Term
|
Definition
| Inside aspect of leg, ankle and foot |
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Term
|
Definition
| Outside aspect of leg, ankle, and foot |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
| away from point of reference towards trunk |
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Term
|
Definition
| Away from point of reference towards toes |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
| pushing with finger or thumb onto area to identify specific landmark |
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Term
| Identify: Iliac Crest, Anterior Superior Iliac Spine, Greater Trochanter (femur), Patella, Fibular head, Tibial tuberosity, Common Peroneal Nerve |
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Definition
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Term
| Identify: Dorsalis Pedis Artery, Medial Malleolus, Navicular tuberosity, 1st metatarsal phalangeal joint, Calcaneous, Tibial Nerve, Posterior Tibial Artery |
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Definition
On anterior and medial foot and ankle..
See slide |
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Term
| Where on the foot can you feel a pulse? |
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Definition
Dorsalis Pedis artery (anterior)
Posterior tibial artery. |
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Term
| What inserts at the navicular tuberosity? |
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Definition
| The tibialis posterior muscle tendon. |
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|
Term
How would you deliver anesthesia to
entire plantar aspect of foot. |
|
Definition
| Via posterior tibial artery |
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Term
| What nerve do you use for local or regional anesthetic injection to the heel? |
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Definition
|
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Term
| Identify: Lateral Malleolus, Dorsal Vein, Calcaneous, 5th Metatarsal Base tuberosity |
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Definition
On Anterior and lateral foot and ankle
See slide |
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Term
| Identify: Medial malleolus, lateral malleolus, navicular tuberosity, calcaneus, 5th metatarsal base tuberosity |
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Definition
On posterior foot ankle
See slide |
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Term
| Lateral and medial malleolus are on the same plane. True/False |
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Definition
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Term
| Identify: 5th Metatarsal head, 1st metatarsal head with sesamoids, plantar fascia, calcaneous |
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Definition
| On plantar foot. See slide. |
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Term
|
Definition
| Entire plantar fascia band becomes hard nodules. |
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Term
| Location of pain in Plantar fascitis |
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Definition
| More proximal, medial, lateral pain |
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Term
| Identify: Quadriceps muscles, patellar ligament, Tibialis anterior, gastrocnemius |
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Definition
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Term
| Identify: Quadriceps, Hamstrings, Gastrocnemius, Soleus |
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Definition
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Term
|
Definition
| Soleus and gastrocnemius combined |
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Term
| Where does the hamstring insert? |
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Definition
| Posterior aspect of tailbone. |
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Term
| Identify: Hamstring muscles, Popliteal fossa, gastrocnemius, Soleus, Achilles tendon |
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Definition
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Term
| Contents of popliteal fossa |
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Definition
NVA- Nerve Vein Artery
From medial to lateral |
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Term
| Locate: Hamstring, Quadricepts, Iliotibial band, Peroneal muscles, Gastrocnemius muscle, soleus muscle |
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Definition
All on lateral Leg.
See slide |
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Term
| If you lay on left side and raise right leg against resistance, what will you feel? |
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Definition
| Long tight band called the iliotibial band. |
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Term
|
Definition
| Soleus medial (brevis and longus) |
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Term
| Identify: Extensor digitorum brevis, extensor hallucis longus tendon, Extensor digitorum longus tendon, tibialis anterior tendon |
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Definition
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|
Term
| What extensor sepearate out into four separate slivers of tendon? |
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Definition
| Extensor digitorum longus. |
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|
Term
| How can you see the teonds of the dorsal foot? |
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Definition
| Foot to nose against resistance. |
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|
Term
| Function of Extensor hallucis longus? |
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Definition
| Permits big toe to go up in air. |
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|
Term
| Length of achilles tendon? |
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Definition
|
|
Term
| Identify: Tibialis anterior tendon, extensor hallucis longus tendon, achilles tendon |
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Definition
| Medial foot and ankle. See slide. |
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|
Term
| How to tell if Achilles tendon is ruptured? |
|
Definition
| Leg overhanging, will see a dell or dip. |
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Term
| Identify: Peroneal tendons, Extensor digitorum brevis, extensor digitorum longus tendons |
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Definition
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|
Term
| Sit in a chair and move foot away from the midline against resistance, what will you see? |
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Definition
| Two prominant peritoneal tendons. |
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Term
|
Definition
Toes down
Foot is "plantar-flexed" |
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Term
|
Definition
Toes up
Foot is "dorsiflexed" |
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Term
|
Definition
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Term
|
Definition
| Away from midline of body |
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Term
|
Definition
Varus position
Plantar foot towards midline |
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Term
|
Definition
Valgus position
Plantar foot away from midline |
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Term
|
Definition
| Simulataneous movement of the foot in the direction of adduction, inversion, and plantarflexion |
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|
Term
|
Definition
| Simultaneous movement of the foot or part of the foot in the direction of abduction, eversion, and dorsiflexion |
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Term
|
Definition
Digits and phalanges
Metatarsals |
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Term
| How many phalanges per toe? |
|
Definition
Big toe has two
Rest have three |
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Term
|
Definition
Lesser tarsals
Cuneiforms (medial, intermedial, lateral) navicular (behind cuneiforms) and cuboid (laterally) |
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|
Term
| How do you divide the foot into lateral and medial columns? |
|
Definition
| Making a line between cubeiform and cuboid |
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Term
|
Definition
|
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Term
|
Definition
Congenital Deformity
Clubfoot, rearfoot inverted towards the midline. Caused by talus bone.
