Core - Section 12: Foot & Ankle

Front 1

SECTION 12: FOOT AND ANKLE

Back 1

SECTION 12: FOOT AND ANKLE

Front 2

112. Anatomy and Biomechanics of the Foot and Ankle

Back 2

112. Anatomy and Biomechanics of the Foot and Ankle

Front 3

The ATFL is under strain in plantar ______, ______, and ______ rotation; the CFL is under strain in ____flexion and ______.

Back 3

The ATFL is under strain in plantar flexion, inversion, and internal rotation; the CFL is under strain in dorsiflexion and inversion.

Front 4

The spring ligament complex, which supports the _________ joint, comprises the ____________ calcaneonavicular ligament and the _________ calcaneonavicular ligaments.

Back 4

The spring ligament complex, which supports the talonavicular joint, comprises the superomedial calcaneonavicular ligament and the inferior calcaneonavicular ligaments.

Front 5

The Lisfranc ligament originates at the ______ aspect of the ______ cuneiform and continues to the ______ portion of the ______ base of the ______ metatarsal metaphysis.

Back 5

The Lisfranc ligament originates at the plantar aspect of the medial cuneiform and continues to the central portion of the lateral base of the second metatarsal metaphysis.

Front 6

The conjoined tendon of the adductor hallucis inserts at the ______ proximal ______ metatarsal and ______ sesamoid.

Back 6

The conjoined tendon of the adductor hallucis inserts at the lateral proximal first metatarsal and lateral sesamoid.

Front 7

The Achilles tendon fibers rotate ___° toward their insertion. The superficial fibers of the Achilles tendon at the myotendinous junction insert ______ on the calcaneus.

Back 7

The Achilles tendon fibers rotate 90° toward their insertion. The superficial fibers of the Achilles tendon at the myotendinous junction insert laterally on the calcaneus.

Front 8

The talar body receives most of its blood supply _________ from the talar neck, making it prone to ______ and _________ when the talar neck is fractured.

Back 8

The talar body receives most of its blood supply retrograde from the talar neck, making it prone to nonunion and osteonecrosis when the talar neck is fractured.

Front 9

The peroneus brevis tendon lies ______ and the peroneus longus tendon lies ______ to the peroneal tubercle in the ______ peroneal retinaculum.

Back 9

The peroneus brevis tendon lies superior and the peroneus longus tendon lies inferior to the peroneal tubercle in the inferior peroneal retinaculum.

Front 10

The nerves at risk during placement of portals for ankle arthroscopy are: anterolateral—_________ ______ nerve; anteromedial—______ nerve; anterior central—______ _________ nerve; posterolateral—______ nerve; posteromedial—______ nerve.

Back 10

The nerves at risk during placement of portals for ankle arthroscopy are: anterolateral—superficial peroneal nerve; anteromedial—saphenous nerve; anterior central—deep peroneal nerve; posterolateral—sural nerve; posteromedial—tibial nerve.

Front 11

Inversion of the subtalar joint causes the talonavicular and calcaneocuboid joint axes of the transverse tarsal (______) joint to deviate, decreasing motion and locking the ______.

Back 11

Inversion of the subtalar joint causes the talonavicular and calcaneocuboid joint axes of the transverse tarsal (Chopart) joint to deviate, decreasing motion and locking the midfoot.

Front 12

The ______ TMT joint has the least motion; the ______ and ______ have the most.

Back 12

The second TMT joint has the least motion; the fourth and fifth have the most.

Front 13

113. Disorders of the First Ray

Back 13

113. Disorders of the First Ray

Front 14

Hallux Valgus

Back 14

Hallux Valgus

Front 15

Congruency of the joint and degree of articular degeneration are important parameters to consider for treatment. Soft-tissue release should not be performed on a ______ joint.

Back 15

Congruency of the joint and degree of articular degeneration are important parameters to consider for treatment. Soft-tissue release should not be performed on a congruent joint.

Front 16

To decrease the risk of hallux varus, avoid fibular sesamoid ______ during distal soft-tissue release.

Back 16

To decrease the risk of hallux varus, avoid fibular sesamoid excision during distal soft-tissue release.

Front 17

To minimize the risk of osteonecrosis, avoid an extensive ______ capsular release during (chevron) distal metatarsal osteotomy.

Back 17

To minimize the risk of osteonecrosis, avoid an extensive lateral capsular release during (chevron) distal metatarsal osteotomy.

Front 18

Patients with an IMA >___° need proximal metatarsal osteotomy combined with distal soft-tissue release to correct the deformity.

Back 18

Patients with an IMA >13° need proximal metatarsal osteotomy combined with distal soft-tissue release to correct the deformity.

Front 19

A DMAA >___° can be corrected with biplanar (closing wedge) distal metatarsal osteotomy (chevron).

Back 19

A DMAA >15° can be corrected with biplanar (closing wedge) distal metatarsal osteotomy (chevron).

Front 20

MTP fusion is recommended for patients with _________ conditions, such as rheumatoid arthritis, or neurologic disorders, such as cerebral palsy.

Back 20

MTP fusion is recommended for patients with inflammatory conditions, such as rheumatoid arthritis, or neurologic disorders, such as cerebral palsy.

Front 21

Juvenile Hallux Valgus

Back 21

Juvenile Hallux Valgus

Front 22

A congruent joint with an elevated ______ is more common in juvenile hallux valgus than in the adult condition.

Back 22

A congruent joint with an elevated DMAA is more common in juvenile hallux valgus than in the adult condition.

Front 23

Recurrence rates of up to ___% have been noted with surgical treatment of hallux valgus in juveniles.

Back 23

Recurrence rates of up to 50% have been noted with surgical treatment of hallux valgus in juveniles.

Front 24

Hallux Varus

Back 24

Hallux Varus

Front 25

The most common cause of hallux varus is iatrogenic deformity resulting from hallux valgus repair (___% to ___% incidence), which can be due to excessive tightening of the medial joint capsule, excessive resection of the medial eminence, overcorrection of the IM angle, excision of the fibular sesamoid, or excessive lateral capsular release.

Back 25

The most common cause of hallux varus is iatrogenic deformity resulting from hallux valgus repair (2% to 10% incidence), which can be due to excessive tightening of the medial joint capsule, excessive resection of the medial eminence, overcorrection of the IM angle, excision of the fibular sesamoid, or excessive lateral capsular release.

Front 26

Hallux varus is principally _________ and most patients can be treated nonsurgically.

Back 26

Hallux varus is principally asymptomatic and most patients can be treated nonsurgically.

Front 27

If the painful deformity is passively correctable, a soft-tissue procedure with ______ transfer can be performed.

Back 27

If the painful deformity is passively correctable, a soft-tissue procedure with tendon transfer can be performed.

Front 28

If the painful deformity is ______ or significant arthrosis is present, then fusion of the MTP joint is recommended.

Back 28

If the painful deformity is fixed or significant arthrosis is present, then fusion of the MTP joint is recommended.

Front 29

Hallux Rigidus

Back 29

Hallux Rigidus

Front 30

Hallux ______ describes a degenerative arthritic process that leads to functional limitation of motion in the first MTP joint.

Back 30

Hallux rigidus describes a degenerative arthritic process that leads to functional limitation of motion in the first MTP joint.

Front 31

Periarticular osteophytes can create a mechanical block to ______flexion.

Back 31

Periarticular osteophytes can create a mechanical block to dorsiflexion.

Front 32

Cheilectomy involves resection of the dorsal osteophyte along with removal of ___% to ___% of the dorsal aspect of the metatarsal head.

Back 32

Cheilectomy involves resection of the dorsal osteophyte along with removal of 25% to 30% of the dorsal aspect of the metatarsal head.

Front 33

A patient whose main complaint is shoe-wear irritation from the prominence or pain with dorsiflexion is the best candidate for _________.

Back 33

A patient whose main complaint is shoe-wear irritation from the prominence or pain with dorsiflexion is the best candidate for cheilectomy.

Front 34

Dorsal closing wedge (Moberg) osteotomy is usually combined with a cheilectomy and is indicated if cheilectomy does not provide at least ___° to ___° of dorsiflexion.

Back 34

Dorsal closing wedge (Moberg) osteotomy is usually combined with a cheilectomy and is indicated if cheilectomy does not provide at least 30° to 40° of dorsiflexion.

Front 35

Arthrodesis of the MTP joint is the most commonly used procedure for severe hallux rigidus. The preferred alignment is ___° to ___° of valgus and ___° of dorsiflexion relative to the metatarsal shaft. Excessive valgus may increase risk of hallux IP joint degeneration.

