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Miller > foot and ankle > Flashcards

foot and ankle Flashcards

(72 cards)

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1
Q

where does the spring ligament run?

A

calcaneus to navicular, supports talar head

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2
Q

primary stabilizer of longitudinal arch

A

interosseous ligaments

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3
Q

what is an Akin for?

A

increased HVI

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4
Q

IMA < 13 and HVA < 40

A

distal metatarsal osteotomy (chevron)

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5
Q

IMA > 13 or HVA > 40

A

proximal metatarsal osteotomy

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6
Q

risk factors for hallux valgus recurrence

A

undercorrection of IMA, isolated soft tissue reconstruction, isolated resection of the medial eminence

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7
Q

what does dorsal malunion after bunion surgery cause?

A

transfer metatarsalgia

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8
Q

risk factors for hallux varus after bunion surgery

A

resection of fibular sesamoid, overresection of the medial eminence, excessive lateral release, overcorrection of IMA

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9
Q

action of lumbricals

A

flex MTP, extend PIP and DIP

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10
Q

what causes a floating toe deformtiy

A

plantar translation of the metatarsal head after a distal osteotomy places the intrinsics dorsal to the MTP joint axis so lumbricals extend MTP instead of flex

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11
Q

deformity in hammer toe

A

PIP flexion

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12
Q

treatment for flexible hammertoe

A

non op - protective padding, tall-toe box shoes, splints
operative - flexor tenotomy or flexor to extensor tendon transfer

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13
Q

treatment for fixed hammertoe

A

operative - PIP arthroplasty or arthrodesis

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14
Q

deformity in claw toe

A

PIP and DIP flexion, fixed MTP hyperextension

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15
Q

operative treatment for flexible claw toe

A

flexor to extensor tendon transfer of FDL (makes FDL function as an intrinsic), lengthening of EDL and EDB

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16
Q

operative treatment for fixed claw toe

A

PIP arthroplasty or arthrodesis + MTP joint capsulotomy and extensor lengthening. dislocated MTP requires Weil/distal MT shortening osteotomy to reduce joint

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17
Q

deformity in mallet toe

A

DIP flexion

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18
Q

treatment for flexible mallet toe

A

flexor tenotomy

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19
Q

treatment for fixed mallet toe

A

DIP arthroplasty or arthrodesis

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20
Q

what is the key component of a crossover toe

A

disruption of plantar plate

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21
Q

which sesamoid is more frequently involved in trauma?

A

tibial

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22
Q

most common location of interdigital neuroma

A

interdigital nerve usually between third and fourth MT (where medial and lateral plantar nerves meet)

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23
Q

where does the medial plantar nerve frequently get compressed?

A

knot of henry (junction of FHL and FDL tendons)

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24
Q

what are the deforming forces in CMT?

A

PL>TA - first ray plantarflexion, PT>PB - hindfoot varus, extrinsics>intrinsics - claw toe