Person cannot dorsiflex past midline, plantarflexed past midline.
Varus deformity, heel bone inverted towards midline.
Triplanal deformity, metatarsals in abducted position. |
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Term
|
Definition
High arch
Biggest indicator is x-ray, position between calcaneous and weight supporting surface. |
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Term
|
Definition
No arches. Flat foot deformity.
Can be a frontal plane, sagittal plane, or transverse plane problem. Need radiographic workup.
Angle of calcaneus with weight supporting surface is very low (3 degrees) |
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Term
|
Definition
Webbed Feet
May have underlying bones associated with it (bones will determine severity)
Many people have webbing between third and fourth toe, nbd. |
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Term
|
Definition
Extra toe.
Medially (two big toes), Centrally (more than three), or extra fifth toe.
May need surgical intervention to fit into shoe. |
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|
Term
| Cleft foot (lobster foot) |
|
Definition
Rare Congenital Anomaly.
Absence of part of the forefoot.
Nothing done if no problems ambulating, just need shoe gear. |
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Term
|
Definition
Metatarsals gravitate towards midline and adducted position.
Focus on metatarsals in relationship to lesser tarsals of the midfoot. |
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|
Term
Hallux Abductovalgus
Bunion |
|
Definition
Common acquired deformity
Large IM angle.
Develop due to pronating foot type and increase in IM angle |
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Term
|
Definition
Reverse of hallux abductus valgus.
Higher IM angle in 4th and 5th metatarsals resulting in bony prominence outside the fifth.
Known as tailor's bunion. |
|
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Term
|
Definition
Acquired deformity
Big toe of hallux has limited range of motion
Can progress to hallux rigidus where there is no range of motion present
Caused by position of metatarsals (jamming on movement) or arthritic changes (no cartilage to facilitate smooth movements) |
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|
Term
|
Definition
Acquired deformity, looks congenital and may be a developmental problem.
Occurs with an overcorrected bunion or soft tissue overcorrection. |
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Term
| Difference between hallus abductor vallus vs hallus abductor varus |
|
Definition
hallus varus: Frontal plane abnormality
Hallus vallus: big toe abducted and some frontal plane motion |
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|
Term
Hammer Toe
Claw Toe
Mallet Toe
Describe proximal middle distal phalynx |
|
Definition
Acquired Deformities
Hammer toe: basket terminology that includes other two.
Hammertoe: Dorsiflex, plantarflex, dorsiflex or neutral
Mallet toe: Neutral, neutral, plantar flex
Claw toe: Dorsiflex, plantarflex, plantarflex |
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Term
|
Definition
Acquired Deformity
Pump-bump
Bondy prominence on posterior aspect of the calcaneus.
Problems wearing shoes, but no pain otherwise. |
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|
Term
|
Definition
Hyperkeratosis (callous formation due to pressure or friction)
Prominence underneath callus due to contraction. Shoe gear irritation from pressure or friction. Trim down callous and modify shoes. |
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Term
|
Definition
Hyperkeratosis (callous formation due to pressure or friction)
Calous within interspace of toe. Interdigital callus or corn. Tend to be soft due to moisture btwn toes (4th webspace).
Caused by pressure (btwn head of 5th toe prox phalynx and base of 4th toe prox phalynx)or friction.
Trimmin helps, but better to put webspace between 4th and 5th to stabilize 4th toe after removin piece of bone. 5th bone can sit on top of foot if not stabled with syndactly |
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Term
|
Definition
Athlete's foot
Four types: Pappilous squamous type, moccassin, interdigital, vesicular.