Back 35

Arthrodesis of the MTP joint is the most commonly used procedure for severe hallux rigidus. The preferred alignment is 10° to 15° of valgus and 15° of dorsiflexion relative to the metatarsal shaft. Excessive valgus may increase risk of hallux IP joint degeneration.

Front 36

The use of implants in the MTP joint has a high failure rate and is rarely ______.

Back 36

The use of implants in the MTP joint has a high failure rate and is rarely indicated.

Front 37

Turf Toe Injuries

Back 37

Turf Toe Injuries

Front 38

The most common mechanism of turf toe injury is hyper______ of the MTP joint with an axial load applied to a ______ flexed foot.

Back 38

The most common mechanism of turf toe injury is hyperextension of the MTP joint with an axial load applied to a plantar flexed foot.

Front 39

Determining the location of tenderness can help identify injured structures. The ability and comfort associated with ______ _________ can give an indication of the severity of injury.

Back 39

Determining the location of tenderness can help identify injured structures. The ability and comfort associated with weight bearing can give an indication of the severity of injury.

Front 40

An intrinsic minus position of the hallux, with the MTP joint ______ and IP joint ______, indicates a severe injury.

Back 40

An intrinsic minus position of the hallux, with the MTP joint extended and IP joint flexed, indicates a severe injury.

Front 41

An AP radiograph of the foot showing ______ migration of the sesamoids indicates a complete rupture of the plantar plate.

Back 41

An AP radiograph of the foot showing proximal migration of the sesamoids indicates a complete rupture of the plantar plate.

Front 42

The severity of the injury varies significantly and determines the time needed for recovery. Severe injuries may require use of a ______ ___ or ___ ___ ___ until the joint is stable.

Back 42

The severity of the injury varies significantly and determines the time needed for recovery. Severe injuries may require use of a walker boot or short leg cast until the joint is stable.

Front 43

Surgery is indicated when there is _________ of the sesamoids, sesamoid fracture with ______, traumatic ______, or loose ______ in the joint.

Back 43

Surgery is indicated when there is retraction of the sesamoids, sesamoid fracture with diastasis, traumatic bunions, or loose fragments in the joint.

Front 44

Sesamoid Disorders

Back 44

Sesamoid Disorders

Front 45

The sesamoids sit within the flexor hallucis ______ tendon and help increase its mechanical force.

Back 45

The sesamoids sit within the flexor hallucis brevis tendon and help increase its mechanical force.

Front 46

The flexor hallucis ______ tendon glides between the two sesamoids.

Back 46

The flexor hallucis longus tendon glides between the two sesamoids.

Front 47

The tibial sesamoid is bipartite in approximately ___% of the population; in ___% of those people, the condition is bilateral.

Back 47

The tibial sesamoid is bipartite in approximately 10% of the population; in 25% of those people, the condition is bilateral.

Front 48

The ______ (______) sesamoid is larger and more affected by weight bearing; thus, it is more commonly injured.

Back 48

The medial (tibial) sesamoid is larger and more affected by weight bearing; thus, it is more commonly injured.

Front 49

A plantar-flexed first ray with a cavus deformity may be noted on examination and may need correction with a _________ osteotomy of the metatarsal.

Back 49

A plantar-flexed first ray with a cavus deformity may be noted on examination and may need correction with a dorsiflexion osteotomy of the metatarsal.

Front 50

Radiographs may reveal the presence of ______ or _________ changes of the sesamoids.

Back 50

Radiographs may reveal the presence of fracture or degenerative changes of the sesamoids.

Front 51

A bone scan may be helpful but should be interpreted with caution because ___% to ___% of asymptomatic patients may show increased uptake.

Back 51

A bone scan may be helpful but should be interpreted with caution because 25% to 30% of asymptomatic patients may show increased uptake.

Front 52

Tibial sesamoid excision may lead to hallux valgus and fibular sesamoid excision may lead to hallux ___. Excision of both sesamoids should be avoided, as a ___-__ deformity of the toe may occur.

Back 52

Tibial sesamoid excision may lead to hallux valgus and fibular sesamoid excision may lead to hallux varus. Excision of both sesamoids should be avoided, as a cock-up deformity of the toe may occur.

Front 53

114. Forefoot Disorders

Back 53

114. Forefoot Disorders

Front 54

Second MTP joint synovitis in the presence of a long second metatarsal is surgically treated with a ______ ______ osteotomy at the junction of the metatarsal ______ and ______ that allows the metatarsal ______ to be slid proximally.

Back 54

Second MTP joint synovitis in the presence of a long second metatarsal is surgically treated with a short oblique osteotomy at the junction of the metatarsal head and neck that allows the metatarsal head to be slid proximally.

Front 55

In the absence of a long second metatarsal, sagittal plane deformities are corrected with a soft-tissue reconstruction such as an ___-to-___ tendon transfer (______-______ procedure) or an MTP ______ release and ______ tendon lengthening.

Back 55

In the absence of a long second metatarsal, sagittal plane deformities are corrected with a soft-tissue reconstruction such as an FDL-to-EDL tendon transfer (Girdlestone-Taylor procedure) or an MTP capsular release and extensor tendon lengthening.

Front 56

Surgical treatment of a Freiberg infraction commonly involves a ______ ______-wedge osteotomy of the metatarsal head.

Back 56

Surgical treatment of a Freiberg infraction commonly involves a dorsal closing-wedge osteotomy of the metatarsal head.

Front 57

Lesser MTP deformity starts with dysfunction of the ______ ______.

Back 57

Lesser MTP deformity starts with dysfunction of the plantar plate.

Front 58

Recurrent MTP joint instability after surgical correction is usually due to persistent plantar plate dysfunction.

Back 58

Recurrent MTP joint instability after surgical correction is usually due to persistent plantar plate dysfunction.

Front 59

Mallet toe is a hyperflexion deformity at the ___ joint. The deformity may be ______ or ___.

Back 59

Mallet toe is a hyperflexion deformity at the DIP joint. The deformity may be flexible or fixed.

Front 60

Hammer toe is a flexion deformity at the ___ joint and an extension deformity at the ___ and ___ joints. It is the most common deformity seen in the lesser toes.

Back 60

Hammer toe is a flexion deformity at the PIP joint and an extension deformity at the MTP and DIP joints. It is the most common deformity seen in the lesser toes.

Front 61

___ toe is an extension deformity at the MTP joint combined with hyperflexion at the PIP joint and DIP joints. The deformity may be flexible or fixed.

Back 61

Claw toe is an extension deformity at the MTP joint combined with hyperflexion at the PIP joint and DIP joints. The deformity may be flexible or fixed.

Front 62

The difference between a hammer toe and claw toe is the positioning of the ___ joint.

Back 62

The difference between a hammer toe and claw toe is the positioning of the DIP joint.

Front 63

Only a larger bunionette deformity with an IMA >___° or a large bow is treated with an oblique diaphyseal rotational osteotomy and screw fixation.

Back 63

Only a larger bunionette deformity with an IMA >12° or a large bow is treated with an oblique diaphyseal rotational osteotomy and screw fixation.

Front 64

115. Arthritides of the Foot and Ankle

Back 64

115. Arthritides of the Foot and Ankle

Front 65

Arthritides of the Ankle

Back 65

Arthritides of the Ankle

Front 66

Arthritides of the ankle are most often ______ in origin.

Back 66

Arthritides of the ankle are most often posttraumatic in origin.

Front 67

______ is the gold standard treatment for end-stage arthritis of the ankle. The recommended positioning of the ankle for arthrodesis is ______ plantar flexion and dorsiflexion, hindfoot valgus of ___º, and rotation equal to the contralateral limb.

Back 67

Arthrodesis is the gold standard treatment for end-stage arthritis of the ankle. The recommended positioning of the ankle for arthrodesis is neutral plantar flexion and dorsiflexion, hindfoot valgus of 5º, and rotation equal to the contralateral limb.

Front 68

Long-term follow-up studies have demonstrated that ipsilateral, adjacent, ______ (______) arthritis may develop after uncomplicated ankle fusion surgery.

Back 68

Long-term follow-up studies have demonstrated that ipsilateral, adjacent, hindfoot (subtalar) arthritis may develop after uncomplicated ankle fusion surgery.

Front 69

Arthritides of the Hindfoot

Back 69

Arthritides of the Hindfoot

Front 70

The hindfoot articulations include the ______, ______, and _________ joints.

Back 70

The hindfoot articulations include the subtalar, talonavicular, and calcaneocuboid joints.

Front 71

Isolated _________ joint arthritis is associated with inflammatory arthropathy (RA).

Back 71

Isolated talonavicular joint arthritis is associated with inflammatory arthropathy (RA).

Front 72

Isolated calcaneocuboid, subtalar, and talonavicular joint arthrodeses limit hindfoot motion by approximately ___%, ___%, and ___%, respectively.