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25
position for first MTP fusion
neutral rotation, 10-15 degrees dorsiflexion, 5 degrees valgus
26
position for triple fusion
0-5 degrees hindfoot valgus, neutral abduction/adduction, plantigrade
27
position for tibiotalar fusion
neutral dorsiflexion, 0-5 degrees hindfoot valgus, 5-10 degrees external rotation
28
what is a Cotton osteotmy?
plantarflexion osteotomy - dorsal opening wedge of the cuneiform
29
what is a Dwyer osteotomy?
lateral calcaneal closing wedge osteotomy for hindfoot varus
30
how do medial talar OCDs differ from lateral?
usually more posterior, larger, deeper, more common
31
how do lateral talar OCDs differ from medial
usually related to trauma, more central or anterior
32
structure at risk with anteromedial ankle arthroscopy portal
saphenous nerve and vein
32
structure at risk with anterocentral ankle arthroscopy portal
DP artery
32
structure at risk with anterolateral ankle arthroscopy portal
dorsal intermediate cutaneous branch of SPN
32
structure at risk with posterolateral ankle arthroscopy portal
sural nerve, short saphenous vein
32
structure at risk with posteromedial ankle arthroscopy portal
posterior tib artery
32
what tendinous procedures need to be done in a Chopart amputation
tib ant transfer to talar neck and TAL to prevent equinus
33
what is Bohler's angle and what's a normal value?
line from highest point on calc anterior process to highest point on posterior facet, line tangential to superior edge of tuberosity, normal 20-40 degrees
34
what is the angle of Gissane and what's a normal value?
angle formed by intersection of a line drawn along the dorsal aspect of the anterior process of the calc and along the dorsal slope of the posterior facet, normal 120-145
35
most common complication in operative treatment of Morton's neuroma
formation of stump neuroma
36
complication in dorsal approach to Morton's neuroma
failure to excise neuroma
37
complication in plantar approach for Morton's neuroma
wound healing problems
38
anatomy of lisfranc ligament
between medial cuneiform and base of second metatarsal
39
main blood supply to talar body
artery of the tarsal canal from posterior tibial artery
40
what is the remaining blood supply in type 2 talar neck fractures
medial from deltoid artery (branch of posterior tibial artery)
41
what movement stresses the Lisfranc ligament?
pronation and abduction
42
when is primary arthrodesis indicated in lisfranc injuries?
purely ligamentous high energy injury
43
what deformity is seen after excision of both sesamoids?
cock up deformity/claw toe
44
which intrinsic is not innervated by the tibial nerve?
EDB (DPN)
45
most common complication of medial/tibial sesamoid excision
hallux valgus
46
nerve injury in lateral/fibular sesamoid excision
first common digital nerve
47
repair technique for chronic Achilles with 2-5 cm gap
VY lengthening +/- FHL transfer
48
operative treatment for all stage 2 PTTI
FDL or FHL tendon transfer to navicular
49
PTTI stage 2a + treatment
arch collapse, flexible hindfoot, normal forefoot. add medial slide calc osteotomy
50
PTTI stage 2b + treatment
arch collapse, flexible hindfoot, abducted forefoot (>40% TN uncoverage), lateral column lengthening +/- medial calc slide
51
treatment when forefoot remains supinated in PTTI
Cotton osteotomy (dorsal opening wedge of cuneiform to plantarflex first ray)
52
stage 3 PTTI + treatment
arch collapse, rigid hindfoot and forefoot, subtalar arthritis. -> triple
53
hallux valgus treatment when DMAA > 10, IMA < 13, and HVA < 40
distal MT biplanar closing wedge osteotomy
54
hallux valgus treatment when DMAA > 10 and IMA > 13 or HVA > 40
proximal MT osteotomy and distal MT medial closing wedge osteotomy
55
what is calcaneus gait
weak toe off and dorsiflexed ankle due to weak GSC
56
what is steppage gait?
increased hip and knee flexion to clear foot, foot slap, due to weak TA
57
what is the main muscle action during heel strike?
eccentric contraction of the anterior compartment
58
what is the main muscle action during foot flat?
eccentric contraction of posterior compartment
59
what is the main muscle action during toe off?
concentric contraction of the posterior compartment
60
what is the main muscle action in swing phase?
concentric contraction of the anterior compartment
61
what ABI is needed for wound healing?
0.45
62
what absolute toe pressure is needed for healing?
40
63
what transcutaneous oxygen measurement (PO2) of the toes is needed for healing?
40
64
what nutritional measurements predict healing?
protein > 6, WBC > 1500, albumin > 2.5
65
what tendinous procedure needs to be done in a lisfranc amputation?
transfer peroneals to cuboid to prevent varus
66
what two things are required for a syme amputation?
stable heel pad and patent PT artery
67
amputation with lowest energy expenditure
TMA

Miller (12 decks)

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