Home (/) / Flashcards (/flashcards/) / Preview
Foot & Ankle - Orthobullets
Author
Home (/flashcards/?ref=pp) egusnowski
ID
345823
Get App (/flashcards/?page=wizard&quiz&cardsetID=345823&ref=pp)
Card Set
Foot & Ankle - Orthobullets
Take Quiz Create (/flashcards/?page=wizard&create) Description
Foot and ankle orthobullets
1. Most common casue of adult acquired flatfoot
Updated
Tib post insufficiency م٨:٢٥:٥٠ ٢٠١٩/٣/٧
Show Answers
2. 6 risk factors for Posterior tibial insufficiency
Obesity
Hypertension
Diabetes
Increased age
corticosteroids
Seronegative inflammatory disorders
3. Acquired flatfoot deformities in the foot
Pes planus
Hindfoot valgus
Forefoot varus
Forefoot abduction
4. Tib post: origin
Innervation
3 limbs insertion
Blood supply
HOw to test strenght
POsterior fibula/tibia/IOM
Tibial nerve L4-5
Anterior: inserts onto navicular tuberosity and first
cuneiform
Middle limb: seond and third cuneiform, cuboid and
2-4 metatarsals
POsterior limb: sustentaculum tali
Posterior tibial artery: watershed area 2-6 cm proximal to
navicular insertion
Isolate by placing foot in plantar flexion and eversion and
test resistance
5. Tib post: major antagonist
Works during what phase of gait
Peroneus brevis
During toe off phase: PTT fires and locks the transverse
tarsal joints creating a rigid lever arm
During stance phase: adducts and supinated forefoot
6. Posterior tibial tendon dysfunction stages: mention
deformity, physical exam , radiographs
Stage 1
Tenosynovitis
Able to do single heel raise
Normal x rays
Stage 2A
Flatfoot deformity
flexible hindfoot
Normal forefoot
unable to do single heel raise
Arch collapse on x rays
Stage 2B
FLatfoot deformity
Flexible hindfoot
Forefoot abduction >40 degrees
Too many toes sign
unable to do single heel raise
Stage 3
Flatfoot deformity
Rigid hindfoot valgus
RIgid forefoot abduction
Arch collapse and subtalar arthritis
Stage 4
Same as 3 but with deltoid incompetence
X ray shows lateral talar tilt
7. Normal value for: Meary angle
Calcaneal pitch`
-4 to 4: if <-4, indicates pes planus
NOrmal btw 17 and 32 degrees
8. Primary static stabilizer of TN joint
Spring ligament
9. Treatment of tib post insufficienc: non op (2)
Operative
AFO with medial arch support: Stage 2-4
Cast 3-4 months: for stage 1
Surgical
Stage 2: FDL transfer to tib post 1st TMT fusion, calc
osteotomy (medial), TAL, lateral column lenghtening, PTT
debridement (all if no signs of arthritis, cotton osteotomy
Stage 3: Hindfoot fusion >>typically triple
Stage 4: tibiocalcaneal arthrodesis
10. What tendon transfer can be done for tib post
insufficiency and for what stage
Stage 2 disease (flexible): transfer FDL to PT, identify it at
knot of henry
11. 2 corrective osteotomies than can be used for stage 2
tib post inssuficiency
Medial calc slide
Lateral calc neck lenghtening: better for correction of
forefoot abduction
12. INidication for cotton osteotomy
COtton osteotomy: dorsal opening wedge medial cuneiform
osteotomy
In stage 2 PTTI if residual forefoot varus after correction of
hindfoot, use this osteotomy to make a plantigrade foot by
recreating the tripod effect
13. Treatment for stage 3 tib psot dysfunction
Triple arthodesis
14. Polio: classic finding
Onset
Motor weakness normal sensation
20-40 yeasr after infection
15. Morton's neuroma: location
Structure that compresses
Physical exam
Provocative tests
Confirm diagnosis using
SUrgical treatment
2nd and third interdigital nerves between the
metatarsal heads
Transverse intermetatarsal ligament
Paresthesia in plantar aspect of webspace
Mulder's click: bursal click elicited by squeezing
metatarsals together
Common digital nerve block: relief of pain
Neurectomy: failed non op>>>dorsal neurectomy with burial
stump within intrinsics + release of transverse ligament
16. Foot deformity caused by CVA or TBI
Equinovarus deformity
Equinus: from overactive gastrocs
Varus: From overactive tib ant
17. Acquired equinovarus foot defomity: 2 causes
