What are the three types of Tailor’s Bunion?
Type A - large head
Type B - meta-diaphyseal flare or deviation
Type C - enlarged 4-5 IM angle
What’s the IFCC value range of good HbA1c control?
Between 48-58 mmol/mol
What’s a normal HbA1c?
Below 42 mmol/mol
Why is the HbA1c test unreliable in people with anaemia or sickle-cell disease, and Vitamin B12 or folate deficiency?
Because the RBC lifespan may be shortened (due to premature RBC death) or prolonged, thereby affecting the time available for glycosylation to occur, leading to under- or overestimation, respectively.
What is the alternative test for HbA1c?
Fructosamine test
What is the fructosamine test?
A measurement of the glycation of serum protein (albumin). Because albumin has a half-life of 20 days, the fructosamine concentration reflects recent (2-3 week) changes in blood glucose
What is CRP?
C-reaction protein is an acute-phase reactant (protein) that is released into the blood at the start of inflammation or infection or after tissue injury
What’s the physiologic role of CRP?
To complement (enhance) phagocytosis to clear microbes and damaged cells
What’s a normal CRP?
< 5 mg/L
What does ESR measure?
Erythrocyte sedimentation rate is a measure of chronic inflammation
How does ESR work?
The physics of how blood settles has to do with the zeta potential between the red cells. The zeta potential is the normal, negative force that exists between red cells and pushes them apart from each other. Things that disrupt the zeta potential make it easier for the red cells to come close to each other, and thus the cells settle faster in the tube (and ESR goes up). Things that increase the zeta potential between the red cells (making them more repellant than usual) will cause the red cells to settle at a slower rate.
Increased blood levels of certain protein molecules (e.g. fibrinogen or immunoglobulins, which are increased in inflammation) get in between red cells and disrupt (decrease) the zeta potential between the red cells, making them settle at a faster rate in the ESR test.
Recite the podiatrists’ exemption (POMS) list
- Amoxicillin
- Amorolfine hydrochloride cream
- Amorolfine hydrochloride lacquer
- Co-Codamol
- Co-dydramol 10/500
- Codeine
- Erythromycin
- Flucloxacillin
- Silver Sulfadiazine
- Tioconazole
- Topical hydrocortisone
- Bupivacaine
- Ropivacaine
- Lignocaine
- Mepivacaine
- Prilocaine
- Adrenaline
- Methylprednisolone
What is Allopurinol and how does it work?
Anti-gout medication. Inhibits xanthise oxidase - a major enzyme in uric acid synthesis
How does colchicine work?
Acts by interfering with WBC’s ability to phagocytose urate crystals, thus reducing inflammation
What are radiographic findings of gout?
- Periarticular swelling
- Cloud sign - tophaceous material at joint margins
- Rat-bite punched out erosions
What would a joint aspirate of gout show?
Needle-shaped monosodium urate crystals that are negatively birefringent under polarised light
N.B. CPPD would show rhomboid-shaped and positively birefringent
State 12 or 13 corticosteroid injection side-effects
- Skin discolouration (hypopigmentation) over the injection site
- Steroid flare - a transient increase in pain beginning hours after injection and subsiding within 24-48 hours - apply ice
- Failure to resolve problem
- Localised discomfort (for a few days)
- Infection
- Dimpling of the skin - a loss of fat where the injection was given (may be permanent)
- Soft-tissue atrophy e.g. plantar pat pad
- Facial flushing - for a few hours
- Capsular damage
- Damage to collateral ligaments - causing deviation of the MTP joint (particularly after multiple injections)
- Disruption to diabetic control (gluconeogenesis)
- Temporary bleeding/bruising
- High blood pressure
What should the tourniquet pressure be at the ankle?
Inflate 100 to 120 mmHg above systolic blood pressure
What are nosocomial infections?
Hospital-acquired infections
What’s the normal bone density?
A T-score between -0.9 and 0.9 is normal
A T-score between -1.0 and -2.5 is osteopenia
A T-score of -2.5 or below is osteoporosis
What is the fleck sign?
A small bony fragment that is seen in the Lisfranc space (between 1st and 2nd metatarsal) associated with avulsion of the Lisfranc ligament
What is the post-op care for a Scarf procedure?
- At 1/52 post-op redress + post-op X-ray - checks for alignment, good bone and metalwork position, no bone # (osteotomy site won’t reveal any callus as it’s primary intention and will instead appear as a lytic line).
- At 2/52 stitches removed + big toe physiotherapy
What is the post-op care for a Lapidus procedure?
- At 1/52 post-op redress + post-op X-ray
- At 2/52 stitches removed and continue protected WB i.e. crutches + Aircast boot.
- At 4/52 Aircast boot only - weaning in and out of trainers.
- At 12/52 review foot (will still be swollen) but the patient should be getting back to normal activity with trainers.
What is the post-op care for a Cartiva procedure?
- At 1/52 post-op redress + post-op X-ray - walking to tolerance level around the house with the trauma shoe
- At 2/52 stitches removed + ROM exercises started
- At 6/52 the foot should return to normal
What is the post-op care for an Arthrodesis procedure?
- Aircast boot placed in theatre immediately post-op - should be taken off at rest and the foot & ankle mobilised
- At 1/52 post-op redress + post-op X-ray - walking to tolerance level around the house with the Aircast boot
- At 2/52 stitches removed - patient remains full WB in Aircast boot until 6/52
What does the term ‘laser’ stand for?
Light Amplification by Stimulated Emission of Radiation
What does the term ‘scuba’ stand for?
Self-Contained Underwater Breathing Apparatus
How much bone density is already lost by the time osteoporosis becomes evident on plain radiographs?
At least 20 to 30 %
Why are swimming and water aerobics popular exercises for osteoarthritis?
Because the buoyancy of water reduces joint stress
How does connective tissue respond to stretch?
When connective tissue is stretched, some of the elongation is elastic and some is plastic.
N.B. Low-force loads applied for long periods of time result in a greater incidence of plastic deformation.
What kind of injuries are common as a result of too much flexibility?
Joint sprains because the connective tissue surrounding the joint has been elongated and does no longer contribute as effectively to the stability of the joint.
N.B. Excessive flexibility of a joint may contribute to osteoarthritis or joint pain
What effect does a limited range of movement have on flexibility?
Moving the joint through a limited ROM will decrease the flexibility of the joint over time owing to adaptive shortening of the muscle and connective tissue as the elastic nature of connective tissue causes it to shorten when no load is applied
Where is the core temperature regulatory centre located?
Anterior hypothalamus
When exercising in the heat, why should clothing that becomes wet not be changed to dry clothing?
Because evaporative heat loss occurs more efficiently when clothing is wet
