Podiatry Pearls - Flatfoot/hav/juv Hav

Front 1

pt presents with flexible pes valgus, what would you expect on clinical exam

Back 1

-everted heel
-abduction of FF on RF
-collapse of medial column
-foot functions maximally pronated through gait with little or no supination
-equinus

Front 2

what compensation occurs with equinus in pes valgus foot

Back 2

-early heel off
-STJ and midtarsal joint pronation
-medial column sag
-tarsometatarsal breech

Front 3

describe the biomechnaical mechanism involved with compensation for equinus in pes valgus

Back 3

-ankle equinus prevents DF of talus, which maintains its posistion while the rest of the foot DF, abducts and everts from beneath it
-this leads to subluxatory collapse of the RF on FF

Front 4

if transverse plane deformity predominates in pes valgus, what procedure would you do

Back 4

evans

Front 5

axis altering arthroeresis devices (STA peg) are used for flatfoot in what plane

Back 5

frontal plane

Front 6

what neural structures may be encountered when performing an evans

Back 6

sural
intermediate dorsal cutaneous

Front 7

what position do you fuse te foot in for triple arthrodesis for flat foot

Back 7

- 15 degrees out toeing
-neutral ankle
-slight heel valgus

Front 8

when the STJ is pronated which muscles have less then optimal function

Back 8

PL and TP

Front 9

what calc osteotomies follow the arthroeresis principle

Back 9

Extra articular calc osteotomies
-chambers
-selakovich
-baker hill

Front 10

calc osteotomy that uses a bone graft under the sinus tarsi to block translocation of the talus on the calc

Back 10

chambers

Front 11

calc osteot that shifts the posterior calc medially so it lies below the sus tali

Back 11

kouts

Front 12

flatfoot correction that includes nav-cune fusion

Back 12

Miller (nave - 1st cune)
Hoke (nav - 1st,2nd cune)

Front 13

MC cause of peroneal spastic flatfoot

Back 13

tarsal coalition

Front 14

what joints are fused in a Miller

Back 14

-nav cune and cune-1st met

Front 15

Baker Hill

Back 15

-elevates the posterior facet by insertion of lateral bone graft beneath it

Front 16

lowman procedure for FF

Back 16

-TAL
-kidner
-TN wedge fusion

Front 17

where is the osteotomy and bone grafting for a selakovich procedure

Back 17

-sustentaculum tali

Front 18

who is an arthroesis genrally performed in

Back 18

-pt who hasnt reached skeletal maturity
-a felxible FF

Front 19

some causes of congenital FF

Back 19

-congenital vertical talus
-tarsal coalitions
-Z compensated met adductus
-short achilles tendon

Front 20

indications for RF fusion in flat foot

Back 20

-severe DJD
-paralytic deformity
-rupture of TP tendon with collapse of foot and adaptive changes

Front 21

list 2 problems with doing an isolated STJ fusion for flatfoot correction

Back 21

-DJD will occur at other joints
-no correction occurs in the Forefoot

Front 22

describe the cyma line in flat foot

Back 22

anterior break

Front 23

Kites angle

Back 23

talo calc angle
N = 20 on AP

Front 24

ligamentous laxity can occur do to a defect in collagen synthesis causing flat foot; list some dz

Back 24

-marfans
-ehlers danlos
-osteogenesis imperfect

Front 25

radiographic manifestations for sagital plane dominant flat foot

Back 25

-inc talar declination
-nav cune breach
-inc talo calc angle on lateral
-dec cal inc angle

Front 26

name some abduction deformities of the LE that can lead to flexible pes valgus deformity

Back 26

-met adductus
-forefoot abductus
-ext malleolar torsion
-external tibial torsion
-ext femoral torsion
-tight lateral hamstrings

Front 27

name the varus producing osteotomies performed in calc for flatfoot correction

Back 27

gleich - oblique oseot with anterior displacement
dwyer - lat closing wedge
silver - lat opening wedge
kouts

Front 28

what foot deformity cant be present if an evans is performed

Back 28

-met adductus (you would basicaly inc the deformity)
-cause in toe gait and unmask the deformity

Front 29

youngs procedure

Back 29

-reroute the TA to under the navi

Front 30

what muscle is encountered in an evans

Back 30

EDB

Front 31

instability of which column is more indicative of a pathological flatfoot

Back 31

lateral column

Front 32

during gait, the talus and the leg internally rotate and adduct to take up motion in what plane

Back 32

transverse

Front 33

dwyer osteot

Back 33

-opening wedge in lateral calc (MC)
-closing wedge in medial calc

Front 34

how is congenital calcaneovalgus deformity easily distinguished from congenital convex pes valgus deformity on clinical exam