If tendon transfer
Stroke
TBI
Do split: SPLATT same as CP, put tib ant on cuboid
18. Freibergs disease: definition
Most common location
Location of defect
Non op mgmt
Operative mgmt of advanced disease
Infarction and fracture of the metatarsal head
2nd MT: 4th and 5th rarely affected
Upper half of articular surface
Activity modification, NSAI's, shoes with MT bars or
pads
Partial MT resection arthroplasty and tissue
interposition (EDL)
19. Hammer toe: deformities 3
PIP flexion
DIP extension
MTP neutral or extended
20. Hammer toe: caused by
How to check if flexible
Treatment if flexible
Treatment if rigid
Overpull of EDL and intrinsic inbalance
Deformity should correct with ankle dorsiflexion
Transfer FDL to EDL
PIP resection arthroplasty +/- tenotomy and tendon
transfers
21. Mallet toe: DIP
PIP
MTP
Flexion
NOrmal
NOrmal
22. Claw toe: DIP
PIP
MTP
Flex
flex
Hyperextend
23. Mallet toe: main deformity
Caused by
Operative treatment if flexible
Operative treatmentif rigid
Hyperflexion of DIP
Flexion contracture of FDL: from shoes, often toe is
longer
Percutaneous FDL tenotomy or FDL transfer to
dorsum
DIP fusion
24. Most common deformity of lesser toes
Hammer toe
25. Turf toe: injury to what structure
Hyperextension of D1 leading to injury of plantar plate and
sesamoid complex at the MTP
26. 1st toe MTP 4 stabilizing structures
Osseous: MT and proximal phalanx articulation
Tendons: FHB, Abductor hallucis and adductor hallucis
Ligaments: MCL, LCL, intermetatarsal ligament
Plantar plate: joint capsule that attaches to adductor
hallucis, flexor tendon sheath, deep transverse
intermetatarasal ligament
27. Turf toe: physical exam manouver
2 x ray findings
Non op treatemnt
Op treatment
Long term complication
Vertical lachman; compare to other side
Sesamoid fracture
Sesamoid migrated proximally
Stiff soled shoe or walking boot: as well as rest and NSAID's
Repair or excision of seamoid fracture: can use abductor
hallucis transfer to reconstruct
Hallux rigidus
28. Claw toes: caused by
MTP hyperextension: leads to unnoposed flexion of DIP and
PIP by FDL
29. Intrinsic weakness leads to what toe deformity
Claw toes
30. Claw toes operative management
If rigid: EDB tenotomy, EDL lenghtening, FDL flexor to
extensor transfer +/- PRoximal phalanx head and neck
resection
If flexible: FDL to extensor surface transfer
31. TAA: Survivorship
ROM post
Pain?
at 10 years 70-90%
Pre op ROM is best predictor of post op ROM: no
significant improvement after TAA
Significant improvement in pain and function
32. Ideal patient for TAA 4 characteristics
Older and low demand
Normal BMI
Well aligned stable hindfoot
Good soft tissues
33. 7 contraindications to TAA
Active infection
Peripheral vascular disease
Inadequate soft tissue coverage
Charcot arthropathy
Insufficient bone stock
Severe osteoporosis
Osteonecrosis of the talus
34. 3 common technical errors in TAA
Prosthesis too lateral
Prosthesis too small: subsides
Not addressing pre op hindfoot valgus or varus
35. TAA: most common location of intra op fracture
Medial malleolus
36. How to prevent bowstringing in TAA
Avoid opening Tib ant tendon sheath
37. 3 main vessels supplying blood to the foot
Peroneal artery
Dorsalis pedis: from anterior tibial
POsterior tibial
38. Peroneal artery: Location
Terminal branch
Anterior to syndesmosis: pierces IOM 5 cm above
lateral malleolus
Lateral calcaneal branch: brach that supplies flaps in
clac ORIF
39. 3 branches of posterior tibial artery in ankle
3 branches to foot of posterior tibial artery
POsterior medial malleolar
COmmunicating branch
Artery of tarsal canal: major blood supply to talar
body
Medial calcaneal branch: supply heel pad
Branch to adductor digiti minimi
Branch to fifth toe
40. Os trigonum: location
Symptomatic in what population
DDX
Treatment
Posterolateral tubercle of talus
Ballet dancers: extreme plantar flexion
Sheperds fracture: fracture of posterior process of
