Mrc - Foot And Ankle

Front 1

In what type of bunion are orthotics useful?

Back 1

Bunion with a flat-foot

Front 2

Normal Intermetatarsal angle

Back 2

9 or less degrees

Front 3

Normal Hallux Valgus angle

Back 3

Less than 15 degrees

Front 4

Normal Distal metatarsal articular angle

Back 4

Less than 15 degrees; angle between articular surface and line perpendicular to shaft

Front 5

Distal metatarsal articular angle in congruent bunions are > or < 15 degrees?

Back 5

Typically >15 degrees

Front 6

Congruent bunion with high distal metatarsal articular angle osteotomy?

Back 6

biplanar Chevron

Front 7

Aitken osteotomy for what

Back 7

Hallux valgus interphalangeus

Front 8

Osteotomy for large inter-metatarsal angle (>15 deg)

Back 8

Proximal osteotomy

Front 9

Hypermobile first MT-cuneiform joint and bunion

Back 9

Do first MT-cuneiform joint arthrodesis (called Lapidus)

Front 10

What is Lapidus procedure

Back 10

Fusion first MT-cuneiform joint

Front 11

Degenerative bunion treatment

Back 11

fusion MTP joint- no implant arthroplasty or Keller resection arthroplasty; position in 15-20 degrees extension

Front 12

Keller resection arthroplasty problem

Back 12

transfer metatarsalgia; cock up deformity;

Front 13

Low intermetatarsal angle and high hallux valgus angle- procedure to do?

Back 13

Distal (Chevron plus lateral release)

Front 14

If patient has hallux varus complication- what to do surgically?

Back 14

tendon transfer to lateral ligamentous area.

Front 15

Hallux rigidus: treatment

Back 15

mild arthritis w/ preserved joint space = non-operative (Morton’s splint); osteophytes and mild joint space narrowing = cheilectomy; osteophytes with severe joint space narrowing = MTP fusion

Front 16

How much cheilectomy can be performed in hallux rigidus?

Back 16

up to 30% of articular surface

Front 17

Describe Hammertoe

Back 17

Extension MTP, Flexion PIP, Extension DIP

Front 18

Describe clawtoe

Back 18

Extension MTP, Flexion PIP, Flexion DIP

Front 19

Describe Mallet toe

Back 19

Flexion DIP (no problem with MTP or PIP)

Front 20

Weil osteotomy

Back 20

2nd metatarsal shortening osteotomy; Index minus forefoot (second metatarsal too long so get transfer metatarsalgia);

Front 21

Diagnosis of sesamoid disorders

Back 21

MRI; bone scan non-specific

Front 22

Treatment of fracture of sesamoid

Back 22

cast 6 weeks NWB; these are at high risk of nonunion.

Front 23

Complication of lateral sesamoidectomy

Back 23

Hallux Varus (avoid with repair of flexor hallucis brevis); also lateral plantar nerve is at risk

Front 24

Morton’s neuroma

Back 24

between 2nd and 3rd metatarsals “patient feels like they’re walking on marble”

Front 25

Recurrent resection Morton’s Neuroma

Back 25

Long plantar inter-metatarsal approach proximal of MT heads

Front 26

Issue with proximal osteotomy 5th MT for bunionette?

Back 26

High risk of non-union; if high inter-metatarsal angle, do mid-shaft osteotomy

Front 27

What kind of screw for Jones fracture?

Back 27

SOLID (non-canulated), biggest you can fit down 5th MT canal

Front 28

Indications for ORIF Jones Fx

Back 28

cavus foot; re-fracture; non-union; high level athlete

Front 29

Where are strongest ligaments in midfoot

Back 29

Plantar: Transverse, oblique, and longitudinal (Strongest is 2nd oblique ligament)

Front 30

Where is LisFranc ligament?

Back 30

plantar from medial cuneiform to 2nd MT base

Front 31

Midfoot arthritis orthotic

Back 31

soft ‘plastizote’ insert that can accomodate their rigid deformity; sole of shoe may be stiff

Front 32

Accessory Navicular

Back 32

usually shoe irritation issues; Type 1-3 based on size and symptomatology; get external oblique x-ray; Tx: modified shoe; excise and advance tib post if refractory

Front 33

Navicular stress fracture

Back 33

central 1/3 is vascular watershed; Tx: either NWB w/ cast if undisplaced or cannulated screws

Front 34

Appropriate placement of screws for navicular stress fracture

Back 34

place screws dorso-lateral to plantar-medial, two 4.0 mm cannulated screws

Front 35

Exam test for adolescent with painful flatfoot

Back 35

assess for stability by toe raise- if foot doesn’t correct into varus, suspect coalition

Front 36

Best x-ray for seeing medial facet talo-calcaneal coalition?

