First Ray Surgery - 3 Etiology & Anatomy Of Hav

Front 1

What are the stepwise approach of the lateral release?

Back 1

Release DTML
Release adductor tendon
Release fibular sesamoid

Front 2

What are some common causes of HAV?

Back 2

Pronation
90% genetic correlation
Arthritis
Trauma
Neuromuscular disease
Shoe pressure

Front 3

Name some examples of neuromuscular diseases that cause bunions.

Back 3

Poliomyelitis
Cerebral vascular accidents
Charcot arthropathy
Myotonic dystrophy
Cerebral palsy
Gullain Barre
Multiple sclerosis

Front 4

What are some arthritic causes of HAV?

(any disease that causes an INFLAMMATORY rxn of the mPJ that will eventually alter the extensor and flexor tendons of the hallux)

Back 4

RA
Psoriatic arthritis
Osteoarthritis

Front 5

What are some traumatic causes of HAV?

Back 5

Hallux rigidus
limitus
removal of tibial sesamoid
crushing injury
sprain injury

Front 6

What are some genetic disorders that can result in HAV?

Back 6

Marfans
Ehler danlos
Downs syndrome
Williams syndrome
Saethre chatzen syndrome
Multiple synostosis syndrome
Fibrodysplasia ossificans progressiva

Front 7

Medially, the structures will be elongated.

Laterally, the structures will be very tight.

In normal first ray biomechanics, the first ray will plantar flex, but if the calcaneus is everting (as in pronation) -- the first ray will dorsiflex causing impaction.

What muscle is responsible of first ray plantar flexion during propulsion?

Back 7

Peroneus Longus

Front 8

What are the requirements for 1st ray PF?

(there are 4)

HINT:
H - S - S- S

Back 8

HEEL LIFT

S TJ supination

S horter 1st MT than 2nd MT

N ormal sesamoid function

Front 9

T/F
Metatarsus adductus,
metatarsus primus varus, & collapsing pes plano valgus
are all examples of abnormal biomechanical foot function that could lead to HAV.

Back 9

TRUE.

Front 10

Hallux valgus is a triplane deformity.

It occurs in 3 planes.

Hallux is rotated with dorsal or plantar deviation. What plane does this occur in

Back 10

Sagittal

Front 11

Hallux is laterally rotated towards lesser toes. What plane does this occur in?

Back 11

Transverse

Front 12

Valgus rotation of the hallux so that plantar aspect is more prominent laterally. Occurs in what plane?

Back 12

Frontal

Front 13

The biomechanics of the 1st MPJ exhibits 2 distinct axes of motions:
Vertical
&
Transverse
---------
Transverse allows what motions?

Back 13

Transverse:Pure DF & PF of the hallux

Vertical: Adduction & Abduction

remember: an axes is a line around which a plane of motion occurs. in other words, the MPJ functions like a door hinge. the door hing is located upon a vertical axes, therefore allows open & closed swinging of the door. ie: good method to explain biomech.

GOLDEN RULE; motion in joint must occur PERPENDICULAR to the axis.

Front 14

No axis of motion occurs in the frontal plane b/c if there was motion in the frontal plane of the MPJ, it would result in ______________---

Back 14

Any eversion/inversion can likely result in subluxation or jamming of the 1st MPJ

Front 15

Phases during ambulation include:
DISTRACTION
GLIDING
COMPRESSION

Distraction is:

Back 15

the 1st phase of DF that increases joint space for the next phase

Front 16

Gliding is:

Back 16

As the MT PF, and the hallux moves to increase DF and extension of the MPJ

Front 17

Compression ocurrs:

Back 17

At the end of ROM, proximal phalanx compresses against the dorsal surface of the metatarsal head allowing the rigid level to become complete.

Front 18

What is hypermobility's relationship to HAV?

Back 18

The amt determines the rate of development of HAV.

Front 19

In what planes does HAV characterized by?

Back 19

Sagittal plane, Transverse plane

Front 20

Describe what happens in STAGE 1 of HAV formation.

Back 20

Lateral subluxation of the base of the proximal phalanx of the hallux in relation to the 1st met head.

It can be seen in the AP view.

Efficiency of PL muscle to PF the 1st ray is reduced.

Front 21

In a stage 2 deformity, what occurs?

Back 21

Hallux is seen to place pressure against 2nd toe.

Hyperkeratotic lesions of the contiguous surfaces of the hallux and 2nd toe indicate large pressure force as hallux abducts.

Front 22

What does stage 4 HAV look like?

Back 22

Dislocation or major subluxation of the hallux.

Hallux frequently underrides the 2nd toe and becomes abducted.

Arthritic changes.

Front 23

What are the 3 intrinsic muscles that surround the 1st MPJ?

Back 23

EHB
ABD H
ADD H

Front 24

Concerning the sesamoids---

the Medial sesamoid in embedded in the medial head of the tendonS ______ & ___________

Back 24

ABD HALL.

FHB

Front 25

The lateral sesamoid is embedded in the lateral head of the tendons ___________& ___________

Back 25

ADD HALL

FHB

Front 26

What is trackbounding?
-

Back 26

The hallux is passively taken through DF through sagittal plane excursion.

If hallux can't be brought back to rectus position, it is considered track bound.

In other words, the lateral deviation of the hallux stays the way it appears in HAV, despite manually moving it.

Front 27

What is tracking?

Back 27

If the hallux can be moved back into a rectus position but has a tendency to deviate back laterally, this is known as TRACKING.

This occurs PRIOR to the joint being trackbound, and indicates soft tissue contractures on the hallux.

Front 28

Reverdin & Peabody both correct what angle?

Back 28

PASA

Front 29

Reverdin is performed in the ________ of the metatarsal.

Back 29

Head of the met

Front 30

Peabody is performed in the ___________ of the metarsal.

Back 30

Neck of the met