talus
Symptomatic: if non op failed then can excise
41. Treatment for tibiotalar impingement
Arthroscopic debridement
42. 5 casues of hallux varus
COngenital
Iatrogenic: overcorrection hallux valgus
Trauma
Inflammatory
Neurological
43. 3 possible components of hallux varus deformity
Medial deviation of hallux relative to first MTP
Supination phalanx
Claw toe deformity
44. Hallux varus treatment: non op
Operative
shoe modifiactions
Adductor hallucis reattachment to lateral sesamoid
Transfer EHL or EDB under transverse ligament to the
metatarsal neck
1st MTP fusion
45. PLantar fascia: origin
insertion
FUnction
Medial calcaneal tuberosity
Base 5th MT, base of 5 proximal phalanges
Increase arch height as toes dorsiflex: major medial
arch support
46. 2 components of chopart joint
How to lock/unlock it
TN
CC
Lock it with inversion
Unlock it with eversion
47. Ligamentous support of TN joint
Spring ligament
48. Ligamentous support of calcaneocuboid joint
Superficial and deep inferior CC ligaments
Lateral limb of bifurcate ligament
49. Lisfranc joint 3 columns and components
Medial column: 1st MTP
Middle column: 2-3 MTP
Lateral column: 4-5 MTP, both articulate with cuboid
50. TMT Joint: Weakest layer
Strognest layer
Dorsal layer
Interosseous layer: contains lisfranc ligament from
medial cuniform to base 2nd MT
51. TMT joint: most mobile column
Column least mobile
Column that carries most load
Lateral
Middle
Medial
52. OCD talus 2 main locations / causes and
characteritics
Medial: usually posterior, no trauma, larger and deeper than
lateral
Lateral: central or anterior, associated with trauma, tend to
be smaller and more superficial
53. OCD lesions: whish location has lower incidence of
healing
Lateral: thought to be casued by trauma
54. OCD talus lesion classification
Stage 1: small area of subchondral compression
Stage 2: partial fragment detachment
Stage 3: complete detachment but undisplaced
Stage 4: displaced fragment
55. OCD lesion: non op management
Operative
Short leg cast and non weight bearing for 6 weeks: only if
acute symptomatic
Arthroscopic microdrilling, ORIF, osteochondral grafting
56. High ankle sparin: mechanism of injury
ER foot: talus pushes fibula away from tibia
57. Syndesmosis composition 5
AITFL: avulsion leads to chaput fragment
PITF: Avulsion leads to volkman fragment
IOM
Interosseous ligamnt
Inferior transverse ligament
58. BEst predictor of return to play following high ankle
sprainx
Abscence of syndesmosis tenderness
59. 3 physical exam tests for the syndesmosis
Squeeze test: compression midcalf leads to pain
ER stress test: pain with External rotation and
dorsiflexion of foot
Fibular translation: anterior and posterior drawar to
the fibula casues pain
60. 4 x ray findings of syndesmosis injury
Tibiofibular overlap < 6mm on AP (
Tibiofibular overlap <1mm on mortice
Medial clear space < 5mm
Increased tibiofibular clear space: >5mm (measured
1 cm abovee joint line
61. Non op management of high ankle sprain
No eidence of ankle instability
NWB CAM for 2-3 weeks: delay weightbearing until pain free
62. 5 risk factors for tib ant rupture
Older age
DM
fluoroquinilone
Local steroids
inflammatory arthritis
63. Ankle dorsiflexors: primary
secondary
Tib ant
EHL, EDL
64. Type of gait with tib and rupture
Steppage gait: like drop foot
65. Tib ant rupture surgical treatment: If acute
If chronic
< 6 weeks: direct repair
> 6 weeks reconstruction: EHL split or full transfer
66. most common reason for lower extremity
amputations
Foot ulcers: 85%
67. DIabetic foot ulcers: 2 factors associated with
increased healing potential
5 factors associated with decreased healing potential
Serum albumin > 3 (30 in canada)
Total lymphocyte count > 1500
Uncontrolled hyperglycemia
Inability to offload affected area
Poor circulation
Infection
Poor nutrition
68. Diabetic foot ulcers: 2 contributing factors to
formation of ulcers
Neuropathy
Angiopaphy: peripheral vascular disease
