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ABOS PART ONE > Foot and Ankle > Flashcards

Foot and Ankle Flashcards

1
Q

ankle coupled motion

A

fibula externally rotates and migrates proximally with ankle dorsiflexion

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2
Q

transverse tarsal joints during heel-strike, and position of the foot

A

parallel, supple. The foot is in dorsiflexion, forefoot abduction, and hindfoot valgus

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3
Q

transverse tarsal joints during toe-off

A

divergent, locked. Foot is in plantarflexion, forefoot adduction, hindfoot varus.

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4
Q

why there is no heel-rise in PTT deficiency

A

the PT is not able to lock the transverse tarsal joints

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5
Q

the primary stabilizer of the longitudinal arch of the foot

A

plantar interosseous ligaments, not the plantar fascia

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6
Q

hindfoot during foot-flat cycle

A

unlocked/everted for ground accommodation

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7
Q

hindfoot during heel strike cycle

A

unlocked/everted for energy absorption

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8
Q

windlass mechanism

A

as the MTPs extend during toe-off the plantar fascia is tightened, accentuating the longitudinal arch

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9
Q

foot exam: position of hindfoot in cavovarus

A

plantar flexed first ray, hindfoot varus

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10
Q

stance phase in antalgic gait

A

this is shortened. don’t want to linger on a painful limb

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11
Q

vascular predictors of adequate healing in the foot

A

toe pressures > 40mmHg, or TcPO2 > 30 mmHg

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12
Q

insensitivity to this size semmes-weinstein predictor of foot ulcer

A

5.07

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13
Q

varus stress test of the ankle evaluates this

A

calcaneofibular ligament

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14
Q

anterior drawer test of the ankle evaluates this

A

anterior talofibular ligament

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15
Q

how to perform test of calcaneofibular ligament

A

inversion of the ankle in dorsiflexion

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16
Q

why flexing the knee is part of the silverskiold test

A

the soleus doesn’t cross the knee joint, so if flexing the knee loosens an equinus contracture, it is just gastroc and not soleus

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17
Q

migration of this implicated in hallux valgus

A

plantar-lateral migration of the abductor hallucis, which causes the muscle to pronate and plantar-flex the phalanx

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18
Q

normal hallux valgus angle

A

less than 15 degrees

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19
Q

normal IMA (foot)

A

less than 9 degrees

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20
Q

normal DMAA

A

less than 10 degrees

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21
Q

this is never done by itself in hallux valgus

A

modified mcbride

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22
Q

Indications for chevron osteotomy, +distal soft tissue release

A

IMA 13* or less, -AND- HVA is 40* or less

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23
Q

indications for proximal metatarsal osteotomy, +distal soft tissue release

A

IMA >13, -OR- HVA >40

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24
Q

indications for adding distal medial closing wedge osteotomy to hallux valgus procedures

A

DMAA greater than 10*. Done IN ADDITION to other indicated procedures based on the angular measurements

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25
Q

this is highly associated with lapidus and proximal crescentic osteotomy

A

transfer metatarsalgia from dorsal malunion

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26
Q

common cause for iatrogenic hallux varus

A

overresection of the medial eminence during hallux valgus surgery

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27
Q

technical difference in the surgery to correct severe hallux valgus in adolescent

A

proximal osteotomy done through medial cuneiform instead of the first met if physes are open

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28
Q

complex hammer-toe

A

hammer-toe is hyperflexion of the PIP joint. with weightbearing the MTP joint appears dorsiflexed. if this does not go away when not weightbearing, it is considered complex

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29
Q

mgmt of flexible claw toe

A

flexor to extensor transfer; causes the FDL to act as an intrinsic

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30
Q

mgmt of fixed claw toe

A

depends on whether the MTP is reduced. If so, PIP arthroplasty/arthrodesis, MTP joint capsulotomy, and extensor lengthening. If the MTPJ is not reduced you will add a Weil distal MT osteotomy

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31
Q

key for mallet toe development

A

plantar plate attenuation (often iatrogenic - steroids)

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32
Q

indication for proximal osteotomy in bunionette deformity

A

because of blood supply concerns you don’t cut proximally on the fifth MT

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33
Q

indication for diaphyseal osteotomy in bunionette deformity

A

type 3, or 4-5 IMA >8*

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34
Q

indication for distal osteotomy in bunionette deformity

A

type 2, or those with distal lateral bowing

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35
Q

indication for distal condylectomy in bunionette deformity

A

type 1, or those with prominent MT head

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36
Q

the sesamoids are part of this tendon

A

flexor hallucis brevis

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37
Q

the sesamoids protect this tendon

A

flexor hallucis longus

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38
Q

turf toe type 1

A

1 - capsular strain, normal films, normal ROM. Immediate RTP

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39
Q

turf toe type 2

A

2 - painful ROM, limited weightbearing, normal films. Out for 2 weeks

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40
Q

turf toe type 3

A

3 - complete plantar plate rupture. abnormal films (proximal migration) requires plantar plate repair if migrated more than 3mm. Out 6weeks.

