Sm Caq - Foot Injuries

Front 1

Talocalcaneal joint total motion?

Back 1

25-30 degrees

Front 2

Spring ligament?

Back 2

calcaneonavicular

Front 3

Plantar layers of the foot: First Layer?

Back 3

-plantar aponeurosis
-abductor digit minimi
-flexor digitorum brevis
-inf extensor retinaculum

Front 4

Plantar layers of the foot: Second layer?

Back 4

-flexor digitorum longus
-flexor hallucis longus
-quadratus plantae
-lumbricals 1-4

Front 5

Plantar layers of the foot: Third layer?

Back 5

-flexor digiti minimi brevis
-adductor hallucis, transverse and oblique heads
-flexor hallucis brevis

Front 6

Plantar layers of the foot: Fourth layer?

Back 6

-posterior tibial tendon
-peroneal longus tendon
-interossei - 4 dorsal and 3 plantar

Front 7

Saphenous nerve distribution?:

Back 7

medial ankle

Front 8

Sural nerve distribution?

Back 8

lateral foot and ankle

Front 9

Deep peroneal nerve distribution?

Back 9

medial branch to 1st dorsal web space

Front 10

Superficial peroneal nerve distribution?

Back 10

dorsal medial cutaneous and dorsal intermediate cutaneous

Front 11

postop ankle scope w paesthesias to dorsal and lateral aspect of foot: nerve most likely injured?

Back 11

superficial peroneal nerve

Front 12

Os trigonum is what position relative to FHL (in planning surgery)

Back 12

lateral (see q p 520)

Front 13

Inability to reduce a subtalar dislocation most likely a result of ???

Back 13

entrapment of the posterior tibial tendon

Front 14

When harvesting the Flexor Digitorum Longus distally in the foot which tendon crosses immediately below it?

Back 14

Flexor Hallucis Longus

Front 15

What nerve supplies the EDL?

Back 15

Superficial peroneal

Front 16

during plantar fascial release the deep fascia of the abductor hallucis muscle is released to relieve pressure on which structure?

Back 16

First branch of the lateral plantar nerve

Front 17

Nerve vulnerable on lateral approach to ankle and heel?

Back 17

Sural

Front 18

Nerve most vulnerable to removal of calcaneonavicular bar and ORIF Lisfranc injury (eg dorsal approach to 1st and 2nd TMT)

Back 18

deep peroneal nerve

Front 19

Anterior tarsal tunnel syndrome?

Back 19

Deep Peroneal Nerve is compressed beneath the inferior retinaculum.

Front 20

Nerve vulnerable to injury during bunion surgery?

Back 20

Superficial Peroneal Nerve

Front 21

FHL relationship to os trigonum?

Back 21

FHL is medial to os trigonum

Front 22

Pronation combined motions?

Back 22

DF ankle +
eversion subtalar +
abduction transverse tarsal

Front 23

Supination combined motions?

Back 23

PF ankle +
inversion subtalar +
adduction transverse tarsal

Front 24

Normal gait: Stance v Swing phase %?

Back 24

Stance 62%
Swing 38%

Front 25

ground reaction forces for walking relative to BW?

Back 25

1.5x BW

Front 26

When best time for athlete to have hallux valgus surgery?

Back 26

at completion of athletic career

Front 27

non-op hallux rigidus treatment?

Back 27

stiff-soled rocker bottom shoe
intraarticular steroid (only one injection indicated)

Front 28

Indication for MTP fusion for Hallux Rigidus?

Back 28

pain at mid-range of movement

Front 29

Fusion position for hallux rigidus?

Back 29

10-15 degrees valgus
20-30 deg DF relative to 1st MT
10-15 deg DF relative to the plantar aspec of the foot

Front 30

Turf-Toe def?

Back 30

Sprain of first MTPJ
pain w push-off and difficulty running

Front 31

Turf-Toe mechanism of injury?

Back 31

-axial load on foot fixed in equinus w MTPJ in hyperextension
-spectrum of injury from mild sprain to plantar plate disruption to complete dislocation of first MTPJ

Front 32

Where does plantar plate and capsule tear in Turf Toe?

Back 32

distal to sesamoids

Front 33

Turf Toe Dx?