69. Brodsky classification of diabetic ulcers and treatment
0: at risk, no ulcer >>>education
1: Superficial ulceration, not infected >>>off loading total
contact cast
2: Deep ulceration, exposing tendon or joint >>>surgical
debridement and wound care
3: Extensive ulceration or abcess >>>debridement or
amputation
A: non ischemic
B: Ischemia with no gangrene >>>refere to vascular
C: Partial foot gangrene >>>>>>vascular reconstruction or
amputation
D: Complete gangrene >>>>amputation
70. DIabetic ulcer: gold standard to assess wound healing
potential
Gold standrd for mechanical relief of plantar
ulceration
Transcutaneous oxygen pressures: >30-40 have good
potential
Total contact casting
71. Diabetic ulcers: 4 tests that show decreased healing
potential
Transcutaneous oxygen pressure < 20
ABI <45
Albumin <3
Total lymphocyte < 1500
72. Lisfranc injury: mechanism of injury
lisfranc ligament location
Which tarsometatarsal ligaments are weakest
Provocative physical exam manouver
Axial load with foot in plantar flexion
Medial cuneiform to base 2nd MT
Dorsal: hence dorsal displacement of 2nd MT on
lateral
Pronation and abduction: this is position of stress
test
73. xplain the concept of 3 columns of the TMT complex
and its components
Medial column: Medial cuneiform and 1st metatarsal
Middle columb: Middle and lateral cuneiform + 2nd
and 3rd MT
Lateral column: 4th + 5th MT + cuboid
74. X-ray findings of lisfranc injury (5)
On AP: Medial border of 2nd MT with medial border
of middle cuneiform
On Oblique: Medial border of 4th MT with medial
border of cuboid
On Lateral: No dorsal subluxation of MT
Fleck sign: avulsion # off base 2nd MT
Widening >2mm btw 1st MT/Cuneiform and 2nd MT
75. Best x ray to order if suspecting lisfranc + alternative
AP weight bearing of both feet on one cassette
Pronation abduction stress xray
76. Describe fixation principle for Medial and lateral
columns in complex TMT injuries
Medial: rigid fixation
Lateral: Flexible temporary fixation
77. Describe general principles of fixation for TMT
complex injuries (what to fix first)
Start from proximal to distal
Continue from medial to lateral
78. Describe surgical approach for 3 column TMT
complex injury (include mention of structures in
danger)
2 INCISIONS
Dorsal-medial:
Btw 1st and 2nd rays
Dorsalis pedis and Deep peroneal nerve identified
and mobilized lateral
Interval BTW EHL and EHB
Visualize 1st TMT and medial aspect of 2nd TMT
Protect branches of SPN in proximal part of incision
Dorsal Lateral
Centered over 4th MT
Visualize lateral 2nd MT + 3rd/4th TMT
Common extensor tendons mobilized medially
Muscle belly of EDB split in line with its fibers
79. Lisfranc injuries evidence behind ORIF vs Arthrodesis
for ligamentous patterns (4 advantages
Arthrodesis group had
Improved functional outcome
Higher return to pre injury levels
Lower revision
Less pain
THIS IS THE QUOTED PAPER THATS SAYS
ARTHRODESIS IS BETTER
80. Hallux rigidus classification and treatment
Based on physical exam and x rays
Grade 0: stiffness, normal x ray
Grade 1: Mild pain at extremes , mild dorsal osteophyte >>>
dorsal cheilectomy
Grade 2: Moderate pain with ROM, moderate dorsal
osteophyte < 50% joint space narrowing >>> dorsal
cheilectomy
Grade 3: Pain at extremes ROm but no mid range pain ,
severe dorsal osteophyte + >50% joint space
narrowing >>> MTP fusion
Grade 4: Pain at midrange, x ray same as grade 3 >>>MTP
FUSION
81. Hallux rigidus: Non op orthosis
INdication for MTP fusion
Position of fusion
Hard soled shoe or orthotic with morton's extension
>50% joint space narrowing and dorsal osteophytes
Position
10-15 degrees valgus
15 degrees dorsiflexion relative to the floor
82. 9 risk factors for hallux valgus
Narrow shoes with heel
Genetic predisposition
Increased DMAA
ligamentos laxity : 1st MTP
Convex metatarsal head
2nd toe amputation
pes planus
RA
CP
83. Hallux valgus: deforming forces 2
Adductor hallucis