Back 72

Isolated calcaneocuboid, subtalar, and talonavicular joint arthrodeses limit hindfoot motion by approximately 25%, 40%, and 90%, respectively.

Front 73

The desired position for triple arthrodesis is ___° to ___° of hindfoot valgus and a congruent talus-first metatarsal angle on the AP and lateral radiographs (0º).

Back 73

The desired position for triple arthrodesis is 5° to 7° of hindfoot valgus and a congruent talus-first metatarsal angle on the AP and lateral radiographs (0º).

Front 74

The union rate for isolated subtalar arthrodesis is ___% to ___%. In a triple arthrodesis, the most common joint not to fuse is the _________ joint.

Back 74

The union rate for isolated subtalar arthrodesis is 88% to 96%. In a triple arthrodesis, the most common joint not to fuse is the talonavicular joint.

Front 75

Arthritides of the Midfoot

Back 75

Arthritides of the Midfoot

Front 76

The etiology of midfoot arthritis can be primary, inflammatory, posttraumatic (______ fracture-dislocation), or neuropathic (______ neuroarthropathy). Primary ___ of the midfoot is the most common type of midfoot arthritis.

Back 76

The etiology of midfoot arthritis can be primary, inflammatory, posttraumatic (Lisfranc fracture-dislocation), or neuropathic (Charcot neuroarthropathy). Primary OA of the midfoot is the most common type of midfoot arthritis.

Front 77

Untreated TMT joint (______) fracture-dislocation typically leads to loss of the longitudinal ______ and forefoot ______.

Back 77

Untreated TMT joint (Lisfranc) fracture-dislocation typically leads to loss of the longitudinal arch and forefoot abduction.

Front 78

Midfoot joints may be viewed as nonessential joints, and if fused in ______ alignment, physiologic foot function is generally anticipated.

Back 78

Midfoot joints may be viewed as nonessential joints, and if fused in anatomic alignment, physiologic foot function is generally anticipated.

Front 79

Given the high prevalence of midfoot arthritis following Lisfranc injury, primary _________ may be considered.

Back 79

Given the high prevalence of midfoot arthritis following Lisfranc injury, primary arthrodesis may be considered.

Front 80

Nonsurgical treatment of arthritides of the midfoot includes longitudinal arch supports and shoe modifications (______ soles). ______-______ bracing in combination with shoe modifications (______ soles) may further unload the midfoot during gait.

Back 80

Nonsurgical treatment of arthritides of the midfoot includes longitudinal arch supports and shoe modifications (rocker soles). Fixed-ankle bracing in combination with shoe modifications (rocker soles) may further unload the midfoot during gait.

Front 81

Near full physiologic foot function, in particular during push-off, can be reestablished with successful realignment and arthrodesis of the first through ______ TMT and/or naviculocuneiform joints. The ______ and ______ TMT joints are not fused, in order to preserve the accommodative function of the foot during the stance phase of gait.

Back 81

Near full physiologic foot function, in particular during push-off, can be reestablished with successful realignment and arthrodesis of the first through third TMT and/or naviculocuneiform joints. The fourth and fifth TMT joints are not fused, in order to preserve the accommodative function of the foot during the stance phase of gait.

Front 82

Arthritides of the Forefoot

Back 82

Arthritides of the Forefoot

Front 83

Arthritides of the forefoot most commonly affect the first MTP joint (______ ______). The most likely etiology is repetitive ______, but metabolic (gout) or inflammatory conditions (eg, RA) also may be contributing factors.

Back 83

Arthritides of the forefoot most commonly affect the first MTP joint (hallux rigidus). The most likely etiology is repetitive trauma, but metabolic (gout) or inflammatory conditions (eg, RA) also may be contributing factors.

Front 84

Arthritis of the forefoot involving the lesser MTP joints is typically ______ (eg, ___) and rarely occurs secondary to osteonecrosis of the lesser metatarsal head (______ infraction).

Back 84

Arthritis of the forefoot involving the lesser MTP joints is typically inflammatory (eg, RA) and rarely occurs secondary to osteonecrosis of the lesser metatarsal head (Freiberg infraction).

Front 85

Hallux rigidus refers to degenerative joint disease of the ______ MTP joint.

Back 85

Hallux rigidus refers to degenerative joint disease of the first MTP joint.

Front 86

Symptoms of first MTP joint arthritis isolated to dorsal impingement (pain with push-off) can typically be effectively managed with ______ _________.

Back 86

Symptoms of first MTP joint arthritis isolated to dorsal impingement (pain with push-off) can typically be effectively managed with dorsal cheilectomy.

Front 87

Pain at the midrange of the motion arc, particularly with severe limitation of motion, suggests more advanced arthritis of the hallux MTP joint. This finding influences treatment decisions. Typically, global arthritis of the first MTP joint is not effectively managed with ______ cheilectomy.

Back 87

Pain at the midrange of the motion arc, particularly with severe limitation of motion, suggests more advanced arthritis of the hallux MTP joint. This finding influences treatment decisions. Typically, global arthritis of the first MTP joint is not effectively managed with dorsal cheilectomy.

Front 88

Optimal position for hallux MTP arthrodesis is ______ toe alignment relative to the plantar surface of the foot (toe just clears, tuft barely touches floor), no _________, and slight (___°) ______.

Back 88

Optimal position for hallux MTP arthrodesis is neutral toe alignment relative to the plantar surface of the foot (toe just clears, tuft barely touches floor), no pronation, and slight (5°) valgus.

Front 89

Although theoretically an attractive alternative to arthrodesis, first MTP joint prosthetic replacement lacks sufficient ______-___ support in the orthopaedic literature to recommend it over arthrodesis.

Back 89

Although theoretically an attractive alternative to arthrodesis, first MTP joint prosthetic replacement lacks sufficient evidence-based support in the orthopaedic literature to recommend it over arthrodesis.

Front 90

In select cases, interpositional arthroplasty using the patient’s native extensor ______ _________ tendon and ______ capsule may relieve symptoms while preserving hallux motion.

Back 90

In select cases, interpositional arthroplasty using the patient’s native extensor hallucis brevis tendon and dorsal capsule may relieve symptoms while preserving hallux motion.

Front 91

Inflammatory arthritis (eg, RA) involving the entire forefoot is typically best managed with first MTP joint _________ and lesser metatarsal head ______ (______-_________ procedure).

Back 91

Inflammatory arthritis (eg, RA) involving the entire forefoot is typically best managed with first MTP joint arthrodesis and lesser metatarsal head resections (Clayton-Hoffmann procedure).

Front 92

Failure of first MTP joint silicone prostheses may require structural bone grafting to regain the length of the ______ ray.

Back 92

Failure of first MTP joint silicone prostheses may require structural bone grafting to regain the length of the first ray.

Front 93

116. Acute and Chronic Injuries of the Ankle

Back 93

116. Acute and Chronic Injuries of the Ankle

Front 94

Ninety percent of acute ankle sprains resolve with ____ and early functional rehabilitation.

Back 94

Ninety percent of acute ankle sprains resolve with RICE and early functional rehabilitation.

Front 95

Consider MRI if pain persists __ weeks after acute ankle sprain. Rule out osteochondral lesions, peroneal pathology, occult fractures of the talus or anterior calcaneus, tarsal coalition, bone bruise, and impingement lesions.

Back 95

Consider MRI if pain persists 8 weeks after acute ankle sprain. Rule out osteochondral lesions, peroneal pathology, occult fractures of the talus or anterior calcaneus, tarsal coalition, bone bruise, and impingement lesions.

Front 96

Chronic lateral ankle instability is best treated with physical therapy and bracing, followed by direct ______ ______ if nonsurgical treatment fails.

Back 96

Chronic lateral ankle instability is best treated with physical therapy and bracing, followed by direct anatomic repair if nonsurgical treatment fails.

Front 97

Malalignment associated with chronic lateral ankle instability must be corrected when considering lateral ligament stabilization. ______ ______ testing helps distinguish between fixed and flexible hindfoot varus.

Back 97

Malalignment associated with chronic lateral ankle instability must be corrected when considering lateral ligament stabilization. Coleman block testing helps distinguish between fixed and flexible hindfoot varus.

Front 98

In chronic lateral ankle instability, a tendon graft should be considered to supplement repair in patients with failed prior surgery, generalized ligamentous ___, and ___ functional demands.

Back 98

In chronic lateral ankle instability, a tendon graft should be considered to supplement repair in patients with failed prior surgery, generalized ligamentous laxity, and high functional demands.

Front 99

______ ______ is the most common complication after tendon rerouting reconstruction for chronic ankle instability.

Back 99

Subtalar stiffness is the most common complication after tendon rerouting reconstruction for chronic ankle instability.