Back 33

proper Hx of injury
pain, swelling, dec ROM
great toe Lachman test
compare to opposite side

Front 34

xray findings for turf toe?

Back 34

-if suspicious, comparison AP - proximal sesamoid migration = plantar plate rupture
-comp lateral increased distance from distal sesamoid to base of phalnax=plantar plate tear

Front 35

Turf toe indications for surgery?

Back 35

-large capsular avulsion w unstable joint
-diastasis of bipartite sesamoid or sesamoid fracture
-sesamoid retraction
-traumatic bunion or varus

Front 36

Bipartite patella?

Back 36

medial in 10% (~25% of those bilat) lateral rarely bipartite, therefore if lat abN on xray, prob Fx

Front 37

DDx of bilateral seamoiditis in young adult male?

Back 37

Reiter's disease
Psoriatic arthritis
Seronegative RA
Other inflammatory arthritis

Front 38

operative indications for sesamoids?

Back 38

Sx>3-12mo
ORIF +/- bone grafting
consider DF oseotomy
sesamoid excision: only excise 1 to avoid claw toe deformity

Front 39

radiograph of 44yo tennis player w great toe pain x 5 years p 527?

Back 39

Psoriatic arthritis (not sure lesson w this one)

Front 40

most important feature for deciding fusion of MTP v cheilectomy?

Back 40

Pain at midrange of motion in the first MTPJ

Front 41

24yo lacross w severe pain great toe at first MTPJ. Most likely reason for symptoms is?

Back 41

forced hyperextension injury (Turf Toe)

Front 42

Hyperextension injury to MTP of great toe most comonly results in a tear of the ?

Back 42

insertion of the plantar plate on the proximal phlanx.

Front 43

most common reason for failure of Morton's excision?

Back 43

inadequate proxiamal excision of the common digital nerve

Front 44

structure interdigital nerve is compressed w Morton's?

Back 44

transverse MT ligament

Front 45

Mulder's sign?

Back 45

squeeze the foot from medial to lateral while palpating the web space. + = click and pain

Front 46

most common location for Morton's?

Back 46

Between 3 and 4 MT heads

Front 47

Most accurate confirmatory test for Mortons?

Back 47

History and Physical

Front 48

Lisfranc's ligament?

Back 48

medial cuneiform to the base of the 2nd MT

Front 49

Mech of injury for Lisfranc?

Back 49

1)abduction - fixed hindfoot w appliede abduction force to the forefoot
2) plantar flexion - most recognized pattern w force applied to heel in line of axis of the foot with toes in fixed position

Front 50

Lisfranc xrays?

Back 50

**need wtbearing!!**
normal=medial border of 2nd MT parallels the medial border of middle cuneiform on AP and oblique
normal alignment = medial border of 4th MT aligns w medial border of cuboid
(see p 531)

Front 51

Dx Lisfranc injury?

Back 51

widening of MC-MT2 more than 2mm compared to uninjured on WB xr indicates Lisfranc subluxation

Front 52

polo player w suspected Lisfranc injury. Most appropriate imaging modality?

Back 52

Comparison wt-bearing xrays of the foot (not CT!)

Front 53

optimal treatment of acute Lisfranc?

Back 53

ORIF (see p 531)

Front 54

The Lisfranc ligament connects to the base of the...?

Back 54

second MT and the medial cuneiform.

Front 55

most common foot stress fx in dancers?

Back 55

2nd MT base

Front 56

nonop Jones fx?

Back 56

4-6 weeks in NWB cast then 4-6 in WB cast or boot
~75% Jones fx will healw nonop but 1/3-1/2 will refx

Front 57

Indications for ORIF 5th MT base fx?

Back 57

-acute fx in elite athlete
-stress fx w delayed or nonunion
-refracture
-cavovarus foot w lateral overload

Front 58

first MT treatment if displaced at all?

Back 58

ORIF

Front 59

15yo female long distance runner w tibial stress fx. Most important topic for Hx?

Back 59

eating disorder Hx and menstrual abnormalities

Front 60

How dofferentiate accessory navicular from a navicular fx?

Back 60

bone scan

Front 61

When remove accessory navicular?