Abductor hallucis: after sesamoids subluxed >>
forces plantarflexion and pronation of phalanx
84. 4 factors that differentiate juvenile from adult hallux
valgus
Often bilateral and familial
Usually not painful
DMAA increased
Usually flexible flatfoot present
85. Hallux valgus: other than measurement of angles, 2
other thngs to look for in x ray
Presence or absence of arthritis
Lateral displacement of sesamoids
86. Hallux valgus: 4 angles to measure and normal values
Hallux valgus angle: long axis 1st MT and proximal phalanx
<15 degrees
Intermetatarsal angle: < 9 degrees
DMAA: btw longitudinal axis of 1st MT and line through the
base of the distal articular cap .....<10 degrees
87. Hallux valgus surgery: 5 broad categories and
indications for each
Soft tissue (modified mcbride): HVA <25, IMA <15, DMAA
not congruent
Distal osteotomy: IMA < 13, HVA <40
Proximal or combined osteotomy: IMA >13, HVA >40
1st TMT fusion (lapidus): TMT arthritis or joint intability
MTP fusion: severe deformity or arthritis or spasticity
88. Modified mcbride 3 parts
Release adductor from lateral sesamoid
Lateral capsulotomy
Medial capsule plication
89. Hallux valgus in young patient with open
physis...surgical procedure to offer
1st cuneiform osteotomy
90. Hallux varus complications 5
Recurrence: most common
AVN: 2 incisions
Malunion
Hallux varus
COck up deformity from injury to FHL
91. Achilles tendon rupture: location
Blod supply
4-6 cm above calcaneal insertion in watershed area
From posterior tibial artery
92. Achilles tendon rupture physical exam findings 3
Palpable gap
Thompson test: no dorsiflexion with gastrocs
contraction
Increased resting tension lenght
93. Achille stendon tear operative manangemnt: acute
Chronic 2
Direct repair
Gastrocs VY advancement
FLH Transfer: find it at the knot of henry
94. base 5th metatarsal #: 3 zones + treatment
Zone 1: pseudo jones ...enters articular surface..caused by
peroneal brevis....non op >>>>Protected weight bearing in
boot or hard soled shoe
Zone 2: Jones #: Meta/dia junction.inter intermetatarasal
joint...vascular watershed area > increased risk of non
union>>>> Non weight bearing in cast
Zone 3: Proximal diaphyseal #>>>usually stress fracture
>>>Non weight bearing or operative if signs of non
union/sclerosis
95. Jones # orif: size screw
3 things that lead to increase in rate of failure
4.5: shown to increase rate of non union if smaller
Elite athlete
Return to sports prior to radiographic union
Fracture distraction or malreduction
96. MTP dislocation: direction
Stages of failure
Dorsomedial
Plantar plate disrupted > LCL fails >medial structure
contracted > plantar plate fails
97. What is the weil procedure and what is done for
Done for MTP dislocation
It is a shortening oblique osteotomy along with with soft
tissue procedures to stabilize MTP
98. FHL: Origin
Action
path behind ankle
relationship to FDS
Insertion
mechanism of injury
Posterior fibula
Plantarflexion of hallux and MP joint
Btw postermedial/posterolateral tubercle of posterior
talus
Dorsal to FDS
Distal phalanx toe
Excessive plantar-flexion
99. FHL tendinitis: non op
Operative mgmt
Rest/NSAID/arch support
Release FHL from fibro-osseus tunnel +/- tendon
repair
100. Tarsal tunnel syndrome: caused by
5 causes
Compression of tibial nerve
Ganglion cyst
osteophyte
tumor
Systemic inflammatory
Tenosynovitis
101. Posterior tarsal tunnel: borders
Contents (5)
Roof: Flexor retinaculum
Medial: calcaneus/talus
Inferior: abductor hallucis
Tibial nerve
Posterior tibial artery
FHL
FDL
Tib Post
102. Anterior tarsal tunnel: borders
contents (4)
Inferior extensor retinaculum
Fascia over talus and navicular
Deep peroneal nerve
EHL
EDL
dorsalis pedis artery
103. Tibial nerve distal branches
Medial plantar
Lateral plantar
Medial calcaneal
104. Best physical exam manouver to test tarsal tunnel
syndrome
PLantar flexion and inversion of ankle
105. 3 layers that must be released in tarsal tunnel
syndrome