Front 100

Syndesmotic injury requires surgical stabilization when the ______ ankle has been disrupted (ie, ______ rupture or ______ malleolar fracture).

Back 100

Syndesmotic injury requires surgical stabilization when the medial ankle has been disrupted (ie, deltoid rupture or medial malleolar fracture).

Front 101

Chronic deltoid insufficiency usually is associated with ______ foot deformity.

Back 101

Chronic deltoid insufficiency usually is associated with planovalgus foot deformity.

Front 102

Subtalar instability is difficult to distinguish from ankle instability because the _________ ligament contributes to the stability of both joints.

Back 102

Subtalar instability is difficult to distinguish from ankle instability because the calcaneofibular ligament contributes to the stability of both joints.

Front 103

117. Arthroscopy of the Ankle

Back 103

117. Arthroscopy of the Ankle

Front 104

The workhorse portals for ankle arthroscopy are the ______, ______, and ______ portals.

Back 104

The workhorse portals for ankle arthroscopy are the anteromedial, anterolateral, and posterolateral portals.

Front 105

Complications of arthroscopic ankle surgery occur in about ___% of patients. The most common complication is neurologic injury, with approximately 50% involving the ______ ______ nerve.

Back 105

Complications of arthroscopic ankle surgery occur in about 10% of patients. The most common complication is neurologic injury, with approximately 50% involving the superficial peroneal nerve.

Front 106

A ______ ______ ______ is a more common complication with ankle arthroscopy than with arthroscopy of other joints.

Back 106

A synovial cutaneous fistula is a more common complication with ankle arthroscopy than with arthroscopy of other joints.

Front 107

The structures that are at greatest risk during placement of the anteromedial portal are the ______ ______ nerve and the ______ vein.

Back 107

The structures that are at greatest risk during placement of the anteromedial portal are the greater saphenous nerve and the saphenous vein.

Front 108

The structure that is at greatest risk during placement of the anterolateral portal is the ______ ______ cutaneous branch of the ______ ______ nerve.

Back 108

The structure that is at greatest risk during placement of the anterolateral portal is the intermediate dorsal cutaneous branch of the superficial peroneal nerve.

Front 109

The structures that are at greatest risk during placement of the posterolateral portal are the ___ nerve and the ___ ___ vein.

Back 109

The structures that are at greatest risk during placement of the posterolateral portal are the sural nerve and the lesser saphenous vein.

Front 110

Anterolateral soft-tissue impingement is a common cause of chronic ankle pain after one or more ______ ankle sprains. It has been noted to occur with or without associated ______ ankle instability.

Back 110

Anterolateral soft-tissue impingement is a common cause of chronic ankle pain after one or more lateral ankle sprains. It has been noted to occur with or without associated lateral ankle instability.

Front 111

A physical examination test specific for anterolateral soft-tissue impingement involves reproduction of the pain with ______ of the ankle, followed by thumb pressure at the ______ ankle joint and, finally, ______ of the ankle. This test has been reported to be reproducible and accurate.

Back 111

A physical examination test specific for anterolateral soft-tissue impingement involves reproduction of the pain with plantar flexion of the ankle, followed by thumb pressure at the anterolateral ankle joint and, finally, dorsiflexion of the ankle. This test has been reported to be reproducible and accurate.

Front 112

Injury to the ankle syndesmosis can result in persistent pain and dysfunction secondary to syndesmotic ______.

Back 112

Injury to the ankle syndesmosis can result in persistent pain and dysfunction secondary to syndesmotic impingement.

Front 113

Excellent or good results can be expected approximately ___% of the time with arthroscopic removal of anterior ankle bone spurs and scar/synovitis when joint-space narrowing is not present.

Back 113

Excellent or good results can be expected approximately 75% of the time with arthroscopic removal of anterior ankle bone spurs and scar/synovitis when joint-space narrowing is not present.

Front 114

118. Tendon Disorders

Back 114

118. Tendon Disorders

Front 115

Achilles Tendon Disorders

Back 115

Achilles Tendon Disorders

Front 116

The Achilles tendon consists of the two heads of the gastrocnemius and soleus muscles and is innervated by the ___ nerve.

Back 116

The Achilles tendon consists of the two heads of the gastrocnemius and soleus muscles and is innervated by the tibial nerve.

Front 117

A vascular watershed region in the tendon is found ___ to ___ cm from the calcaneal insertion.

Back 117

A vascular watershed region in the tendon is found 2 to 6 cm from the calcaneal insertion.

Front 118

The Achilles tendon lacks a true tendon sheath; instead, it is surrounded by a ______.

Back 118

The Achilles tendon lacks a true tendon sheath; instead, it is surrounded by a paratenon.

Front 119

Symptoms of acute paratenonitis/tendinitis are typically associated with overuse or a change in activity or ______.

Back 119

Symptoms of acute paratenonitis/tendinitis are typically associated with overuse or a change in activity or intensity.

Front 120

Tendinitis is typically associated with ______, more ______ patients, whereas patients with chronic tendinosis are typically ___ and more ______.

Back 120

Tendinitis is typically associated with younger, more active patients, whereas patients with chronic tendinosis are typically older and more sedentary.

Front 121

Most Achilles tendon disorders will respond to nonsurgical treatment. Acute Achilles tendon ruptures occur most commonly in the ___ to ___ decade of life in men who are weekend warriors.

Back 121

Most Achilles tendon disorders will respond to nonsurgical treatment. Acute Achilles tendon ruptures occur most commonly in the third to fourth decade of life in men who are weekend warriors.

Front 122

The most common complication of surgical treatment of Achilles tendon disorders is ___ ______ (eg, infection, necrosis, and adhesions).

Back 122

The most common complication of surgical treatment of Achilles tendon disorders is skin complications (eg, infection, necrosis, and adhesions).

Front 123

Ruptures more than ___ months old, or chronic injuries with greater than ___% involvement, often will require reconstruction with a turndown procedure, V-Y advancement, tendon transfer, and/or augumentation.

Back 123

Ruptures more than 3 months old, or chronic injuries with greater than 50% involvement, often will require reconstruction with a turndown procedure, V-Y advancement, tendon transfer, and/or augumentation.

Front 124

Peroneal Tendon Disorders

Back 124

Peroneal Tendon Disorders

Front 125

The tendons run in a sulcus formed in the fibula posteriorly called the ______ ______ and are further stabilized by a fibrocartilaginous rim and the ______.

Back 125

The tendons run in a sulcus formed in the fibula posteriorly called the peroneal groove and are further stabilized by a fibrocartilaginous rim and the SPR.

Front 126

Within the groove, the PB tendon is ______ and ______ to the PL tendon.

Back 126

Within the groove, the PB tendon is anterior and medial to the PL tendon.

Front 127

The primary function of the peroneal tendons is to ______ the hindfoot; they secondarily ___ ___ the ankle, and the PL ___ ___ (___) the first ray.

Back 127

The primary function of the peroneal tendons is to evert the hindfoot; they secondarily plantar flex the ankle, and the PL plantar flexes (pronates) the first ray.

Front 128

There is a vascular watershed region just ______ to the fibula, which corresponds to the most common area of injury.

Back 128

There is a vascular watershed region just posterior to the fibula, which corresponds to the most common area of injury.

Front 129

Most peroneal tendon tears are in the PB tendon at the level of the fibular groove. They often are caused by ______ injuries.

Back 129

Most peroneal tendon tears are in the PB tendon at the level of the fibular groove. They often are caused by inversion injuries.

Front 130

Complete ruptures are rare; tears are often ______ in the tendon and typically are seen in chronic situations.

Back 130

Complete ruptures are rare; tears are often longitudinal in the tendon and typically are seen in chronic situations.

Front 131

Patients with chronic peroneal tendon injuries are treated with ___ to the healthy tendon or ______ of the ___ when both tendons are involved.

Back 131

Patients with chronic peroneal tendon injuries are treated with tenodesis to the healthy tendon or transfer of the FDL when both tendons are involved.

Front 132

Dislocation or subluxation occurs during an inversion injury to a _________ ankle with rapid reflexive contraction of the PL and PB tendons. A disruption of the ______ or fibrocartilage ridge results.

Back 132

Dislocation or subluxation occurs during an inversion injury to a dorsiflexed ankle with rapid reflexive contraction of the PL and PB tendons. A disruption of the SPR or fibrocartilage ridge results.

Front 133

Dislocation or subluxation may be elicited on examination with ankle rotation or with forcing the foot from a position of inversion and plantar flexion to a position of ___ and ___flexion.