Back 36

Harris axial view

Front 37

Treatment tarsal coalition

Back 37

Symptomatic and < 14 years: resection and interposition grafting and wax; if older patient and >50% total articular surface area, then fuse

Front 38

Tarsal tunnel syndrome

Back 38

Entrapment of posterior tibial nerve; borders: medial maleolus, sustentaculum tali; covered by flexor retinaculum in this area; burning behind medial mal; + tinel’s sign

Front 39

Adult acquired flatfoot

Back 39

posterior tendon insufficiency and failure of Spring Ligament (joins calcaneus to navicular (sling holding up talus)

Front 40

Importance of spring ligament

Back 40

Even with insufficient tin post tendon, no flatfoot until spring ligament stretches out (sling under talus; runs from calcaneus to navicular)

Front 41

Orthotic for flexible flatfoot

Back 41

early: medial heel and sole wedge; late: UCBL which cups the heel and brings heel out of valgus

Front 42

Stage II tib post insufficiency

Back 42

flexible flat-foot; cannot do single-leg heel rise; Tx: tendon and bony work = FDL to tin post transfer and medial displacement calcaneal osteotomy (if medial pain only) Add lateral column lengthening if lateral pain

Front 43

Stage III tib post insufficiency

Back 43

rigid flatfoot not passively correctible; requiring triple arthrodesis

Front 44

State I tib post insufficiency

Back 44

tendonitis; Tx: physical therapy; tenosynovectomy only if no deformity

Front 45

Tib post insufficiency and heel-cord tightness

Back 45

most of tib post patients have gastrocnemius tightness and corrective surgeries should be combined with Strayer Gastroc recession

Front 46

Cavus foot: deformity

Back 46

Varus hindfoot, varus midfoot, pronated forefoot

Front 47

Coleman block test

Back 47

in cavo-varus foot; trying to determine if varus hindfoot is due to plantar-flexed first ray; unload plantarflexed 1st MT and see if varus deformity corrects; if this is true, you have “forefoot driven cavus deformity”

Front 48

Treatment for “forefoot driven cavus deformity”:

Back 48

first metatarsal extension osteotomy with plantar fascial release; This is for correctable hindfoot on coleman block test; also can transfer peroneus longus to brevis to decrease flexion force on 1st metatarsal

Front 49

If no correction of hindfoot varus on coleman block test?

Back 49

must combine extension osteotomy 1st metatarsal with valgus osteotomy of calcaneus

Front 50

Plantar Fasciitis

Back 50

non-op treatment; Night splints 1st line of treatment; Operative Tx: release 1/4 of medial slip of plantar fascia; more creates flatfoot

Front 51

Physical exam for calcaneal stress fracture:

Back 51

Heel squeeze from medial and lateral; this diagnosis is in dDx of plantar fasciitis

Front 52

Achilles tendon watershed area

Back 52

2-6mm proximal of calcaneal insertion; prone to degenerative tendinopathy and secondary rupture

Front 53

Techniques to fill void if segmental loss achilles

Back 53

FHL (required if you debride more than 50% breadth achilles); V-Y advancement; gastroc turndown

Front 54

Talus OCD: Tx

Back 54

drill first; OATS only if drilling fails

Front 55

Ankle arthrodesis position

Back 55

5-10 degrees ER; 0-5 deg dorsiflexion; 5-10 deg valgus

Front 56

Semmes-Weinstein monofilament size & importance

Back 56

5.07; protective sensation

Front 57

Diabetic ulcers of which part of the foot have the worst prognosis?

Back 57

heel- most difficult to heal

Front 58

Treatment of non-infected recalcitrant ulcer

Back 58

total contact cast

Front 59

Achilles lengthening and forefoot ulcer

Back 59

if patient often develops forefoot ulcers, heel cord lengthening can help by taking pressure off forefoot

Front 60

Length of immobilization for diabetics with ankle fracture?

Back 60

2-3 x normal (12+ months)

Front 61

When does braking reaction time return after ORIF ankle fracture?