Flexor retinaculum
Deep investing fascia of lower leg
Superficial and deep fascia of abductor hallucis
106. Most commonly used sesamoid on foot
Tibial sesamoid (medial(: Its largerm has more weight
bearing
107. Tendon btw foot sesamoids
FHL
108. Main complication following excision of both foot
seasmoids
COck up deformity of toe
109. Plantar fasciitis: caused by
2 risk factors
Physical exam finding
Inflamation at origin of plantar fascia (calcaneous)
Obesity
Decreased ankle dorsiflexion
Tenderness to palpation medial calc tuberosity
110. PLantar fasciitis: non op
Operative (2)
NSAID's, cushioned heel pads, dorsiflexion night splint
Plantar fascia release: release medial 1/3 to 2/3
Distal tarsal tunnel decompression
111. Haglund defomity: what is it
Enlargement of posterosuperior tuberosity of calc
112. Puncture wound in foot: most common cause soft
tissue infection
Most common cause osteomyelitits
Treatment if acute (within hours)
Staph A
Pseudomonas
Tetanus + prophylactic abx
113. Bunionnette: classification
Type 1: enlarged 5th MT head or lateral exostosis
Type 2: congenital bow 5th MT, normal IMA
Type 3 (most common): increased IMA
Normal IMA6.5-8 degrees
114. Bunionnette treatemnt: type 1
Type 2-3 IMA <12
Type 2-3 IMA >12
Resection lateral third of 5th MT head
Distal metatarsal osteotomy
Onlique diaphyseal rotational osteotomy
115. Navicular #: mechanism if avulsion
Tuberosity # mechanism
Body # mechanism
Plantar flexion
Eversion and contraction of posterior tibial tendon
Axial loading
116. Navicular articulates with what bones (4)
Cuneiforms
Cuboid
Calcaneous
Talus
117. Navicular body # classification
Type 1: transverse of dorsal fragment that involves <50%
bone (no deformity)
Type 2: Oblique dorsolateral-plantarmedial..may have
adduction deformity
Type 3: Central or lateral comminution...abduction
deformity
118. Navicular # indications for ORIF (3) + goals of
treatment
Avulsion # >25% articular surface
Tuberosity # > 5mm diastasis
Body # that are displaced or intra-articular
Goal of treatment is maintain lateral column lenght
119. Peroneal tendon subluxation: mechanism
Physical exam
tendon that usually tears
associated injury
Innervation of tendons
Rapid dorsiflexion of inverted foot
Apprehension to dorsiflexion and eversion
Peroneus brevis
ATFL: 75%
Superficial peroneal nerve: S1
120. Peroneal tendons: which one is posterior in sulcus
Relationship to one another in the foot
What holds them in the retromalleolar sulcus
Longus is posterior: takes the long way
Superior peroneal retinaculum
At the level of the peroneal tubercle of the calc, longus is
inferior and brevis is superior...here it is covered by inferior
peroneal retinaculum
121. Classification of superior peroneal retinaculum tears
Grade 1: SPR partially off fibula>>both tendons sublux
Grade 2: separated from cartilofibrous ridge of lateral
mall>>tendons sublux btw SPR and cartilofibrous ridge
Grade 3: Cortical avulsion off fibula>>>tendons move under
bony fragment
Grade 4: SPR torn from Calc
122. Peroneal tendon subluxation: non op mgmt/outcome
Surgical options if acute
Surgical options if chronic
All acute injuries in non-professional athletes>cast x 6
weeks with the tendon reduces>>>outcome 50% success
Acute: direct repair and fibular groove deepening
Chronic:Fibular groove deepening + reconstruction
with plantaris grafting
123. Peroneal tendon tears: surgery if simple tear
surgery if complex tear
Simple: core repair and tubularization
Complex tear: Tendon debridement and tenodesis of
proximal and distal ends of tendon to peroneous
longus
124. Ankle scope portals and landmarks 4
Anteromedial:Medial to tib ant at the level of joint
Anterolateral: lateral to peroneous tertius and SPN
Posterolateral: 2cm proximal from tip of lateral mall, btw
peroneals and achilles
Posteromedial: same levelas posterolateral but just medial
to achilles tendon
125. Ankle scope: Primary anterior viewing portal