Back 133

Dislocation or subluxation may be elicited on examination with ankle rotation or with forcing the foot from a position of inversion and plantar flexion to a position of eversion and dorsiflexion.

Front 134

Treatment in acute injuries is with cast immobilization to allow the ___ to heal; however, in higher level athletes, acute ___ and ___-___ procedures are a reasonable option.

Back 134

Treatment in acute injuries is with cast immobilization to allow the SPR to heal; however, in higher level athletes, acute SPR and groove-deepening procedures are a reasonable option.

Front 135

Posterior Tibial Tendon Disorders

Back 135

Posterior Tibial Tendon Disorders

Front 136

The posterior tibial tendon acts primarily as an invertor of the ______ and supinator of the ______ during the stance phase of gait.

Back 136

The posterior tibial tendon acts primarily as an invertor of the hindfoot and supinator of the forefoot during the stance phase of gait.

Front 137

Activation of the posterior tibial tendon during the toe-off phase of gait locks the ______ ______ joints, thus creating a rigid lever arm for push off.

Back 137

Activation of the posterior tibial tendon during the toe-off phase of gait locks the transverse tarsal joints, thus creating a rigid lever arm for push off.

Front 138

Pathology occurs most commonly in the watershed region of the tendon from the ______ ______ to its insertion on the ______.

Back 138

Pathology occurs most commonly in the watershed region of the tendon from the medial malleolus to its insertion on the navicular.

Front 139

Posterior tibial tendon dysfunction is the most common cause of an acquired ______ deformity.

Back 139

Posterior tibial tendon dysfunction is the most common cause of an acquired flatfoot deformity.

Front 140

Collapse of the ______ longitudinal arch, hindfoot ______, and forefoot ______ is the classic triad of foot deformity associated with posterior tibial tendon insufficiency.

Back 140

Collapse of the medial longitudinal arch, hindfoot valgus, and forefoot abduction is the classic triad of foot deformity associated with posterior tibial tendon insufficiency.

Front 141

The “too many toes” sign and the inability to perform a single-limb ______ ___ are additional classic findings of posterior tibial tendon insufficiency.

Back 141

The “too many toes” sign and the inability to perform a single-limb heel rise are additional classic findings of posterior tibial tendon insufficiency.

Front 142

Plain radiographs reveal loss of the ___ angle (talar–first metatarsal), loss of ___ pitch, and ______ subluxation.

Back 142

Plain radiographs reveal loss of the Meary angle (talar–first metatarsal), loss of calcaneal pitch, and peritalar subluxation.

Front 143

Nonsurgical treatment consists of a University of California Biomechanics Laboratory–type orthotic for stage ___, and an AFO or Arizona brace for stage ___ and ___ disease.

Back 143

Nonsurgical treatment consists of a University of California Biomechanics Laboratory–type orthotic for stage II, and an AFO or Arizona brace for stage III and IV disease.

Front 144

Surgical treatment of stage II disease consists most commonly of ___ transfer in conjunction with a ___ procedure, most commonly a ___ ___ displacement osteotomy or a ___ ___ lengthening.

Back 144

Surgical treatment of stage II disease consists most commonly of FDL transfer in conjunction with a bony procedure, most commonly a medial calcaneal displacement osteotomy or a lateral column lengthening.

Front 145

Surgical treatment of stage ___ disease is a hindfoot ___, most commonly a ___ ___.

Back 145

Surgical treatment of stage III disease is a hindfoot arthrodesis, most commonly a triple arthrodesis.

Front 146

Peroneal Tendon Disorders

Back 146

Peroneal Tendon Disorders

Front 147

The tendons run in a sulcus formed in the fibula posteriorly called the ___ groove and are further stabilized by a fibrocartilaginous rim and the ___.

Back 147

The tendons run in a sulcus formed in the fibula posteriorly called the peroneal groove and are further stabilized by a fibrocartilaginous rim and the SPR.

Front 148

Within the groove, the PB tendon is ___ and ___ to the PL tendon.

Back 148

Within the groove, the PB tendon is anterior and medial to the PL tendon.

Front 149

The primary function of the peroneal tendons is to ___ the hindfoot; they secondarily ___ ___ the ankle, and the PL plantar flexes (___) the first ray.

Back 149

The primary function of the peroneal tendons is to evert the hindfoot; they secondarily plantar flex the ankle, and the PL plantar flexes (pronates) the first ray.

Front 150

There is a vascular ______ region just posterior to the fibula, which corresponds to the most common area of injury.

Back 150

There is a vascular watershed region just posterior to the fibula, which corresponds to the most common area of injury.

Front 151

Most peroneal tendon tears are in the ___ tendon at the level of the fibular groove. They often are caused by inversion injuries.

Back 151

Most peroneal tendon tears are in the PB tendon at the level of the fibular groove. They often are caused by inversion injuries.

Front 152

Complete ruptures are rare; tears are often ___ in the tendon and typically are seen in chronic situations.

Back 152

Complete ruptures are rare; tears are often longitudinal in the tendon and typically are seen in chronic situations.

Front 153

Patients with chronic peroneal tendon injuries are treated with ___ to the healthy tendon or transfer of the ___ when both tendons are involved.

Back 153

Patients with chronic peroneal tendon injuries are treated with tenodesis to the healthy tendon or transfer of the FDL when both tendons are involved.

Front 154

Dislocation or subluxation occurs during an inversion injury to a ______ ankle with rapid reflexive contraction of the ___ and ___ tendons. A disruption of the ___ or ___ ridge results.

Back 154

Dislocation or subluxation occurs during an inversion injury to a dorsiflexed ankle with rapid reflexive contraction of the PL and PB tendons. A disruption of the SPR or fibrocartilage ridge results.

Front 155

Dislocation or subluxation may be elicited on examination with ankle rotation or with forcing the foot from a position of inversion and plantar flexion to a position of ___ and ______.

Back 155

Dislocation or subluxation may be elicited on examination with ankle rotation or with forcing the foot from a position of inversion and plantar flexion to a position of eversion and dorsiflexion.

Front 156

Treatment in acutre injuries is with cast immobilization to allow the SPR to heal; however, in higher level athletes, acute ___ and ___-deepening procedures are a reasonable option.

Back 156

Treatment in acutre injuries is with cast immobilization to allow the SPR to heal; however, in higher level athletes, acute SPR and groove-deepening procedures are a reasonable option.

Front 157

Anterior Tibial, FHL, EHL, and EDL Tendon Disorders

Back 157

Anterior Tibial, FHL, EHL, and EDL Tendon Disorders

Front 158

The most common types of anterior tibial tendon pathology include ___ and ___ ruptures.

Back 158

The most common types of anterior tibial tendon pathology include laceration and closed ruptures.

Front 159

Closed anterior tibial tendon ruptures are either the result of strong ______ contraction in younger individuals or ______ ruptures in older patients with musculoskeletal compromise.

Back 159

Closed anterior tibial tendon ruptures are either the result of strong eccentric contraction in younger individuals or attritional ruptures in older patients with musculoskeletal compromise.

Front 160

Examination reveals swelling, a palpable gap, weakness with resisted ______, and steppage or ___-___ pattern gait.

Back 160

Examination reveals swelling, a palpable gap, weakness with resisted dorsiflexion, and steppage or slap-foot pattern gait.

Front 161

Acute anterior tibial tendon ruptures should be repaired ___ end to end or to bone with a suture anchor. Chronic injuries may require supplementation with ___ advancement versus ___ ___ graft.

Back 161

Acute anterior tibial tendon ruptures should be repaired primarily end to end or to bone with a suture anchor. Chronic injuries may require supplementation with V-Y advancement versus free tendon graft.

Front 162

The FHL runs through its fibro-osseous tunnel, ___ to the posteromedial tubercle of the talus, ___ the sustentaculum tali and through the knot of ___ before inserting into the base of the ___ phalanx of the ___ toe.

Back 162

The FHL runs through its fibro-osseous tunnel, lateral to the posteromedial tubercle of the talus, under the sustentaculum tali and through the knot of Henry before inserting into the base of the proximal phalanx of the great toe.

Front 163

___ are the most common form of FHL injury.

Back 163

Lacerations are the most common form of FHL injury.

Front 164

Stenosing tenosynovitis commonly occurs in the fibro-osseous tunnel posterior to the talus in the ___. It is most common in dancers and gymnasts and may coexist with posterior ankle impingement (ie, ___ ___).

Back 164

Stenosing tenosynovitis commonly occurs in the fibro-osseous tunnel posterior to the talus in the FHL. It is most common in dancers and gymnasts and may coexist with posterior ankle impingement (ie, os trigonum).

Front 165

FHL tendinitis can be elicited with physical examination of pain with resisted ___ ___ of the IP joint as well as posterior ankle pain with forceful ___ ___.