Back 61

9 weeks

Front 62

In what type of bunion are orthotics useful?

Back 62

Bunion with a flat-foot

Front 63

Normal Intermetatarsal angle

Back 63

9 or less degrees

Front 64

Normal Hallux Valgus angle

Back 64

Less than 15 degrees

Front 65

Normal Distal metatarsal articular angle

Back 65

Less than 15 degrees; angle between articular surface and line perpendicular to shaft

Front 66

Distal metatarsal articular angle in congruent bunions are > or < 15 degrees?

Back 66

Typically >15 degrees

Front 67

Congruent bunion with high distal metatarsal articular angle osteotomy?

Back 67

biplanar Chevron

Front 68

Aitken osteotomy for what

Back 68

Hallux valgus interphalangeus

Front 69

Osteotomy for large inter-metatarsal angle (>15 deg)

Back 69

Proximal osteotomy

Front 70

Hypermobile first MT-cuneiform joint and bunion

Back 70

Do first MT-cuneiform joint arthrodesis (called Lapidus)

Front 71

What is Lapidus procedure

Back 71

Fusion first MT-cuneiform joint

Front 72

Degenerative bunion treatment

Back 72

fusion MTP joint- no implant arthroplasty or Keller resection arthroplasty; position in 15-20 degrees extension

Front 73

Keller resection arthroplasty problem

Back 73

transfer metatarsalgia; cock up deformity;

Front 74

Low intermetatarsal angle and high hallux valgus angle- procedure to do?

Back 74

Distal (Chevron plus lateral release)

Front 75

If patient has hallux varus complication- what to do surgically?

Back 75

tendon transfer to lateral ligamentous area.

Front 76

Hallux rigidus: treatment

Back 76

mild arthritis w/ preserved joint space = non-operative (Morton’s splint); osteophytes and mild joint space narrowing = cheilectomy; osteophytes with severe joint space narrowing = MTP fusion

Front 77

How much cheilectomy can be performed in hallux rigidus?

Back 77

up to 30% of articular surface

Front 78

Describe Hammertoe

Back 78

Extension MTP, Flexion PIP, Extension DIP

Front 79

Describe clawtoe

Back 79

Extension MTP, Flexion PIP, Flexion DIP

Front 80

Describe Mallet toe

Back 80

Flexion DIP (no problem with MTP or PIP)

Front 81

Weil osteotomy

Back 81

2nd metatarsal shortening osteotomy; Index minus forefoot (second metatarsal too long so get transfer metatarsalgia);

Front 82

Diagnosis of sesamoid disorders

Back 82

MRI; bone scan non-specific

Front 83

Treatment of fracture of sesamoid

Back 83

cast 6 weeks NWB; these are at high risk of nonunion.

Front 84

Complication of lateral sesamoidectomy

Back 84

Hallux Varus (avoid with repair of flexor hallucis brevis); also lateral plantar nerve is at risk

Front 85

Morton’s neuroma

Back 85

between 2nd and 3rd metatarsals “patient feels like they’re walking on marble”

Front 86

Recurrent resection Morton’s Neuroma

Back 86

Long plantar inter-metatarsal approach proximal of MT heads

Front 87

Issue with proximal osteotomy 5th MT for bunionette?

Back 87

High risk of non-union; if high inter-metatarsal angle, do mid-shaft osteotomy

Front 88

What kind of screw for Jones fracture?

Back 88

SOLID (non-canulated), biggest you can fit down 5th MT canal

Front 89

Indications for ORIF Jones Fx

Back 89

cavus foot; re-fracture; non-union; high level athlete

Front 90

Where are strongest ligaments in midfoot

Back 90

Plantar: Transverse, oblique, and longitudinal (Strongest is 2nd oblique ligament)

Front 91

Where is LisFranc ligament?

Back 91

plantar from medial cuneiform to 2nd MT base

Front 92

Midfoot arthritis orthotic

Back 92

soft ‘plastizote’ insert that can accomodate their rigid deformity; sole of shoe may be stiff

Front 93

Accessory Navicular

Back 93

usually shoe irritation issues; Type 1-3 based on size and symptomatology; get external oblique x-ray; Tx: modified shoe; excise and advance tib post if refractory

Front 94

Navicular stress fracture

Back 94

central 1/3 is vascular watershed; Tx: either NWB w/ cast if undisplaced or cannulated screws

Front 95

Appropriate placement of screws for navicular stress fracture

Back 95

place screws dorso-lateral to plantar-medial, two 4.0 mm cannulated screws

Front 96

Exam test for adolescent with painful flatfoot

Back 96

assess for stability by toe raise- if foot doesn’t correct into varus, suspect coalition

Front 97

Best x-ray for seeing medial facet talo-calcaneal coalition?