Type of fungal infection |
|
|
Term
| What occurs when a patient has both interdigital tenia and a bacterial infection? |
|
Definition
| Two infections together cause skin sloughing and raw beefy tissue due to multiple infections occurring at the same time. |
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Term
|
Definition
| Diabetes, neuropathy, charcot arthropathy. |
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Term
|
Definition
| Malignant type of skin tumor. Tumors in lower extremity are more rare, but can still be encountered. |
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Term
|
Definition
Tenia infection (athlete's foot) of the nail.
Thickened, discoloration, brittle and irregular. Fungal nail infections. |
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Term
|
Definition
Ingrown toenail.
Caused by many things, but ends up happening that nail penetrates soft tissue around the border causing localized inflammation, but not necessarily infection.
In infected, perinicheum. |
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Term
|
Definition
| Inflammation to muscle or tendon |
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|
Term
|
Definition
| Inflammation to muscle or tendon |
|
|
Term
|
Definition
Ligament Injury.
Injury or inflammation to ligament structure. |
|
|
Term
| Difference between strain and sprain. |
|
Definition
Sprain: Able to palpate ligaments involved.
Strain: Less muscle strength and may not be possible to palpate ligament.
MRI will show what it is. |
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|
Term
Arthritis
Bursitis
Neuritis
Dermatitis |
|
Definition
Arthritis: Joint inflammation
Bursitis: Soft tissue sac inflammation
Neuritis: Nerve inflammation
Dermatitis: Skin inflammation |
|
|
Term
|
Definition
Type of neurogenic arthritis typical with diabetes and neuropathy.
Can occur within only a couple of weeks.
Blood flow demineralizes bone and combined neuropathy will cause fractured fragmentation to occur at location.
Can occur at any joints of the lower extremity. |
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Term
|
Definition
Typically metatarsal-phalangeal joints.
Uniform joint space narrowing, bone washout, errosive changes at metatarsal.
Causes deformities and contractures of digit. |
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|
Term
| Fat bed atrophy in rheumatoid arthritis |
|
Definition
At forefoot, will thin out or migrate putting individuals at risk for soft tissue breakdown.
Metatarsal heads more tender due to lack o ccushioning. |
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Term
|
Definition
Many different bursas, by achilles tendons.
Inflammation of fluid filled sack used as cushions. |
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|
Term
| Causes of pain at achilles tendon |
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Definition
| Can be bursitis, tendonitis, or small fracture of the bone. Differentiate |
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Term
|
Definition
Inflammatory process infecting the skin
Most common is contact dermatitis due to allergens coming in contact with the skin or from a type of adhesive. |
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Term
|
Definition
Soft tissue infection. Significantly red and looks inflamed.
Will be bacteria associated with inflammatory process making infection. |
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Term
|
Definition
Bone inflammation
Bone washout and changes underneath where bone is much narrower not continuous.
Patient may have ulceration associated, open wound with contaminents and infection and exposed bone will lead to osteomyelitis or bone infection. |
|
|
Term
|
Definition
NOT a medical emergency.
Due to poor circulation or lack of profusion to the soft tissues, digits are not profusin so no blood, nutrients, or oxygen.
Take surgery or work-up appropriately (send to vascular to find where occlussion is at or if it is fixable, bypass, or stent to improve circulation) possibly amputate. |
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|
Term
|
Definition
MEDICAL EMERGENCY
Large big black bulla on plantar aspect of foot. Dark changes in tissue in radiograph.
Anaerobic bacteria produce gas, will spread up the leg if not treated immediately.
Operating room that day and remove all tissue not profusing. |
|
|
Term
| Yearly diabetic amputations in US |
|
Definition
|
|
Term
| 25% of diabetic admissions |
|
Definition
|
|
Term
| How much annually, does treatment of foot complications cost the US healthcare system? |
|
Definition
|
|
Term
| Prevalence of diabetes in the US |
|
Definition
6% of population
10.4% older than 65
1 million new cases diagnosed yearly
90% type II
50% of type II diabetics are undiagnosed. |
|
|
Term
| Major diabetic complications |
|
Definition
Nephropathy: leading cause of kidney failure
Retinopathy: Leading cause of blindness
Neuropathy: Leading cause of amputation
Heart and Peripheral Vascular disease: Occurs at younger age
Immunosuppression |
|
|
Term
| Diabetic complications effect on healing |
|
Definition
Immunocompromised will cause infected open sore to have less redness or fever.