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41
Q

this occurs if bilateral sesamoidectomies are performed

A

cock-up toe deformity

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42
Q

this approach places the lateral plantar nerve at risk

A

incisions on the plantar surface (TTC nail)

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43
Q

etiology of the most common deformity of the foot in upper motor neuron disorders

A

equinovarus; equinus bc gastroc overactivity, varus bc everything medial to the ankle axis is overpulling. Mostly AT, but also FHL, FDL, and Tib Post

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44
Q

mgmt of flexible equinovarus due to upper motor neuron disorder

A

the equinus is fixed with TAL or Z lengthening. Since the varus is bc the medial sided muscles (usually AT) are overpulling, you can transfer all or part of AT to the lateral cuneiform

45
Q

root cause of the plantar-flexion in CMT

A

overpull of the peroneus longus

46
Q

result of the plantar-flexion in CMT

A

forefoot cavus, and resultant compensatory hindfoot varus

47
Q

root cause of the compensatory hindfoot varus in CMT;

A

with the AT overpowered by the peroneus longus, the posterior tib can pull the hindfoot into even more varus, since the peroneus brevis can’t resist it

48
Q

surgical mgmt of cavovarus

A

Everyone: release plantar fascia, dorsiflexion 1st MT (cotton) osteotomy, peroneus longus to brevis transfer, then test coleman block. If doesn’t correct, then add lateral calc slide or closing-wedge osteotomy

49
Q

chronic gout treatment

A

been going on A-LONG time? ALLOpurinol

50
Q

portion of foot involved in RA

A

forefoot more than mid or hind

51
Q

deformity on the forefoot of RA

A

dorsal subluxation, valgus deviation, and hammering of the toes

52
Q

why ankle fusion not always the mgmt of tibiotalar joint arthritis

A

it is, unless there is hindfoot arthritis (needs a triple) or already has a triple. Avoid ANYthing that would lead to a PANtalar fusion, which has horrible outcomes.

53
Q

main concern with TAA in RA

A

would healing issues

54
Q

most common complication of RA forefoot arthroplasty

A

intractable plantar keratoses

55
Q

orthotic mgmt of hallux rigidus

A

stiff foot plate with morton first ray extension

56
Q

orthotic mgmt of midfoot arthritis

A

stiffsoled or steel shank with rocker bottom

57
Q

position for 1st met fusion in hallux rigidus

A

no rotation, a little bit of valgus, and enough plantarflexion to touch floor

58
Q

to fix a malunited triple arthrodesis

A

transverse tarsal osteotomy to rotate into plantigrade, and calcaneal osteotomy to correct the varus or valgus

59
Q

these increase the rate of nonunion of subtalar arthrodesis

A

prior tibiotalar arthrodesis and smoking. smokers actually heal better than prior fusions

60
Q

this procedure leads to lower failure rate with the Agility TAA

A

syndesmotic fusion

61
Q

who does best with TAA: RA, osteoarthritis, or post-traumatic

A

TAA shows the best outcomes in osteoarthritis

62
Q

indications and potential drawbacks of subtalar bone-block arthrodesis

A

Done for pts with prior calcaneus fx with loss of height, but can have anterior ankle impingement and pain

63
Q

rigid pes planus

A

triple

64
Q

incompetence of this is associated with increasing flatfoot deformity

A

spring, or calcaneonavicular, ligament, which is the primary static stabilizer of the talonavicular joint

65
Q

pes planus indicated radiographically by

A

negative mearys angle, or the lateral talometatarsal angle

66
Q

orthotics for pes planus

A

medial post, medial wedge. AFO.

67
Q

nonop mgmt for pes planus

A

AFO with physical therapy has shown the highest success rate

68
Q

all stage II PTT includes this

A

FHL or FDL transfer to the navicular to reconstruct the PT.

