describe the GAIT cycle
Describe anatomical changes with Halgus Valgus:
Describe the normal angular measurments for Halgus Valgus:
what are the three main presenting types of bunion deformity?
How do you treat a degenerative bunion?
What are some options to treat Halux Varus complication after bunion surgery?
Is avascular necrosis a complication of bunion surgery?
What are the three radiology grades of Halgus Rigidus?
Grade 1: Stiff ROM, maintained joint space, minimal osteophytes
Grade II: large osteophytes, narrowed joint space
Grade III: severe osteophytes, loss of joint space
What are the treatment options for Halgus Ridigus?
CONSERVATIVE: extra depth shoe to accomodate osteophyte, carbon fiber footplate with Morton's extension.
OPERATIVE GRADE 1,2: Chielectomy (up to 30% metatarsal head), +/- moberg dorsiflexion osteotomy
OPERATIVE GRADE 3: Joint Fusion: neutral, 5 deg valgus, 10-15 dorsiflexion, keller resection arthoplasty only medical ill, frail.
Define the three lesser toe deformities
What is the anatomic definition of lesser toe deformities?
Describe the surgical treatment for hammer and mallet toe:
Describe the surgical treatment for claw toe deformity:
What is a Frieberg infarction of the toe?
Treatment options are:
Orthotics limited benefit
No evidence for core decompression
Dorsal closing wedge osteotomy
excision of metatarsal head not supported
type 1: elarged metatarsal head
Type II- Bowing of the diaphysis of the 5th metatarsal
Type III: greater than 8 degrees IMA
Type 1-distal chevron osteomtomy 1mm for 1 degree
Type II, III- obligue diaphyseal metatarsal osteotomy
avoid proximal metatarsal osteotomy
Name some key facts about the seasamoids:
Describe Turf Toe
Forced Dorsiflexion injury
Avulsion of plantar plate
Proximal migration of seasamoids
seasamoids do not move with fluroscopic ROM
GRADE 1: (Capsule Strain) Stiff insole, toe taping
GRADE II-(partial tear) stiff insole, no sports 2wks/ rtp painless dorsiflexion greater than 60 degrees
Grade III-(Complete tear)-surgical repair, RTP 6 weeks
Mandatory with 3mm or more proximal retraction
Pearls on Seasamoid pathology
all recalcitrant seasamoid pathology best treated by removal of the seasamoid.
seasamoid removal complications are:
halgus valgus, halgus varus, cock-up deformity
Morton's Neuroma Diagnosis Pearls
Non-operative treatments for Morton's Neuroma
Operative treatment for Morton's Neuroma
What to do with a recurrent Morton Neuroma?
How to diagnosis and treat 5th metatarsal fractures
Zone 1: Peroneus Brevus avulsion fracture vs inversion injury-- Boot
Zone 2: metaphyseal/diaphyseal watershed area (Jones)
operative in an elite athlete/ NWB Boot x 6 weeks
Zone 3: Diaphyseal
33% refracture risk with non-op, consider ORIF with bone grafting
What is the best operative treatment for purely ligamentous lisfranc injuries?
What are some common ways to diagnose a Lisfranc Injury?
Describe the anatomy considerations of a Lisfranc injury:
Key Points to an Accessory Navicular
Type 1: small accessory bone with no attachment
type 2: tuberosity separated by 2mm fibrous cartilage
Type 3: accessory bone united by bony bridge
KEY RADIOGRAPH:EXTERNAL OBLIQUE FOOT
operative treatment: modified Kidner--(os excision with advancement of posterior tibial tendon
Navicular Stress Fractures
tx- nwb in boot 6-8 weeks, ct scan prior to activity:
need to operate on any fracture displacement (>2mm)
single or multiple screws
add bone graft if any sclerotic edges
CT scan required prior to return to play