Back 34

congenital calcaneovalgus is flexible and allows for passive correction

Front 35

in tarsal coaltion, what happens with hubscher manuever

Back 35

-nothing

Front 36

what happens in normal hubscher maneuver

Back 36

-PF of 1st ray
-supination of RF
-ext rotation of leg
-inc in medial arch height

Front 37

calc osteotomies are classified into three groups; list the groups and procedures in each group

Back 37

- extra articular: chambers, baker hill and selakovich
- anterior: evans
-posterior osteotomies: gleich, dwyer, silver, kouts

Front 38

axis of STJ

Back 38

- 42 from transverse plane
-16 from sagittal plane
-this allows for equal amts of frontal and transverse plane motion

Front 39

what is a kidner

Back 39

-resect an accessory navi
-transpose the insertion of the TP tendon underside of the navi

Front 40

young procedure

Back 40

-reroute the TA through a slot in the navi without detaching the tendon from its insertion
-TP reattached beneath the navi

Front 41

describe the midtarsal joint when the STJ is in its maximally pronated with the calc everted

Back 41

-TN and CC joints become divergent from each other with their axes more paralell allowing full independent motion of each of these joints and inc the ROM of the MTJ itself

Front 42

where is the osteotomy made for the evans

Back 42

1.5 cm proximal to the CC joint

Front 43

how is the evans cut directed

Back 43

-directed anteriorly to avoid the middle facet of the STJ

Front 44

Halluc abductus angle (HA)

Back 44

N <15

Front 45

IM angle

Back 45

N <8-12

Front 46

Met adductus angle (MA)

Back 46

N <15

Front 47

PASA

Back 47

N<8

Front 48

DASA

Back 48

N <8

Front 49

Hallux Abductus Interphalangeus Angle (HAI)

Back 49

N<10

Front 50

MPD (met protrusion distance)

Back 50

+/- 2 mm

Front 51

TSP (tibial ses position)

Back 51

N is 3 or less

Front 52

what is the relationship between the IM and MA angle

Back 52

-as the MA angle increases above 15, the IM angle becomes more significant at a lower angle

Front 53

what is the effective IM angle

Back 53

MA - 15 + IM angle
-in other words, every degree of MA angle over 15 is added to the IM angle

Front 54

what does tracking of 1st MPJ mean

Back 54

-that the hallux wants to drift back into a uncorrected position after having been placed in corrected position and put through ROM

Front 55

what is the diff between positional deformity and structural deformity

Back 55

PASA+DASA = HA (structural)
Same, Structural
PASA + DASA < HA (positional component)

Front 56

how is met primus elevatus demonstrated on lateral WB view

Back 56

-by comparing dorsal cortical lines of 1st and 2nd met shafts
-the cortex of the 1st met will be seen to diverge from that of the 2nd

Front 57

what structures are cut when excising a fibular sesamoid

Back 57

-lateral joint capsule
-fib ses lig
-lateral head of FHB
-lig between fib ses and prox phalanx
-intersesamoid lig

Front 58

what are the advantages of distal metaphyseal osteotomy

Back 58

-cancellous bone of metaphysis has better blood supply
-pt can WB post op
-can be performed on a child with an open metaphysis, since the metaphysis is at the base

Front 59

where would you aim you apical guide for an Austin to:
PF?
DF?
Shorten?
Lengthen?

Back 59

PF (DorsoMed to PL)
DF (PlantarMed to DL)
shorten (distal medial to proximal lateral)
lengthen (prox med to distal lateral)

Front 60

does an austin correct an abnormal IM angle

Back 60

-no, it corrects a relative IM angle
-to correct the actual IM angle, you have to move the shaft and the head closer to the 2nd met

Front 61

green modification to a Reverdin

Back 61

-L exits behind the sesamoids

Front 62

Laird modification to a reverdin

Back 62

cuts all the way through to shift capital fragment laterally

Front 63

geode

Back 63

-a degenerative cyst seen in the medial eminence of a bunion

Front 64

when would you use a mitchell

Back 64

-a bunion with a long 1st met

Front 65

prox akin corrects for?

