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62 Cards in this Set
- Front
- Back
Spring ligament
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Inferior and superomedial calcaneonavicular ligaments. Help support longitudinal arch
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Lisfranc ligament
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2nd metatarsal to medial cuneiform. Plantar strongest part
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Components of transverse tarsal joints
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talonavicular and calcaneocuboid- parallel during eversion/ divergent during inversion
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Stride
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heel-strike to heel-strike. 62% stance/ 38% swing. Stance phase decreases with increasing speed.
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Foot changes from heel-strike to toe-off
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1. plantar fascia tightens as MTPJ extends. 2. Longitudinal arch accentuated. 3. PTT supinates hindfoot. 4. Transverse tarsal joint locks--> rigid lever arm
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Cutaneous nerves of the foot
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1. sural- lateral border. 2. Saphenous- medial eminence of great toe. 3. Medial dorsal cut br SPN- dorsomedial foot. 4. Intermediate dorsal cut br SPN- Dorsolateral foot. 5. DPN- 1st dorsal webspace. 6. Posterior tibial- plantar foot
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Canale view- foot XR
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15 degrees internal rotation- talar neck fx
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Harris view- foot XR
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Axial heel view
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Broden's view- foot XR
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Subtalar medial oblique at 10 deg
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Location of hallux sesamoids
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in FHB
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Hallux valgus interphalangeal angle
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<8deg
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Hallux valgus angle
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<15 deg
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Metatarsus primus varus angle
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1st MT vs medial cuneiform. <25deg
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1st IMA
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<10 deg
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DMAA
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<15deg
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Complications Keller resection arthroplasty
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transfer metatarsalgia, loss of weight bearing function, cock-up toe deformity. Salvage w/ 1st MTPJ arthrodesis +/- interpositional graft
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Silver bunionectomy
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medial eminence resection + distal soft tissue release.; High risk of recurrence
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Position 1st MTPJ arthrodesis
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110deg dorsiflexion relative to floor/ 25deg dorsiflexion relative to 1st MT/ 10-15deg valgus
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Treatment hallux varus
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AbHL release/ Tx EHL or EHB under IM lig to proximal phalanx. Fusion if fixed
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Assess flexibility of lesser toe deformities
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Push up test. Pressure on plantar forefoot reduces deformity- removes overactive intrinsics
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Mallet toe
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flexion deformity DIPJ. 2/2 overactive FDL. Tx: FDL tenotomy/ excisional arthroplasty if rigid.
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Claw toes
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Usually neurologic origin. Tx: flexor to extensor transfer + EDB tenotomy/EDL lengthening. If fixed-resection arthroplasty or PIP arthrodesis. Weil osteotomy (oblique shortening MT osteotomy) increases correction.
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Treatment flexible hammer toes
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FDL flexor to extensor tendon transfer. Add EDL lengthening/tenotomy if active flexion <10-15deg
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Treatment flexible mallet toe
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Percutaneous FDL tenotomy
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Treatment crossover 2nd toe
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Extensor tenotomy, dorsa/medial MTPJ capsule and MCL release
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Treatment overlapping 5th toe
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Capsule release, Z-plasty dorsal skin, EDL lengthening
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Treatment underlapping 5th toe
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Kids- FDL/FDB tenotomy. Adults- flexor to extensor transfer, syndactylization
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Etiology crossover 2nd toe
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Attritional rupture LCL/lateral capsule + attenuation 1st dorsal IO/plantar plate
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Proximal osteotomies for bunionette deformity
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AVOID- tenuous blood supply to proximal metadiaphyseal junction
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Complications sesamoid excision
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Medial: hallux valgus; Lateral: hallux varus; Both: cock-up deformity
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Location interdigital neuroma
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Between 3rd and 4th metatarsal.
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Recurrent metatarsal neuroma
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Secondary to traction neuritis due to neural stump adherence. Tx: excision- plantar or dorsal incision. 65-75% success rate
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Tarsal tunnel syndrome
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Compression posterior tibial nerve. Increased risk w/ pes planus/ hindfoot valgus.
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Anterior tarsal tunnel syndrome
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Compression DPNunder inferior extensor retinaculum. Cause: tight shoes/ anterior osteophytes/pes cavus/tendinitis. Sx worse w/ ankle plantarflexion and toe extension. Tx: night splints/ shoewear modifications/retinacular release w/ bone spur excision- relief may take months
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Treatment adolescent CMT w/ supple deformity
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1. plantar fascia release. 2. closing wedge dorsiflexion osteotomy 1st MT. 3. calcaneal slide and closing wedge osteotomy. 4. transfer PL to PB at distal fibula. 5. TAL
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Treatment clawed hallux
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arthrodesis of IPJ and transfer EHL to 1st MT
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Position ankle arthrodesis
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5deg DF/ 5-10deg ER/ neutral varus and valgus
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Position subtalar arthrodesis
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10deg valgus/ 0deg rotation
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Position talonavicular arthrodesis
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0 deg varus/valgus hindfoot; 0 deg Meary's angle
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Stage I PTT dysfunction
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pain- nml alignment. Bracing/ synovectomy
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Stage II PTT dysfunction
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Flexible pes planovalgus. UCBL orthosis/ AFO/TAL; FDL transfer; medial calc slide
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Stage III PTT dysfunction
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Rigid deformity. Hindfoot arthritis. Triple arthrodesis + TAL/gastroc slide
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Stage IV PTT dysfunction
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Ankle involvement. Triple arthrodesis + TAL+ deltoid reconstruction
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Unilateral cavus foot
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R/o intraspinal etiology
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Initially affected muscles CMT
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TA/ EDL/ PB
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Most common location stenosing tenosynovitis of FHL
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bet posterolateral and posteromedial tubercles of talus
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Achilles debridement over 50%
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Need augmentation w/ tenodon transfer (FHL)
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ABI
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1.0= nml/ 0.45 needed for wound healing
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Toe pressures
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100mmHg=nml/ 40mmHg needed for healing
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TcPO2
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>40mmHg predictive of healing
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Cuboid syndrome
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Subluxation. More common in ballet dancers. Pain/ click when foot dorsiflexed/everted
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Joint where most hindfoot motion occurs
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talonavicular
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Cause navicular avulsion fx
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forcible contraction tibialis posterior
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Treatment navicular body fracture
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ORIF even if non-displaced
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Blood supply to talus
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posterior tibial/ dorsalis pedis/ perforating peroneal. Artery of tarsal canal is main supply esp to body. Artery of tarsal sinus/ DP important for head/neck
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Malunion talar neck fractures
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Varus deformity most common- more if medial comminution. Causes cavus/supination of foot--> tx w/ medial column lengthening/lateral column shortening/talar neck osteotomy
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Reduction talar neck fractures
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Plantarflexion and manipulation of heel. Immediate reduction necessary.
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Anterior process of calcaneus fracture
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Avulsion of bifurcate ligament. Fix or excise if displaced over 1cm
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Most common location intra-articular calcaneus fractures
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posterior facet
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Normal Bohler's angle
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25-40deg
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Compartments of the foot
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medial: AbH/FHB. Central: FHB,lumbricals,QP, AdH. Lateral: flexors, abductors, opponens of 5th toe. Interosseous compartment.
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Risk of compartment syndrome w/ calcaneus fracture
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10%
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