Back 97

Harris axial view

Front 98

Treatment tarsal coalition

Back 98

Symptomatic and < 14 years: resection and interposition grafting and wax; if older patient and >50% total articular surface area, then fuse

Front 99

Tarsal tunnel syndrome

Back 99

Entrapment of posterior tibial nerve; borders: medial maleolus, sustentaculum tali; covered by flexor retinaculum in this area; burning behind medial mal; + tinel’s sign

Front 100

Adult acquired flatfoot

Back 100

posterior tendon insufficiency and failure of Spring Ligament (joins calcaneus to navicular (sling holding up talus)

Front 101

Importance of spring ligament

Back 101

Even with insufficient tin post tendon, no flatfoot until spring ligament stretches out (sling under talus; runs from calcaneus to navicular)

Front 102

Orthotic for flexible flatfoot

Back 102

early: medial heel and sole wedge; late: UCBL which cups the heel and brings heel out of valgus

Front 103

Stage II tib post insufficiency

Back 103

flexible flat-foot; cannot do single-leg heel rise; Tx: tendon and bony work = FDL to tin post transfer and medial displacement calcaneal osteotomy (if medial pain only) Add lateral column lengthening if lateral pain

Front 104

Stage III tib post insufficiency

Back 104

rigid flatfoot not passively correctible; requiring triple arthrodesis

Front 105

State I tib post insufficiency

Back 105

tendonitis; Tx: physical therapy; tenosynovectomy only if no deformity

Front 106

Tib post insufficiency and heel-cord tightness

Back 106

most of tib post patients have gastrocnemius tightness and corrective surgeries should be combined with Strayer Gastroc recession

Front 107

Cavus foot: deformity

Back 107

Varus hindfoot, varus midfoot, pronated forefoot

Front 108

Coleman block test

Back 108

in cavo-varus foot; trying to determine if varus hindfoot is due to plantar-flexed first ray; unload plantarflexed 1st MT and see if varus deformity corrects; if this is true, you have “forefoot driven cavus deformity”

Front 109

Treatment for “forefoot driven cavus deformity”:

Back 109

first metatarsal extension osteotomy with plantar fascial release; This is for correctable hindfoot on coleman block test; also can transfer peroneus longus to brevis to decrease flexion force on 1st metatarsal

Front 110

If no correction of hindfoot varus on coleman block test?

Back 110

must combine extension osteotomy 1st metatarsal with valgus osteotomy of calcaneus

Front 111

Plantar Fasciitis

Back 111

non-op treatment; Night splints 1st line of treatment; Operative Tx: release 1/4 of medial slip of plantar fascia; more creates flatfoot

Front 112

Physical exam for calcaneal stress fracture:

Back 112

Heel squeeze from medial and lateral; this diagnosis is in dDx of plantar fasciitis

Front 113

Achilles tendon watershed area

Back 113

2-6mm proximal of calcaneal insertion; prone to degenerative tendinopathy and secondary rupture

Front 114

Techniques to fill void if segmental loss achilles

Back 114

FHL (required if you debride more than 50% breadth achilles); V-Y advancement; gastroc turndown

Front 115

Talus OCD: Tx

Back 115

drill first; OATS only if drilling fails

Front 116

Ankle arthrodesis position

Back 116

5-10 degrees ER; 0-5 deg dorsiflexion; 5-10 deg valgus

Front 117

Semmes-Weinstein monofilament size & importance

Back 117

5.07; protective sensation

Front 118

Diabetic ulcers of which part of the foot have the worst prognosis?

Back 118

heel- most difficult to heal

Front 119

Treatment of non-infected recalcitrant ulcer

Back 119

total contact cast

Front 120

Achilles lengthening and forefoot ulcer

Back 120

if patient often develops forefoot ulcers, heel cord lengthening can help by taking pressure off forefoot

Front 121

Length of immobilization for diabetics with ankle fracture?

Back 121

2-3 x normal (12+ months)

Front 122

When does braking reaction time return after ORIF ankle fracture?

Back 122

9 weeks