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Miller > foot and ankle > Flashcards

foot and ankle Flashcards

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
Q

position for first MTP fusion

A

neutral rotation, 10-15 degrees dorsiflexion, 5 degrees valgus

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26
Q

position for triple fusion

A

0-5 degrees hindfoot valgus, neutral abduction/adduction, plantigrade

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27
Q

position for tibiotalar fusion

A

neutral dorsiflexion, 0-5 degrees hindfoot valgus, 5-10 degrees external rotation

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28
Q

what is a Cotton osteotmy?

A

plantarflexion osteotomy - dorsal opening wedge of the cuneiform

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29
Q

what is a Dwyer osteotomy?

A

lateral calcaneal closing wedge osteotomy for hindfoot varus

30
Q

how do medial talar OCDs differ from lateral?

A

usually more posterior, larger, deeper, more common

31
Q

how do lateral talar OCDs differ from medial

A

usually related to trauma, more central or anterior

32
Q

structure at risk with anteromedial ankle arthroscopy portal

A

saphenous nerve and vein

32
Q

structure at risk with anterocentral ankle arthroscopy portal

A

DP artery

32
Q

structure at risk with anterolateral ankle arthroscopy portal

A

dorsal intermediate cutaneous branch of SPN

32
Q

structure at risk with posterolateral ankle arthroscopy portal

A

sural nerve, short saphenous vein

32
Q

structure at risk with posteromedial ankle arthroscopy portal

A

posterior tib artery

32
Q

what tendinous procedures need to be done in a Chopart amputation

A

tib ant transfer to talar neck and TAL to prevent equinus

33
Q

what is Bohler’s angle and what’s a normal value?

A

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
Q

what is the angle of Gissane and what’s a normal value?

A

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
Q

most common complication in operative treatment of Morton’s neuroma

A

formation of stump neuroma

36
Q

complication in dorsal approach to Morton’s neuroma

A

failure to excise neuroma

37
Q

complication in plantar approach for Morton’s neuroma

A

wound healing problems

38
Q

anatomy of lisfranc ligament

A

between medial cuneiform and base of second metatarsal

39
Q

main blood supply to talar body

A

artery of the tarsal canal from posterior tibial artery

40
Q

what is the remaining blood supply in type 2 talar neck fractures

A

medial from deltoid artery (branch of posterior tibial artery)

41
Q

what movement stresses the Lisfranc ligament?

A

pronation and abduction

42
Q

when is primary arthrodesis indicated in lisfranc injuries?

A

purely ligamentous high energy injury

43
Q

what deformity is seen after excision of both sesamoids?

A

cock up deformity/claw toe

44
Q

which intrinsic is not innervated by the tibial nerve?

A

EDB (DPN)

45
Q

most common complication of medial/tibial sesamoid excision

A

hallux valgus

46
Q

nerve injury in lateral/fibular sesamoid excision

A

first common digital nerve

47
Q

repair technique for chronic Achilles with 2-5 cm gap

A

VY lengthening +/- FHL transfer

48
Q

operative treatment for all stage 2 PTTI

A

FDL or FHL tendon transfer to navicular

49
Q

PTTI stage 2a + treatment

A

arch collapse, flexible hindfoot, normal forefoot. add medial slide calc osteotomy

50
Q

PTTI stage 2b + treatment

A

arch collapse, flexible hindfoot, abducted forefoot (>40% TN uncoverage), lateral column lengthening +/- medial calc slide

51
Q

treatment when forefoot remains supinated in PTTI

A

Cotton osteotomy (dorsal opening wedge of cuneiform to plantarflex first ray)

52
Q

stage 3 PTTI + treatment

A

arch collapse, rigid hindfoot and forefoot, subtalar arthritis. -> triple

53
Q

hallux valgus treatment when DMAA > 10, IMA < 13, and HVA < 40

A

distal MT biplanar closing wedge osteotomy

54
Q

hallux valgus treatment when DMAA > 10 and IMA > 13 or HVA > 40

A

proximal MT osteotomy and distal MT medial closing wedge osteotomy

55
Q

what is calcaneus gait

A

weak toe off and dorsiflexed ankle due to weak GSC

56
Q

what is steppage gait?

A

increased hip and knee flexion to clear foot, foot slap, due to weak TA

57
Q

what is the main muscle action during heel strike?

A

eccentric contraction of the anterior compartment

58
Q

what is the main muscle action during foot flat?

A

eccentric contraction of posterior compartment

59
Q

what is the main muscle action during toe off?

A

concentric contraction of the posterior compartment

60
Q

what is the main muscle action in swing phase?

A

concentric contraction of the anterior compartment

61
Q

what ABI is needed for wound healing?

A

0.45

62
Q

what absolute toe pressure is needed for healing?

A

40

63
Q

what transcutaneous oxygen measurement (PO2) of the toes is needed for healing?

A

40

64
Q

what nutritional measurements predict healing?

A

protein > 6, WBC > 1500, albumin > 2.5

65
Q

what tendinous procedure needs to be done in a lisfranc amputation?

A

transfer peroneals to cuboid to prevent varus

66
Q

what two things are required for a syme amputation?

A

stable heel pad and patent PT artery

67
Q

amputation with lowest energy expenditure

A

TMA

Miller (11 decks)

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