69
Q

stage II PTT that has hindfoot valgus and

A

add a MEDIAL calcaneal osteotomy. This adds power to the flexor tendon transfer, and corrects the hindfoot valgus

70
Q

stage II PTT that has hindfoot valgus and >40% talar head uncovering includes this

A

same as stage 2 without forefoot abduction (TN uncovering), only you add lateral column lengthening (Evans): FDL/FHL transfer, medial calc slide, lat column lengthening

71
Q

stage II PTT that has forefoot supination

A

depends on whether the medial column is stable or not; cotton if it is, fusion if it isn’t

72
Q

stage III PTT

A

rigid = triple

73
Q

peroneal tendon subluxation requires repair of

A

superior peroneal retinaculum

74
Q

associated with plantar fasciitis

A

achilles tendon contracture

75
Q

release of the plantar fascia can cause

A

obviously will stress the longitudinal arch, but can also overload the lateral column and lead to dorsolateral foot pain

76
Q

muscle and nerve involved with Baxter’s neuritis

A

baxter’s nerve, obviously, which is the first branch of the lateral plantar nerve. Pain is located more medial than plantar fasciitis, over abductor hallucis

77
Q

motor neuropathy of this is most common in diabetics

A

common peroneal nerve, which leads to footfrop (loss of AT) and the intrinsics which causes clawtoes and toe ulcers

78
Q

minimum ABI for healing in diabetics

A

0.45mmHg

79
Q

in diabetics these are lab values indicative of poor healing potential

A

total protein

80
Q

swelling and redness of charcot compared to osteo

A

charcot is better in the morning, after it hasn’t been dependent all day

81
Q

when can custom braces be done for charcot

A

after the warmth and swelling subsides

82
Q

what technical step must be done in both lisfranc and chopart amputations

A

both need tendon transfers, but also need achille’s lengthenings, which prevent equinus

83
Q

tendon transfer done after lisfranc amputation

A

to prevent varus you have to transfer the peroneal tendons to the cuboid

84
Q

tendon transfer done after chopart amputation

A

to prevent varus you have to transfer the anterior tibialis tendons to the talus

85
Q

foot amputation with lowest energy expenditure

A

transmet

86
Q

foot amputation with second lowest energy expenditure

A

Syme

87
Q

indications for fxs of 2-4 MT

A

more than 10* sagittal plane deformity or if all 3 are fxd.

88
Q

purely ligamentous Lisfranc fx disloc’n

A

primary fusion

89
Q

typical location of navicular stress fxs

A

central 1/3rd

90
Q

gold standard for navicular stress fx diagnosis

A

CT scan

91
Q

screw placement for navicular fxs

A

only done for displaced or evidence of nonunion, and placed from dorsolateral to plantarmedial

92
Q

three blood supplies to the talus

A

body supplied by artery to the tarsal canal (deltoid br of posterior tibial), the neck supplied by dorsalis pedis and peroneal perforators

93
Q

talus fxs with comminution in this location have this characteristic deformity

A

medial neck comminution leads to varus deformity

94
Q

Varus malunion of a talus fx leads to

A

cavovarus deformity, which limits hindfoot eversion, and causes lateral foot pain

95
Q

talar neck fxs: Hawkins good, Hawkins bad?

A

The subchondral lucency of the talus, or Hawkin’s sign, indicative of revascularization. GOOD…

96
Q

laterality of the wound in open calcaneal fxs, with respect to complication rate

A

medial wounds do not increase the complication rate as much as lateral wounds

97
Q

at risk during placement of lateral to medial screws while ORIF of calc fx

A

FHL, where it courses past the sustentaculum

98
Q

obstacles to reduction in medial subtalar disloc’n

A

EDB, peroneal tendons, capsule

99
Q

obstacles to reduction in lateral subtalar disloc’n

A

posterior tib, FHL

100
Q

mechanism and location of lateral OCD talar lesions

A

dorsiflexion, inversion. Anterior.

101
Q

mechanism and location of medial talar OCD lesions

A

plantarflexion, inversion, located posteriorly. Deeper, and occur spontaneously

102
Q

full thickness P brevis tear

A

transfer peroneus longus

103
Q

these peroneus brevis tears can be repaired

A

partial longitudinal tears

104
Q

this treatment for OCD lesions results in hyaline cartilage formation

A

autologous osteochondral transplant

105
Q

most common complication after Morton’s neuroma injection

A

hammertoe

106
Q

mgmt of hallux varus that is passively correctable

A

split EHL transfer, MT osteotomy, medial capsule release. If it is not flexible, fuse it…

107
Q

FHL transfers are done for this type of Achille’s tendon injury

A

chronic tears more than 5cm

108
Q

only proven risk factor for mortons neuroma

A

female gender

ABOS PART ONE (11 decks)

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