Portal that places SPN at risk
Portal places saphenous vein at risk
Portal that places sural nerve at risk
Anteromedial
Anterolateral
Anteromedial
Posterolateral
126. Low ankle sprain: refers to injury to what ligaments
Physical exam finding
Non op mamagent
ATFL and CFL
Drawer laxity in plantarflexion (ATFL), drawer laxity in
dorsiflexion (CFL)
Short immobilization followed by PT (neuromuscular
training) with a functional brace
127. ATFL reconstruction technique
Gould modification of bronstrom
Anatomic shortening and reinsertion of CFL and ATFL
reinfroced with extensor retinaculum
128. 2 medial ligaments in the ankle
Deltoid
Spring ligament
129. ATFL: origin
insertion function
10mm proximal to tip of fibula
Articular cartilage of talus: 18mm from joint line
Resist inversion whith th ankl ein plantar flexion
130. CFL: origin
insertion
function
9mm proximal to tip of fibula
calcaneous 13mm distal to ST joint
Restraint of inversion with ankle plantarflexed
131. Deltoid: 2 layers, origin, insertions and function
Superficial
Origin: anterior colliculus
Insertion: neck of talus, sustentaculum tali,
posteromedial talar tubercle
FUnction: resist calc eversion
Deep
Origin: inferior and posterior aspect of medial mal
Insertion: medial and posteromedial talus
Function: Resist ankle Eversion
132. Location of stress fracture in foot in ballet dancers
2nd MT: becasue it is the longest
133. Indications for ORIF metatarsal # (3)
Open #
Displaced first metatarsal#: no intermetatarsal
ligament support and bears 30-50% of weight
Central metatarsals: sagital plane deformity >10
degrees (transfer metatarsalgia) or 4 mm translation
134. Gait cycle: 2 phases
Which one is longer
Stance (60%): period of time the foot is on the ground
Swing: Period of time foot is moving forward
135. Primary antagonist of tib ant
Peroneous longus
136. Leg nerve entrapments mention cause and location:
Obturator
LFCN
Sciatic
Saphenous
Deep peroneal nerve
Lateral plantar
Medial plantar
Obturator: At the level of hypertrophied adductors (skaters)
..can have chronic medial thigh pain
LFCN: worse with prolonged flexion or tight belts
Sciatic nerve: Ischial tuberosity or at level of piriformis
(piriformis syndrome)
saphenous: Hunter(adductor cannal) from prolonged
kneeling
Deep peroneal: inferior extensor retinaculum (aka anterior
tarsal syndrome)
Baxter nerve: entrappedbtw abductor hallucis longus and
quadratus plantae
Medial plantar: knot of henry where FDL and FHL cross
137. Charcot neuropathy: caused by
Loss of protective sensation
138. Charcot foot: types and stages
Type 1: Involves TMT and TN >>leads ti fixed rocker bottom
Type 2: Involves ST, TN, CC (very unstable needs prolonged
immobilization)
Type 3A: Involves TT joint >>leads to valgus/varus
Type 3B: After calc#>>proximal migration of tuberosity
Type 4: Combination of areas
Type 5: Isolated forefoot
Stage 0: Joint edema, noral x rays
Stage 1 (fragmentation): Osseous fragmentation and joint
dislocation
Stage 2 (coalescence): decreased local edema >>x rays
show colaescence of fragments and absorption of bone
debris
Stage 3 (reconstuction): No local edema..xray show
consolidation and remodelling of fracture fragments
139. Charcot foot: differentiate from osteo with
CRP and ESR values
Non op managemnt
Surgical treatment
Bone scan
Elevates
Total contact casting followed by CROW boot
Resection bony prominence and TAL
Deformity correction if cannot brace
Amputation
140. Ankle arthritis: non op orthotic
indication for supramalleolar osteotomy
Fusion
Rocker bottom shoe
Supramalleolar osteotomy: Normal ROM, minimal
talar tilt ot varus
Medial arthritis
Arthrodesis: Elderly and less active
141. What happens to foot after tibiotalar fusion
50% develop ST arthritis at 10 years
142. Ankle fusion: optimal position
Non union rate
What increases rate non union
Neutral dorsi, 5-10 ER< 5 degrees hindfoot valgus
10%
Smoking
Home (/) / Flashcards (/flashcards/) / Preview