Nutritionally comprised will have problems with healing. |
|
|
Term
| Prevalence of extremity complications in diabetics |
|
Definition
15% lifetime risk of ulceration in diabetes
3% overall yearly risk of ulceration
7% yearly risk of ulceration if neuropathic
15-40 times greater risk of amputation
80% of foot amputations due to diabetic complications. |
|
|
Term
| Why do we trim toe nails? |
|
Definition
| to reduce amputation rates |
|
|
Term
| What is the goal of the U.S. Dept of health and human services |
|
Definition
| Reduce the extremity amputation rate in the diabetic population by 40% |
|
|
Term
| Benefits of reducing amputations |
|
Definition
Reduced patient morbidity and mortality
Limit healthcare expenditures |
|
|
Term
| Risk factors vs. Causal Factors |
|
Definition
| Risk factors increase the possibility of diabetic foot amputations while causal factors cause the need for amputation. |
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|
Term
| Risk factors for amputation |
|
Definition
Age
Diabetes duration
Gender
Smoking
Hyperglycemia
Microalbuminuria
Vascular risk factors |
|
|
Term
| Causal factors for amputation |
|
Definition
Neuropathy
PAOD (loss of blood flow)
Deformity
Trauma (may be microtrauma of walking on hurt foot every day) |
|
|
Term
| What are the most important risk factors for LE complications in diabetes? |
|
Definition
Diabetes > 10 years
Male
Poor diabetes control |
|
|
Term
| How is risk calculated or LE complications in diabetes? |
|
Definition
Cumulatively
1= 1.7x
2= 12.1
3= 36.4 |
|
|
Term
| Causal factors for ulceration |
|
Definition
Sensory neuropathy
Structural deformity
Trauma |
|
|
Term
| Causal Factors for amputation |
|
Definition
PAOD: most common reason for salvage failure
Infection: Most common reason for admission
Foot ulceration: Precedes 85% of amputations |
|
|
Term
| Risk factors for diabetes complications |
|
Definition
|
|
Term
|
Definition
Neuropathy
PAOD
Blindness
Kidney Disease
Heart Disease
Immuno-suppression |
|
|
Term
| Ulceration causal factors |
|
Definition
Neuropathy
Deformity
Trauma |
|
|
Term
| Amputation causal factors |
|
Definition
|
|
Term
|
Definition
Quantitative: Vibratory perception threshold, Semmes-Weinstein monofilament
Qualitative: Sharp-dull, vibration perception, light touch |
|
|
Term
| Semmes-Weinstein Monofilament |
|
Definition
| ADA recomends screeing all diabetic patients neurological status using 5.70 monofilament annually and quarterly. |
|
|
Term
|
Definition
S-W 5.07 Monofilament
10 standard sites on the foot.
Patient with eyes closed, reports location each time they feel the stimulus and the location.
Should be able to feel 7 out of 10 spots or risk developing ulcerations. |
|
|
Term
| Two forms of diabetic ulcer classification |
|
Definition
Wagner
university of Texas |
|
|
Term
| Which diabetic ulcer classification is better and why? |
|
Definition
| Univrsity of Texas since it has information about blood flow. |
|
|
Term
| Wagner Ulcer Classification: Grades 0-5 |
|
Definition
Grade 0: Pre-ulcerative lesion
Grade 1: Superficial, no subcutaneous involvement
Grade 2: Penetration through subcutaneous tissue (may expose bone, tendon, ligament, joint capsule) no abscess or osteomyelitis
Grade 3: Abscess or osteomyelitis
Grade 4: Gangrene of forefoot
Grade 5: Extensive gangrenous involvement of the foot. |
|
|
Term
|
Definition
Sprain: Ligament
Strain: Tendon |
|
|
Term
|
Definition
| Callus has black underneath is dry blood. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Superficial without subcutaneous involvement |
|
|
Term
|
Definition
| Penetration through subcutaneous tissue (may expose bone, tendon, ligament, joint capsule) |
|
|
Term
|
Definition
Osteitis, abscess, or osteomyelitis
cellulitis with abscess |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| University of Texas Wound Classification system |
|
Definition
Grade 0: pre- or post-ulcerative lesion completely epithiliazed
Grade 1: Superficial wound, not involving tendon, capsule, or bone.