Back 165

FHL tendinitis can be elicited with physical examination of pain with resisted plantar flexion of the IP joint as well as posterior ankle pain with forceful plantar flexion.

Front 166

A closed rupture of the EHL/EDL tendons is rare; however, the EHL/EDL tendons are predisposed to lacerations because of their ___ nature.

Back 166

A closed rupture of the EHL/EDL tendons is rare; however, the EHL/EDL tendons are predisposed to lacerations because of their superficial nature.

Front 167

EHL acute ruptures proximal to the extensor hood should undergo an ______ repair; ruptures ______ to the extensor hood may be treated nonsurgically.

Back 167

EHL acute ruptures proximal to the extensor hood should undergo an end-to-end repair; ruptures distal to the extensor hood may be treated nonsurgically.

Front 168

119. Heel Pain

Back 168

119. Heel Pain

Front 169

Heel pain in the elderly and patients with atypical presentations should be investigated to rule out ______ fractures and ___.

Back 169

Heel pain in the elderly and patients with atypical presentations should be investigated to rule out insufficiency fractures and tumors.

Front 170

The patient with plantar fasciitis will most often report “___-___” inferior heel pain and may prefer to walk on the toes for the first few steps.

Back 170

The patient with plantar fasciitis will most often report “start-up” inferior heel pain and may prefer to walk on the toes for the first few steps.

Front 171

Corticosteroid injections should be used sparingly in the treatment of plantar fasciitis because they may increase the risk for plantar fascia ___ or fat pad ___.

Back 171

Corticosteroid injections should be used sparingly in the treatment of plantar fasciitis because they may increase the risk for plantar fascia rupture or fat pad atrophy.

Front 172

The etiology of entrapment of the first branch of the lateral plantar nerve is compression of the nerve between the deep fascia of the ___ ___ and the ___ margin of the ___ ___.

Back 172

The etiology of entrapment of the first branch of the lateral plantar nerve is compression of the nerve between the deep fascia of the abductor hallucis and the inferomedial margin of the quadratus plantae.

Front 173

The first branch of the lateral plantar nerve innervates the ___ ___ ___ muscle. When entrapment of this nerve occurs, nonsurgical treatment should be attempted for at least ___ months.

Back 173

The first branch of the lateral plantar nerve innervates the abductor digiti quinti muscle. When entrapment of this nerve occurs, nonsurgical treatment should be attempted for at least 6 months.

Front 174

120. Tumors and Infections of the Foot and Ankle

Back 174

120. Tumors and Infections of the Foot and Ankle

Front 175

Plantar Fibromatosis (Ledderhose Disease)

Back 175

Plantar Fibromatosis (Ledderhose Disease)

Front 176

Plantar fibromatosis (Ledderhose disease) is a nodular fibrous proliferation associated with the ___ ___.

Back 176

Plantar fibromatosis (Ledderhose disease) is a nodular fibrous proliferation associated with the plantar aponeurosis.

Front 177

Plantar fibromatosis must be histologically differentiated from ___.

Back 177

Plantar fibromatosis must be histologically differentiated from fibrosarcoma.

Front 178

In most cases, simple observation is sufficient treatment for plantar fibromatosis. Excision is associated with a ______ local recurrence rate, and it is ______ indicated or performed.

Back 178

In most cases, simple observation is sufficient treatment for plantar fibromatosis. Excision is associated with a high local recurrence rate, and it is rarely indicated or performed.

Front 179

Giant Cell Tumor of the Tendon Sheath

Back 179

Giant Cell Tumor of the Tendon Sheath

Front 180

A giant cell tumor of the tendon sheath is a benign proliferation that arises from the ______ of a tendon sheath. Such tumors are commonly found in the hand but also occur in the foot.

Back 180

A giant cell tumor of the tendon sheath is a benign proliferation that arises from the synovium of a tendon sheath. Such tumors are commonly found in the hand but also occur in the foot.

Front 181

Subungual Exostosis

Back 181

Subungual Exostosis

Front 182

Subungual exostoses are generally found on the dorsal or medial aspect of the ___ toe and occasionally on the lesser toes, often after trauma or infection.

Back 182

Subungual exostoses are generally found on the dorsal or medial aspect of the great toe and occasionally on the lesser toes, often after trauma or infection.

Front 183

Treatment is primarily surgical. It involves ______ of the exostosis, often with complete ______ of the ___.

Back 183

Treatment is primarily surgical. It involves excision of the exostosis, often with complete excision of the nail.

Front 184

Ganglion

Back 184

Ganglion

Front 185

A ganglion is a cystic mass that is often associated with a ___, ___, or ___.

Back 185

A ganglion is a cystic mass that is often associated with a tendon, bursa, or joint.

Front 186

If a ganglion causes mechanical pain or nerve compression, aspiration can be attempted. If symptoms persist, ___ ___ is performed.

Back 186

If a ganglion causes mechanical pain or nerve compression, aspiration can be attempted. If symptoms persist, surgical excision is performed.

Front 187

Excision must include the ___ of the ganglion to keep recurrence to a minimum.

Back 187

Excision must include the stalk of the ganglion to keep recurrence to a minimum.

Front 188

Melanoma

Back 188

Melanoma

Front 189

Melanoma is a cutaneous malignancy that is characterized by an uncontrolled proliferation of ___. It is the ___ common malignant tumor of the foot.

Back 189

Melanoma is a cutaneous malignancy that is characterized by an uncontrolled proliferation of melanocytes. It is the most common malignant tumor of the foot.

Front 190

All subungual lesions that are growing or have not resolved after ___ to ___ weeks should undergo biopsy along with removal of the nail. The risk of death increases with each millimeter of increasing depth and with ulceration of the lesion.

Back 190

All subungual lesions that are growing or have not resolved after 4 to 6 weeks should undergo biopsy along with removal of the nail. The risk of death increases with each millimeter of increasing depth and with ulceration of the lesion.

Front 191

The standard treatment for melanoma is ___ ___.

Back 191

The standard treatment for melanoma is surgical excision.

Front 192

Synovial Sarcoma

Back 192

Synovial Sarcoma

Front 193

Synovial sarcoma is a malignant soft-tissue tumor that often affects the lower extremities. Most commonly, it affects the ___ and ___ regions, followed by the foot and lower leg/ankle regions.

Back 193

Synovial sarcoma is a malignant soft-tissue tumor that often affects the lower extremities. Most commonly, it affects the thigh and knee regions, followed by the foot and lower leg/ankle regions.

Front 194

Plain radiographs are useful in the evaluation of synovial sarcoma because calcifications are noted within the mass approximately ___% to ___% of the time.

Back 194

Plain radiographs are useful in the evaluation of synovial sarcoma because calcifications are noted within the mass approximately 15% to 20% of the time.

Front 195

Although synovial sarcomas may be in close proximity to a joint, they are rarely ___-___.

Back 195

Although synovial sarcomas may be in close proximity to a joint, they are rarely intra-articular.

Front 196

Foot Infections in the Nondiabetic Patient

Back 196

Foot Infections in the Nondiabetic Patient

Front 197

___ ___ and ___ ___ are the most common causes of cellulitis in the nonimmunocompromised host.

Back 197

Staphylococcus aureus and β-hemolytic streptococci are the most common causes of cellulitis in the nonimmunocompromised host.

Front 198

Predisposing factors for cellulitis include trauma or breaks in the skin, but ___ and ___ dissemination can also be contributing factors.

Back 198

Predisposing factors for cellulitis include trauma or breaks in the skin, but hematogenous and lymphatic dissemination can also be contributing factors.

Front 199

Unless severe systemic involvement exists, the WBC count is usually ___ or ___ elevated.

Back 199

Unless severe systemic involvement exists, the WBC count is usually normal or mildly elevated.

Front 200

Treatment for cellulitis is primarily nonsurgical. Community-acquired infections that result in cellulitis are usually responsive to oral ___ , ___, or ___.

Back 200

Treatment for cellulitis is primarily nonsurgical. Community-acquired infections that result in cellulitis are usually responsive to oral cephalosporin, clindamycin, or ciprofloxacin.

Front 201

Abscesses of the foot and ankle can be classified as ___, ___ ___, or ___-___ infection.

Back 201

Abscesses of the foot and ankle can be classified as felon, necrotizing fasciitis, or deep-space infection.

Front 202

Osteomyelitis is an acute or chronic bone infection that is either secondary to an infection in a contiguous area or the result of ___ spread of infection from a distal site.

Back 202

Osteomyelitis is an acute or chronic bone infection that is either secondary to an infection in a contiguous area or the result of hematogenous spread of infection from a distal site.

