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41 Cards in this Set

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What is the position of a foot in TEV?
The ankle is in equinus and the foot is supinated (varus) and adducted.
What is the clinical/critical measurement for assessing an infant foot for TEV?
Dorsiflexion. Normal is 90 degrees. Normal infant foot usually can be dorsiflexed and everted so that the foot touches the anterior tibia.
TEV hindfoot vs forefoot position
The hindfoot is supinated but the foot is often in a position of pronation relative to the hindfoot.
What causes cavus foot in TEV?
the first ray often drops causing cavus
What is the first step of the ponsetti method? why is it scary?
First step is elevate the first metatarsal, even if it means exacerbating the supination of the foot.
In TEV what is the position of the tibia? Any different? What care should be taken in this consideration?
The tibia often has internal torsion. Rotate the FEET into abduction, not the KNEE, watch for that when casting.
What is the irregularity with the talus?
The talar neck is easily palpable in the sinus tarsi as it is uncovered laterally. Normally, this is covered by the navicular, and the talar body is in the mortise.
What is the irregularity with the medial malleolus in TEV?
MedMal is difficult to palpate and is often in contact with the navicular. The normal navicular-malleolar interval is diminished.
What happens in TEV if you forceably correct the equinus by dorsiflexion against a tight achilles tendond?
You get a spurious (looks like was corrected, but wasn"t) correction of the equinus through a break in the midfoot = rockerbottom
How many casts, how many weeks in ponsetti?
4-7 casts for maximum foot abduction.
Casts are changed weekly.
What is ponsetti's order of TEV correction?
What is included in between steps?
C-cavus
A-adduction
V-varus
E-equinus
Manipulation for 2-3 minutes and then serial weekly casting.
If needed, when will an achilotomy be performed? What are the immobilization angles after that?
What is total treatment time?
After 6 weeks.
70 degrees abducted
20 degrees dorsiflexion for 3 weeks.
Total of 2 months of treatment
met adductus is a deformity of what plane?
Deformity is relative to what?
transverse plane deformity
Mets are medially deviated in relation ot the longitudinal axis fo the lesser tarsus.
Where is the apex of the met adductus deformity?
Apex is at the Lisfranc's articulation
What is the congenital incidence of MetAdductus
1-3/1000
1/1000-1/333 (huge range)
Metatarsus adductus can be associated with what tibial position?
Can be associated with internal tibial torsion.
What shape does a met adductus foot take?
C shaped
concave medial border, convex lateral border.
Prominent sytloid process
Separation of hallux from lesser toes.
What metatarsal deformity is also seen with Met Adductus?
Increased met primus adductus.
What is the rearfoot/forefoot angle for met adductus?
greater than 25 degrees.
What are the reference points for assessing metatarsus adductus?
Lesser tarsus with 2nd Met,
Middle cuneiform with 2nd met (at 2 years old)
Infants cannot be assessed b/c aint got no bones in there!
What are metatarsus adductus angles at
Birth?
Early walker
Adult?
Birth: Anything from 15-30 is considered normal.
Early walking: 20
Walking adult: should be less than 15 degrees. 10-12 is normal.
How is most treatment for met adductus performed?
90% conservative
Describe Met Adductus manipulation and stretching (per McCrea)
Rearfoot is maintained in neutral with one hand, the other hand is used to mobilize the metatarsals laterally on the transverse plane.
This position is then held for a period of about 15 - 20 seconds, then released. This should be continued for about 10 to 15 minutes.
What is the splint used in Met adductus?
Wheaton Splint
What is the age for soft tissue vs osseous surgical procedures for Metatarsus Adductus?
<7 soft tissue
>7 Osseous
What is the Thomson procedure for treatment of metatarsus adductus?
release of the abductor tendon
What is the Heyman Herndon and Strong (HHS) procedure for the correction of metatarsus adductus?
Division of the capsular and intermetatarsal ligaments.
Get way up in there and disconnect errrthang!
What's Sgarlato's stupid explanation for Met Adductus?
Sgarlato [1973] reluctant to excise the abductor hallucis muscle due to the increasing concern regarding the development of hallux abducto valgus, suggested abductor hallucis tendon lengthening and reattachment of the tendon into the base of the proximal phalanx, as the anomalous insertion of the abductor tendon, into the medial aspect of the first metatarsal head, was believed by Sgarlato [1973] (cited in Ganley and Ganley, 1992, p.841) to be the primary cause of metatarsus adductus.
Procedure?
Met Adductus
Berman and Gartland
Treatment/
Treatment?
Metatarsus adductus
Peabody and Muro
what is a definitional overview of Juvenile Rheumatoid Arthritis?
Chronic inflammatory disease of unknown etiology associated with persistent arthritis of one or more joints that exists for at least a months duration with the onset at 16 or younger with the exclusion of other causes
Explain demographics of JRA.
15/100.000 children
peaks at 1-3 and 8-12
Paucarticular vs Polyarticular
Pau= less than 4 joints
Poly= greater than 4 joints
What are the major points of type 1 pauciarticular arthritis?
Females < 5yo
ANA+
RF-
HLA-B27-
Large joints of LE
Iridocyclitis is a major concern
What are the major points of type II (older onset) Paucarticular arthritis?
Males> females, >10yo
ANA-
RF-
HLA-B27+
asymmetric back and heel
Scroiliitis and enthseopathies
Ankylosing spondylitis
What are the major points of Polyarticuar RA.
Many joints
Females> males
Symmetrical small joints of the hand.
ANA+ or-
RF+
HLAB27-
JRA equivalent to adult RA/ Erosive, destructive disease.
Eye problems with Juvenile Rheumatoid Arthritis are associated with what molecule/Test?
ANA+
Systemic onset JRA major Points
10 yrs old, male=female
affects entire person
totally negative ANA/RF/HLAB27
Rheumatoid rash
High fevers
Anemia
MEGALY
What are the two revolutionary drugs for RA? What are their main actions?
Etanercept is a TNF antagonist
Anakinra is an interleukin-1 receptor antagonist.
What is the conclusion of RA lecture?
Dr Jenkins has a dog that he loves deeply and affectionately.