synovitis

Arthroscopy and synovectomy

14

What are 2 associated conditions of anterior ankle impingement?

Ankle instability (up to 35% will continue to have pain after stabilization procedure)

OCD
(Technically NOT OA, b/c this is pre-OA)

15

Best predictor of post-op ROM with TAA

Pre-op ROM

16

Differenes of Juvenile HV vs. Adult:

Juvenile is:

  • Often bilateral
  • Often familial
  • Pain is not the primary complaint
  • varus 1st MT with widened IMA usually present
  • DMAA usually increased
  • often associated with flexible flatfoot

17

In os trigonum syndome, in the absence of an obvious os trigonum, what may be another cause?

scar tissue behind posterior talus (where the os should be)

Found on MRI

18

4 pathologic conditions secondary to cavus foot

(what does cavus foot cause, NOT what causes cavus foot)

Lateral column stress fractures

Lateral ligament injury

peroneal tendon injury

Lateral column overload

19

1st step in lisfranc ORIF?

Intercuneiform reduction and fixation

20

Name & Describe classic tendon transfer for foot drop

Bridle Procedure

  • Classically PTT, TA & PL transfer & tritendon anastomosis

Tib post:

  • transferred to middle/lateral cuneiform
  • THROUGH split in tib ant

Tib Ant

  • Anastomosed to Tib post

Peroneus Longus

  • PL: cut 5cm above fibula
  • Proximal end sewn to PB
  • distal end is anastomosed to newly transferred PTT

Effect

  • As tib post pulls, it will also pull on PL and TA, causing dorsiflexion & eversion (motion lost with peroneal nerve injury)

21

Classification of Hallux Rigidus:

Coughlin & Shurnas Classification

Grade 0:

  • Stiffness with normal x-ray

Grade 1:

  • mild pain at extreme range of motion
  • X-rays show mild dorsal osteophyte and normal joint space

Grade 2:

  • Moderate pain with range of motion
  • Moderate dorsal osteotomy
  • <50% joint space narrowing

Grade 3:

  • Significant stiffness and pain at extreme ROM.  No midrange pain
  • Xrays show severe dorsal osteophyte >50% joint space nrrowing

Grade 4:

  • significant stiffness and pain at extreme ROM AND pain at mid-range
  • x-rays: same as grade 3

 

22

 

List some differentials for failed treatment of ankle sprain (i.e. missed concommitant injuries/pathology)

 

  1. injury to the anterior process of calcaneus
  2. injury to the lateral or posterior process of the talus
  3. injury to the base of the 5th metatarsal
  4. osteochondral lesion
  5. injuries to the peroneal tendons
  6. injury to the syndesmosis
  7. tarsal coalition
  8. impingement syndromes

23

Indications for 1st MTP arthrodesis in HV:

CP

Down's

Ehler-Danlos

RA

Gout

Severe DJD

 

24

What is the mechanism for injury to the superior peroneal retinaculum?

Dorsiflexion & inversion

During reflexive contraction of the peroneal muscles

 

25

4 medications you can use in Charcot Foot

bisphosphonates

neuropathic pain meds

antidepressants

topical anesthetics

26

Isolated fusion of the calcaneocuboid, subtalar, and talonavicular joint arthrodeses result in how much limitation in motion?

limit hindfoot motion by approximately 25% (CC), 40% (ST), and 90% (TN)

27

Name 2 anatomic risks for peroneal tendon instabiliy or rupture

Low lying peroneus brevis muscle

Presence of peroneus quartus muscle

28

Most common foot position after CVA or TBI

equinovarus

29

Risks of failure in isolated subtalar arthrodesis (5)

smoking

the presence of more than two millimeters of avascular bone at the arthrodesis site

failure of a previous subtalar arthrodesis

Use of structural allograft (should use autografto)

Adjacent ankle arthrodesis

30

 

What nerve can cause a painful neruoma if damaged during medial capsular imbrication for HV?

 

Medial branch of dorsal cutaneous nerve (SPN)