Front 203

Radiographic signs often do not develop for ___ to ___ days after the onset of acute osteomyelitis.

Back 203

Radiographic signs often do not develop for 7 to 10 days after the onset of acute osteomyelitis.

Front 204

121. The Diabetic Foot and Ankle

Back 204

121. The Diabetic Foot and Ankle

Front 205

Diabetic Peripheral Neuropathy

Back 205

Diabetic Peripheral Neuropathy

Front 206

___ percent of all patients with diabetes have some form of sensory, motor, or autonomic dysfunction at the time the diabetes is diagnosed; neuropathy develops in ___% of these patients within ___ years of diagnosis.

Back 206

Ten percent of all patients with diabetes have some form of sensory, motor, or autonomic dysfunction at the time the diabetes is diagnosed; neuropathy develops in 50% of these patients within 25 years of diagnosis.

Front 207

Sensory neuropathy is the most obvious and prevalent nerve dysfunction seen in patients with diabetes, affecting as many as ___% of these patients.

Back 207

Sensory neuropathy is the most obvious and prevalent nerve dysfunction seen in patients with diabetes, affecting as many as 70% of these patients.

Front 208

Motor neuropathy is clinically evident in the foot by the development of ___ toes. ___ toes result from intrinsic muscle weakness and equinus contracture of the Achilles tendon.

Back 208

Motor neuropathy is clinically evident in the foot by the development of claw toes. Claw toes result from intrinsic muscle weakness and equinus contracture of the Achilles tendon.

Front 209

Treatment of peripheral neuropathy usually focuses on the symptoms (pain and burning). ___, ___, and topical ___ medications all have been shown to relieve pain to a variable degree.

Back 209

Treatment of peripheral neuropathy usually focuses on the symptoms (pain and burning). Gabapentin, antidepressants, and topical anesthetic medications all have been shown to relieve pain to a variable degree.

Front 210

Ulcerations

Back 210

Ulcerations

Front 211

An estimated ___% of patients with diabetes have foot ulcers.

Back 211

An estimated 12% of patients with diabetes have foot ulcers.

Front 212

Foot ulcers are responsible for approximately ___% of lower extremity amputations in patients with diabetes.

Back 212

Foot ulcers are responsible for approximately 85% of lower extremity amputations in patients with diabetes.

Front 213

The accepted wound-healing levels for diabetes-related ulcerations of the foot and ankle are a serum albumin level of ___ g/dL and a total lymphocyte count >___/mm3.

Back 213

The accepted wound-healing levels for diabetes-related ulcerations of the foot and ankle are a serum albumin level of 3.0 g/dL and a total lymphocyte count >1500/mm3.

Front 214

An ABI ≥___ and toe pressures >___ mm Hg are necessary to heal a diabetes-related ulcer of the foot.

Back 214

An ABI ≥0.45 and toe pressures >40 mm Hg are necessary to heal a diabetes-related ulcer of the foot.

Front 215

___ is the gold standard nonsurgical treatment for off-loading of plantar ulcerations. It permits an even distribution of pressure across the plantar surface of the foot.

Back 215

TCC is the gold standard nonsurgical treatment for off-loading of plantar ulcerations. It permits an even distribution of pressure across the plantar surface of the foot.

Front 216

Before initiating antibiotic treatment for diabetes-related ulcerations, obtain wound culture specimens by ___, ulcer ___, or ___ (rather than by wound swab) to confirm or rule out the presence of osteomyelitis.

Back 216

Before initiating antibiotic treatment for diabetes-related ulcerations, obtain wound culture specimens by biopsy, ulcer curettage, or aspiration (rather than by wound swab) to confirm or rule out the presence of osteomyelitis.

Front 217

Amputation

Back 217

Amputation

Front 218

More than ___ diabetes-related amputations are performed in the United States each year.

Back 218

More than 80,000 diabetes-related amputations are performed in the United States each year.

Front 219

Approximately ___% of patients who have undergone diabetes-related amputation of a lower extremity will lose the contralateral limb within 3 years of the first amputation.

Back 219

Approximately 30% of patients who have undergone diabetes-related amputation of a lower extremity will lose the contralateral limb within 3 years of the first amputation.

Front 220

The American Diabetes Association reports that multidisciplinary foot-care programs, along with comprehensive patient education, can reduce diabetes-related lower extremity amputation rates as much as ___% to ___%.

Back 220

The American Diabetes Association reports that multidisciplinary foot-care programs, along with comprehensive patient education, can reduce diabetes-related lower extremity amputation rates as much as 45% to 60%.

Front 221

In general, forefoot stability is preserved if no more than ___ rays are resected.

Back 221

In general, forefoot stability is preserved if no more than two rays are resected.

Front 222

Achilles tendon lengthening is likely to be necessary for patients undergoing ___ amputations.

Back 222

Achilles tendon lengthening is likely to be necessary for patients undergoing transmetatarsal amputations.

Front 223

Syme amputation is advantageous because there is potential for achieving a ___-___–___ residual limb that is nearly normal in length.

Back 223

Syme amputation is advantageous because there is potential for achieving a full-load–bearing residual limb that is nearly normal in length.

Front 224

Charcot Arthropathy

Back 224

Charcot Arthropathy

Front 225

Up to ___% of patients with diabetes and neuropathy have Charcot arthropathy of the foot and ankle, and ___% to ___% of those have bilateral involvement.

Back 225

Up to 7.5% of patients with diabetes and neuropathy have Charcot arthropathy of the foot and ankle, and 9% to 35% of those have bilateral involvement.

Front 226

Early Charcot arthropathy is often confused with ___, despite the lack of a significantly elevated white blood cell count or fever.

Back 226

Early Charcot arthropathy is often confused with infection, despite the lack of a significantly elevated white blood cell count or fever.

Front 227

___ is the gold standard nonsurgical treatment for Charcot arthropathy of the foot. It permits an even distribution of pressure across the plantar surface of the foot.

Back 227

TCC is the gold standard nonsurgical treatment for Charcot arthropathy of the foot. It permits an even distribution of pressure across the plantar surface of the foot.

Front 228

Surgical indications for Charcot arthropathy of the foot include recurrent ulcers and ___ not controlled by a brace. Surgical options are ___ or reconstruction with ___ and ___.

Back 228

Surgical indications for Charcot arthropathy of the foot include recurrent ulcers and instability not controlled by a brace. Surgical options are exostectomy or reconstruction with osteotomy and fusion.

Front 229

The anatomic ___ of the Charcot arthropathy affects its frequency, prognosis, and treatment.

Back 229

The anatomic location of the Charcot arthropathy affects its frequency, prognosis, and treatment.

Front 230

The goal of treatment for Charcot arthropathy is a ______ foot without recurrent ______.

Back 230

The goal of treatment for Charcot arthropathy is a plantigrade foot without recurrent ulceration.

Front 231

122. Neurologic Disorders of the Foot and Ankle

Back 231

122. Neurologic Disorders of the Foot and Ankle

Front 232

Interdigital Neuroma

Back 232

Interdigital Neuroma

Front 233

Interdigital neuromas are not true neuromas, but rather compressed nerves with ______ ______.

Back 233

Interdigital neuromas are not true neuromas, but rather compressed nerves with perineural fibrosis.

Front 234

The most common location is the ___ web space (between the ___ and ___ toes). Neuromas in the first and fourth web spaces are rare, and an alternative diagnosis should be sought (eg, ___ instability).

Back 234

The most common location is the third web space (between the third and fourth toes). Neuromas in the first and fourth web spaces are rare, and an alternative diagnosis should be sought (eg, MTPJ instability).

Front 235

Pain is typically relieved when not ___ ___ and is exacerbated by ___ ___.

Back 235

Pain is typically relieved when not wearing shoes and is exacerbated by shoe wear.

Front 236

Injections of local anesthesia and corticosteroid can be diagnostic and therapeutic; however, iatrogenic instability of the MTPJ can occur with ___ injections.

Back 236

Injections of local anesthesia and corticosteroid can be diagnostic and therapeutic; however, iatrogenic instability of the MTPJ can occur with repeat injections.

Front 237

______ incisions are recommended for primary neuromas; ______ incisions are recommended for recurrent neuromas.

Back 237

Dorsal incisions are recommended for primary neuromas; plantar incisions are recommended for recurrent neuromas.

Front 238

Tarsal Tunnel Syndrome

Back 238

Tarsal Tunnel Syndrome

Front 239

___ is the most common compressive neuropathy of the foot and ankle.

Back 239

TTS is the most common compressive neuropathy of the foot and ankle.

Front 240

The contents of the tarsal tunnel include the ___, ___, ___ ___ vein and artery, ___ nerve, and the ___.