Back 65

inc DASA

Front 66

when should you use a distal akin

Back 66

inc hallux abductus interphalangeus (HAI)

Front 67

cheater akin

Back 67

-attempts to correct for hallux abductus when the DASA and HAI angle are normal

Front 68

MC complication of a keller

Back 68

-retraction of the hallux and lack of hallux purchase

Front 69

juvara

Back 69

oblique closing base wedge

Front 70

how is the screw placed, if a bas osteotomy is fixed with only one screw

Back 70

-placed halfway between the perpendicular to the long axis of shaft, and perpendicular to the osteotomy
-perpendicular to osteot would give the best compression, but not prevent axial movt
-perpendicular to long axis of shaft prevents axial movt but not compression

Front 71

mid diaphyseal ostetomies of 1st met

Back 71

-ludloff
-mau
-scarf

Front 72

common complication of mid diaphyseal osteotomies

Back 72

troughing

Front 73

trethowan

Back 73

-opening base wedge with medial eminence as a graft

Front 74

indications for lapidus

Back 74

-juv HAV with obliquity or hypermobility of 1st met-cune
-paralytic HAV
-DJD
-HAV > 18
-for correction of flat foot

Front 75

incidence of non union in lapidus

Back 75

10%

Front 76

what precautions must be taken in lapidus dissection

Back 76

-avoid the MDC nerve, attachment of TA, TP and PL

Front 77

when is the crescentic a good choice for HAV

Back 77

-when the pt has a short met
(can be made more stable by crescentic shelf)

Front 78

double osteot of 1st met

Back 78

logriscino
(reverdin and CBWO-loison
balscecu)

Front 79

when fusing the first MPJ, should the adductor be released

Back 79

-no, the adductor is no longer a deforming force and it actually gains mechanical advantagr and pulls the prox phalanx and 1st met closer to 2nd

Front 80

ideal position of MPJ fusion

Back 80

-15-20 abduction
no frontal plane rotation
10 dorsiflexion

Front 81

regnauld

Back 81

mexican hat
-make a hemi implant from base of prox phalanx

Front 82

kessel bonney

Back 82

-closing base wedge of prox pahlanx

Front 83

waterman

Back 83

dorsal closing wedge of met head

Front 84

what does the youngswick modification of austin do

Back 84

-shortening and plantarflexion

Front 85

engles angle

Back 85

-simplified met adductus measurement
-bisect the 2nd met and 2nd cuneiform

Front 86

what % of adult pts with HAV deformity is a result of untreated juv HAV

Back 86

40%

Front 87

gender predisposition towards juv HAV

Back 87

-before age 14 it is found in males
-after age 14 it is 3 times more common in females

Front 88

explain why a child with spastic CP gets HAV

Back 88

-scissor gait due to tight posterior muscles, including the triceps produces equinus force at the ankle
-the joints ditstally try to compensate and DF the foot via pronation throughout contact phase
-the flexible pronated foot doesnt provide an effective lever for muscles to stabilize the 1st ray during propulsion

Front 89

what other deformity often accompnaies juv HAV

Back 89

-met adductus

Front 90

what systemic dz has a high incidence of juv HAV

Back 90

-juv RA

Front 91

name the pedal factors that are implicated in causing the severity of juv HAV

Back 91

-round met head
-atavastic cuneiform
-hypermobile 1st ray
-hyperpronation
-high IM angle

Front 92

what are indications for sx on juv HAV pt before the close of the epiphysis

Back 92

-progressive deformity
-uncontrolable deforming forces
-rigid met head adaptation
-pain
-severe deformity

Front 93

when would you perform a lapidus on juv HAV

Back 93

-severe inc IM angle
(usually associated with NM or collagen disorders)

Front 94

describe 2 techniques for performing epiphysiodesis in juv HAV

Back 94

-lateral stapling of growth plate (reversible)
-or insertion of bone graft into lateral aspect (irreversible)

Front 95

MC complication of epiphydiodesis

Back 95

recurrence

Front 96

name 2 procedures for juv HAV that address the atavastic cune

Back 96

-lapidus
-fowler (open med wedge of med cune with bone graft)

Front 97

name all types of fixation that are appropriate across a growth plate

Back 97

-smooth K wires (less likely to disrupt the growth plate)

Front 98

at what age does the 1st met epiphysis appear radiographically

Back 98

2 yrs

Front 99

when do the sesamoids ossify

Back 99

10-12 yrs

Front 100

what is the major diff between the ossification of lesser mets and the first met

Back 100

-the first met epiphysis is at the base, compared to the heads of the lesser mets

Front 101

the adductor tendon transfer is used an an adjunctive procedure to?

Back 101

relocated and maintain the corrected sesamoid position

Front 102

Hiss procedure

Back 102

transfer of the abductor tendon to the dorsomedial proximal phalanx of hallux

Front 103

is there a strong familial predilection for juv HAV

Back 103

yes 50-78% familial incidences

Front 104

what is the MC post op complication for CBWO

Back 104

elevatus