Back 61

Kidner - when symptoms are intractable

Front 62

Blood supply navicular?

Back 62

dorsolateral and plantar medial

Front 63

imaging choice for suspected navicular stress fx?

Back 63

CT

Front 64

Rx navicular stress fx?

Back 64

NWB SLC for 6-8 weeks

Front 65

initial management of symptomatic accessory navicular?

Back 65

cast immobilization for 4-6 weeks

Front 66

What is watershed zone for tarsal navicular vascularity?

Back 66

central one third

Front 67

%bilaterality of tasal coalition?

Back 67

20-60%

Front 68

PE findings for tarsal coalition?

Back 68

rigid flatfoot
loss of subtalar or TT ROM
no calcaneal inversion w heel rise
stressing coalition may elicit pain

Front 69

lateral process of talus fx MOI?

Back 69

acute DF and inversion of the foot w axial load
acute localized tenderness over lateral talar rocess just below tip of lateral malleolus

Front 70

Imaging for suspected lateral process talus fx's?

Back 70

CT

Front 71

15yo w hindfoot pain, limited subtalar motion, CT shows talocalcaneal coalition w 40% of middle facet. No degen. Rx?

Back 71

resection of the coalition with fat graft interposition

Front 72

30yo with lateral process talus fx, what is the injury mechanism?

Back 72

DF, axial loading, inversion, and external rotation.

Front 73

22yo snowboarder w ankle pain after landing from jump. Most likely Dx?

Back 73

lateral process of the talus fx

Front 74

risk factors for plantar fasciitis?

Back 74

repetitive stress in athletes
obesity
middle age
cavus foot
over-pronated pes planus
tight heel cord
heel spur

Front 75

surgical treatment plantar fasciitis?

Back 75

subtotal PF release and decompression of first branch of laterea plantar nerve

Front 76

best study for suspected calcaneus stress fx?

Back 76

bone scan

Front 77

tarsal tunnel borders?

Back 77

ant - medial malleolus
lat - post process of talus, sustentaculum tali, med calc
covered by flexor retinaculum

Front 78

tarsal tunnel syndrome from..?

Back 78

entrapment neuropathy of the posterior tibial nerve or one of its branches

Front 79

tarsal tunnel surgery?

Back 79

decompress entire tarsal tunnel, release flexor retinaculum, deep fascia of abductor hallucis

Front 80

FHL tenosynovitis most common in ?

Back 80

gymnasts or dancers w post med ankle pain exacerbated by acitivities

Front 81

MM tendon anatomy

Back 81

Tom, Dick, and Harry
PT, FDL, FHL

Front 82

successful outcome from tarsal tunnel surgery most likely with ...?

Back 82

a space-occupying lesion compressing the tarsal tunnel.

Front 83

Adequate decompression of the med and lateral nerves in taral tunnel release requires...?

Back 83

release of the deep fascia of the abductor hallucis muscle

Front 84

ballet student w medial ankle pain w DF Hallux, N xrays, Rx?

Back 84

peroneal tenosynovectomy

Front 85

23yo ballet dancer w hindfoot pain when en pointe. most likely cause of pain?

Back 85

Os trigonum

Front 86

rx for symtomatic os trigonum?

Back 86

excision of the fragment

Front 87

Freiberg's infraction?

Back 87

osteonecrosis of 2nd MT head
teenage/young adult females
dancing and gymnastics

Front 88

operative Rx Freiberg's?

Back 88

MTPJ debridement
*avoid MT head resection

Front 89

Sever's Disease

Back 89

calcaneal apophysitis, ages 9-14.

Front 90

Kohler's disease?

Back 90

self-limiting AVN of navicular
children 4-8
treat symptomatic

Front 91

15yo w pain over 2nt MT, N xray. next step?

Back 91

MRI to check for AVN

Front 92

Rx if xray shows sclerosis 2nd MT head?

Back 92

SLWC!

Front 93

Freiberg's Rx?

Back 93

debridement (not resection of 2nd MT head!)

Front 94

sleddog race and musher has toes that are hard, insensitive, and white. most appropriate treatment?

Back 94

warm the toes by immersion in 40deg C whirlpool