Back 240

The contents of the tarsal tunnel include the PTT, FDL, posterior tibial vein and artery, tibial nerve, and the FHL.

Front 241

The three terminal branches of the tibial nerve are the ___ ___ nerve, ___ ___ nerve, and ___ ___ nerve.

Back 241

The three terminal branches of the tibial nerve are the medial calcaneal nerve, medial plantar nerve, and lateral plantar nerve.

Front 242

TTS may result from soft-tissue or osseous trauma, space-occupying masses, ___ malalignment, or ___.

Back 242

TTS may result from soft-tissue or osseous trauma, space-occupying masses, biomechanical malalignment, or tenosynovitis.

Front 243

The most reproducible objective finding is a positive nerve percussion sign (___ sign).

Back 243

The most reproducible objective finding is a positive nerve percussion sign (Tinel sign).

Front 244

Electrodiagnostic studies are ___% to ___% accurate in diagnosing TTS.

Back 244

Electrodiagnostic studies are 80% to 90% accurate in diagnosing TTS.

Front 245

Nonsurgical treatment includes medications,___ use of injections, immobilization in a ___ or ___, control of ___ and ___ congestion with support stockings, and orthoses if clinically indicated.

Back 245

Nonsurgical treatment includes medications, judicious use of injections, immobilization in a boot or cast, control of edema and venous congestion with support stockings, and orthoses if clinically indicated.

Front 246

Surgical release should include identification and ___ of all three terminal branches.

Back 246

Surgical release should include identification and neurolysis of all three terminal branches.

Front 247

If associated heel pain is present, decompression of the first branch of the ___ ___ nerve is recommended.

Back 247

If associated heel pain is present, decompression of the first branch of the lateral plantar nerve is recommended.

Front 248

The best results of surgery occur in those patients with space-occupying masses and a positive ___ sign.

Back 248

The best results of surgery occur in those patients with space-occupying masses and a positive Tinel sign.

Front 249

Charcot-Marie-Tooth Disease (Cavovarus Foot)

Back 249

Charcot-Marie-Tooth Disease (Cavovarus Foot)

Front 250

___% of patients with Charcot-Marie-Tooth disease have a foot deformity, typically ___.

Back 250

94% of patients with Charcot-Marie-Tooth disease have a foot deformity, typically cavovarus.

Front 251

The first muscles that are involved are the ___ ___ of the foot.

Back 251

The first muscles that are involved are the intrinsic muscles of the foot.

Front 252

Weakness of the ___ ___ muscle results in plantar flexion of the first ray because of overpull of the intact peroneus longus (forefoot valgus).

Back 252

Weakness of the tibialis anterior muscle results in plantar flexion of the first ray because of overpull of the intact peroneus longus (forefoot valgus).

Front 253

Flexible hindfoot varus occurs initially as a result of compensation for the ___ ___.

Back 253

Flexible hindfoot varus occurs initially as a result of compensation for the forefoot valgus.

Front 254

Further hindfoot varus occurs because the intact ___ ___ muscle is not balanced by the weakened peroneus brevis.

Back 254

Further hindfoot varus occurs because the intact tibialis posterior muscle is not balanced by the weakened peroneus brevis.

Front 255

The Coleman block test is used to determine whether the hindfoot varus is correctable with elimination of the ___ ___ ray.

Back 255

The Coleman block test is used to determine whether the hindfoot varus is correctable with elimination of the plantar flexed ray.

Front 256

Unilateral progressive cavovarus deformities may indicate ___ ___ pathology, and careful neurologic examination should be undertaken.

Back 256

Unilateral progressive cavovarus deformities may indicate spinal cord pathology, and careful neurologic examination should be undertaken.

Front 257

Flexible deformities can be treated with soft-tissue releases and transfers, as well as ______ of the hindfoot and midfoot.

Back 257

Flexible deformities can be treated with soft-tissue releases and transfers, as well as osteotomies of the hindfoot and midfoot.

Front 258

Rigid hindfoot deformities require ______ ______.

Back 258

Rigid hindfoot deformities require triple arthrodesis.

Front 259

The Jones procedure is recommended for the ___ ___.

Back 259

The Jones procedure is recommended for the clawed hallux.

Front 260

Nerve Entrapment

Back 260

Nerve Entrapment

Front 261

Five nerves provide sensation to the foot and ankle: ___, ___ peroneal, ___ peroneal, ___, and ___.

Back 261

Five nerves provide sensation to the foot and ankle: tibial, deep peroneal, superficial peroneal, saphenous, and sural.

Front 262

Compression of the deep peroneal nerve under the inferior extensor retinaculum is known as ___ ___.

Back 262

Compression of the deep peroneal nerve under the inferior extensor retinaculum is known as anterior TTS.

Front 263

The superficial peroneal nerve typically exits the crural fascia ___ cm proximal to the fibular tip, and caution should be exercised in plating of fibula fractures at this level.

Back 263

The superficial peroneal nerve typically exits the crural fascia 10 cm proximal to the fibular tip, and caution should be exercised in plating of fibula fractures at this level.

Front 264

Branches of the superficial peroneal nerve can be injured with placement of the ______ arthroscopic portal.

Back 264

Branches of the superficial peroneal nerve can be injured with placement of the anterolateral arthroscopic portal.

Front 265

Sural nerve injury and entrapment can occur after open reduction and internal fixation of ___ fractures and ___ ___ base fractures.

Back 265

Sural nerve injury and entrapment can occur after open reduction and internal fixation of calcaneal fractures and fifth metatarsal base fractures.

Front 266

Saphenous nerve entrapment is rare at the ankle and most commonly occurs about the ___ ___.

Back 266

Saphenous nerve entrapment is rare at the ankle and most commonly occurs about the medial knee.

Front 267

Electrodiagnostic studies may be ___, and the diagnosis is usually made on clinical grounds.

Back 267

Electrodiagnostic studies may be normal, and the diagnosis is usually made on clinical grounds.

Front 268

The most reliable objective finding is a positive nerve percussion test (___ sign).

Back 268

The most reliable objective finding is a positive nerve percussion test (Tinel sign).

Front 269

Motor examination is usually ___ and deep tendon reflexes are ___.

Back 269

Motor examination is usually normal and deep tendon reflexes are preserved.

Front 270

The differential diagnosis always should consider more ___ ___ compression, such as lumbosacral radiculopathy.

Back 270

The differential diagnosis always should consider more proximal nerve compression, such as lumbosacral radiculopathy.

Front 271

Cerebrovascular Accident and Traumatic Brain Injury

Back 271

Cerebrovascular Accident and Traumatic Brain Injury

Front 272

Deformities of the foot and ankle from CVA result from injury to the ___ ___ neurons.

Back 272

Deformities of the foot and ankle from CVA result from injury to the upper motor neurons.

Front 273

Upper motor neuron involvement results in ___ and ___.

Back 273

Upper motor neuron involvement results in spasticity and hyperreflexia.

Front 274

Neurologic recovery after a CVA takes ___ to ___ months; recovery after TBI may take ___ years.

Back 274

Neurologic recovery after a CVA takes 6 to 18 months; recovery after TBI may take several years.

Front 275

The most common foot and ankle deformity is spastic ___.

Back 275

The most common foot and ankle deformity is spastic equinovarus.

Front 276

Deformity may be a result of ___, ___ ___, or both.

Back 276

Deformity may be a result of spasticity, joint contracture, or both.

Front 277

Prevention of contractures during the acute recovery process is achieved by daily ___ and by ___.

Back 277

Prevention of contractures during the acute recovery process is achieved by daily stretching and by splinting.

Front 278

Phenol nerve blocks and botulinum toxin injections are useful; however, their effects are not permanent. The use of these during the recovery phase may reduce ___ while the neurologic recovery occurs.

Back 278

Phenol nerve blocks and botulinum toxin injections are useful; however, their effects are not permanent. The use of these during the recovery phase may reduce deformity while the neurologic recovery occurs.

Front 279

Equinus deformity is treated with lengthening of the ___ tendon, ___ recession, and ___ capsulotomy if necessary.

Back 279

Equinus deformity is treated with lengthening of the Achilles tendon, gastrocnemius recession, and posterior capsulotomy if necessary.

Front 280

The varus deformity is caused by overpull of the ___ ___ and/or ___ ___ muscle. Electromyography can distinguish which muscles are responsible.

Back 280

The varus deformity is caused by overpull of the tibialis anterior and/or tibialis posterior muscle. Electromyography can distinguish which muscles are responsible.

Front 281

___ ___ ___ tendon transfer is useful for a continuously active tibialis anterior muscle.

Back 281

Split anterior tibial tendon transfer is useful for a continuously active tibialis anterior muscle.