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Foot Flash

The document is a comprehensive flashcard set focused on foot and ankle conditions, detailing various topics such as posterior tibial tendon insufficiency, foot deformities, and treatment options. It covers definitions, risk factors, physical exam findings, and management strategies for conditions like Morton's neuroma, hallux varus, and diabetic foot ulcers. Additionally, it includes anatomical details and surgical interventions relevant to foot and ankle orthopedics.
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0% found this document useful (0 votes)
13 views26 pages

Foot Flash

The document is a comprehensive flashcard set focused on foot and ankle conditions, detailing various topics such as posterior tibial tendon insufficiency, foot deformities, and treatment options. It covers definitions, risk factors, physical exam findings, and management strategies for conditions like Morton's neuroma, hallux varus, and diabetic foot ulcers. Additionally, it includes anatomical details and surgical interventions relevant to foot and ankle orthopedics.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Foot & Ankle - Orthobullets


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Foot & Ankle - Orthobullets

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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

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