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40 Cards in this Set

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What are some common causes of Hallux Abducto valgus?
Hypermobile 1st ray
Rheumatic inflammatory disease
Neuromuscular disease
Post-surgical malfunction

Metarsus primus adductus
Long First Ray
Excessive pronation
Gastroc Equinus
Flexible forefoot valgus
Limb length discrepancies
Ehlers Danos Syndrome
Pes Planus foot types
When evaluating a patient History of CC concerning HAV, it is important to note what specific factors relating to pain?
Onset
Duration
Progression
Location
In evaluating a runner w/ who presents w/ HAV, what other deformity is also likely to be present in hallux?
Hallux Limitus
If you are unsure of the vascular status of the patient, what exam would your order to have a definitive evaluation?
Arterial Doppler Exam

which provides
ABIs
Toe Pressures
Segmental Pressures
Normal 1st Ray position is how many degrees upon testing it for movement?
10 degrees

5 degrees up
5 degrees down
How many degrees is the hallux sitting down in a plantarflexed 1st ray?
7 degrees
How does one test for transverse plane mobility?
Straighten out the hallux, and see if you can push the bump in.

In people who are very flexible/ or have a soft tissue deformity, the bump will go in.

In an osseus deformity, the bump will not move.
Metatarsal Cuneiform mobility is indicated for patients with severe HAV along with what foot type?
Flexible feet
Crepitus
Cartilage is destroyed

Bone is rubbing on bone
Trackbound
Lateral soft tissue contracture & increase in the PASA
People with medial bunions generally have underlying ______________________
Metatarsus Adductus
Pinched tyloma's occur as a result of_________________________
Medial Bunions
How does one develop a tyloma under sub-met 1?
Pinched tylomas usually develop as a result of a biomechanical deformity.

If the tyloma is under the met head, then it is a result of a plantar flexed metatarsal.
Name 5 reasons one can develop a tyloma (sub met 2)
Usually a structural abnormality of 1st ray
-Hallux limitus/rigidus
-Hypermobile 1st ray
-Hammertoe 2nd met, leading to functionally PF position
-Contracted 2nd digit
-Short 1st met
-Long 1st met
-Loss of hallux purchase
Keller bunionectomies lead to what possible complication in regards to the hallux and its relationship to the ground?
Loss of hallux purchase to due instability of the intrinsic muscles
Other deformities seen with HAV deformities...include.....
Hallux IPJ deformity - causes the foot to look like it still has a bunion

EHL contracture - use lengthening procedure (Open Z) to correct this

Bursa's
In a patient with a bunion, when doing a WB exam, you notice when they stand their abductors fire causing the hallux to straighten out, what note would you want to make pre-op?
Slightly under correct otherwise this patient may go into hallux varus.
Normal passive DF of the 1st MPJ is_____________
20-30 degrees
The standard views for radiographic evaluation include:
AP, Lateral, MO, Ses Axial
Describe this bunion
There is increase in soft tissue density and volume along the medial aspect of the 1st MPJ
When evaluating a bunion radiographically, what 3 items should be described?
Soft tissue

Joints

Angles
Name this angle and how you derive it.
Standard Met Adductus Angle

Normal is < 15*

Take the base of the medial cuneiform and draw a line to the base of the midpoint of the cuboid.

Bisect the 2nd ray, and bisect the tarsus from that point.
What angle is this?

And how do you derive it?
Engles Angle.

Bisect the 2nd cuneiform & bisect the 2nd met.

Normal is < /= to 24*

Anything greater means they have met adductus!!
What angle is this?

What's normal for this?
Classic IM angle.

Normal is </= to 8*
TRUE IM angle is calculated how?

and why?
Calculated by taking the
(IM angle + Met adduct. angle) - 15*

Indicated because IM angle alone does not account for underlying adductus
What angle is this?

How do you calculate it?

What is normal?
Proximal Articular Set Angle

Normal PASA is 8*.

Bisect the 1st met.
Draw a line from medial to lateral across the effective articular cartilage.

Angle is found by measuring the angle formed by the transverse articular cartilage line VERSUS a line perpendicular to the longitudinal bisection line.
What angle is this?

What is normal?
DASA

Normal is 8* or less.

Formed by taking a longitudinal bisection of the proximal phalanx, and then drawing a line from medial to lateral for the transverse articular cartilage, and then..
MEASURING the angle by drawing a line perpendicular to the transverse articular cartilage line & the existing bisection of the prox phalanx.
What angle is this?

What is normal?

How do you measure it?
Hallux abductus IP angle.

Normal is 10* or less.

Measure by bisecting the prox phalanx and bisecting the dist phalanx.
The degree of abduction of the distal phalanx from the prox phalanx is recorded as the HAIP angle.
If the PASA +DASA = HAA, then it is what kind of foot deformity?
Structural Foot Deformity.

The joint status in this case is congruent.
If the PASA+DASA<HAA, the it is what kind of foot deformity?
(HINT: NORMAL PASA/DASA)
Functional Foot deformity.

The joint status in this case is deviated/subluxed.
If the PASA+DASA<HAA, then it is what kind of foot deformity?

HINT: PASA/DASA ARE ABNORMAL!!
It is a combination foot deformity, it is both structural & functional foot deformity.

The joint status in this case is deviated/subluxed.
What is radiograph displaying?
The Met Protrusion distance.

Normal is +/- 2mm.
Explain how to use this to evaluate sesamoids.

What is considered normal?
Bisect the 1st Met, and look for the tibial sesamoid.

Normal position is 1 to 3. Anything else is abnormal.

Positions 4-7 indicate LATERAL tracking of the medial sesamoid.
How would you evaluate 1st MPJ position?
A normal 1st MPJ position would be evaluated by looking at the position of the sesamoid and seeing that it is proximal to the metatarsal joint line.
A congruous joint is one in which the lines are ______________
A congruous joint is one in which the lines are running PARALLEL.
A deviated joint is one in which
the joint lines ____________________
Intersect outside the joint!
Normal joint width is ?
2mm width is considered normal joint width
This is an example of a _______________
Subchondral bone cyst
The angle being displayed is measuring ______________
The first met declination.

Normal is up to 15*
The shape of the 1st-met cuneiform jt shown here is round- which indicates you will need to do what kind of reduction?
Soft tissue reduction since ROUND 1st-Met Cuneiform Jts are soft tissue in nature.

Square/oblique require an osseus procedure.