Grade II: Wound penetrating to tendon or capsule
Grade III: Wound Penetrating to Bone or joint
Stage A: Wound
Stage B: Infected
Stage C: Ischemic
Stage D: Infected and ischemic. |
|
|
Term
| PAOD Screening: Risk factors |
|
Definition
Age
Genetics
Smoking
HTN
Heart Disease and stroke |
|
|
Term
|
Definition
Pedal pulses
Skin findings (no hair, shiny skin)
Hand held doppler (don't trust your hands)
Segmental pressures and waveforms |
|
|
Term
| Segmental Doppler Testing |
|
Definition
Uses doppler and a blood pressure cuff at multiple levels from the thigh to detect arterial blockage.
Toe pressures are most important predictor of healing
Toe waveforms are not helpful
ABI does not predict healing in the foot |
|
|
Term
| Should you soak ulcerations due to ischemia? |
|
Definition
|
|
Term
| Deformities that can be causal factors for ulcerations |
|
Definition
Stiffness
Equinus
Claw toes
Metatarsal Prominence
Bunions
Contractures |
|
|
Term
| Predicting Impending Ulcer |
|
Definition
Color changes
Dermal thermometry |
|
|
Term
|
Definition
First step in ulcer formation is repetitive trauma.
Trauma leads to skin inflammation
Increased skin temperature accompanies inflammation
>4 degree temperature indicates impending ulcer
Not a risk factor, but an indicator. |
|
|
Term
| How to classify foot risk. |
|
Definition
Identify risk factors
Identify causal factors
Identify history of ulcer/amputation
Assign patients to appropriate level of care |
|
|
Term
| IWGDF Risk Stratification |
|
Definition
FRG-0 No neuropathy, no deformity 0 risk check once a year
FRG-1 Neuropathy, no deformity, 1.7 risk, Check every six months
FRG-2 Neuropathy, deformity, 12.1 risk, check every three months
FRG-3 previous ulcer or amputation, 36.4 risk, frequently |
|
|
Term
| Amputation Prevention Team |
|
Definition
Screenings: Make diagnosis and identify those at risk
Education: Sugar control, life style modification and daily foot exams
Pressure Reduction: Shoes/Insoles/Bracing and correction of deformities
Debridement: Nails, Callus |
|
|
Term
| Podiatrists role in treating diabetes. |
|
Definition
Screening for complications
Treatment of ulcerations and infections
Preventative care/high risk care: Education, shoe gear, nail and callus debridement, treatment of deformities. |
|
|
Term
|
Definition
Extra-depth diabetic shoes with plastizote inserts
Camwalker
Post-op shoe
IPOS shoe
Heel off-loading shoe |
|
|
Term
|
Definition
| Through negative pressure, promotes angiogenesis. Pulls out gross stuff in wound. |
|
|
Term
| Secondary intention wound healing |
|
Definition
| Wound heals by granulation (from the inside out). Allows wound to heal on its own. |
|
|
Term
|
Definition
| Wound is excised and primarily closed |
|
|
Term
|
Definition
| Progressive condition characterized by joint dislocation, pathological fractures, and sever destruction of pedal architecture. |
|
|
Term
Charcot: Pathogenesis.
Two theories |
|
Definition
Neurotraumatic theory: Loss of pain sensation and proprioception combined with mechanical trauma to the foot
Neurovascular Theory: Joint destruction due to an autonomically stimulated vascular reflex causing periarticular osteopenia. Eccentric loading of the foot leads to microfractures, ligamentous laxity and bony destruction. |
|
|
Term
| Waldvogel Osteomyelitis Classification |
|
Definition
Type I: Hematogenous (spreads through blood stream)
Type II: Contiguous focus (direct innoculation)
Type III: OM associated with vascular disease (ischemia/lack of blood flow)
Type IV: Chronic |
|
|
Term
| Metatarsal Stress Fracture |
|
Definition
Overuse, insufficiency fracture
New bone formation cannot keep up with demands on bone.
Insufficient in osteoporosis, elderly |
|
|
Term
| Lesser Metatarsal Fracture (1-4) |
|
Definition
|
|
Term
| 5th Metatarsal Avulsion Fracture |
|
Definition
| Can occur from impact injury |
|
|
Term
|
Definition
Fracture of 5th Metatarsal bone
1/5-3 cm from 5th metatarsal-cuboid joint.
High rate of non-union due to poor vascular supply in region. |
|
|
Term
| Lisfranc's Fracture dislocation |
|
Definition
| Fracture at the metatarsal-cuneiform joints and/or metatarsal cuboid joints. |
|
|
Term
|
Definition
4 types
Avulsion (pull-off)
Tuberosity (medial side)
Body
Stress fracture |
|
|
Term
|
Definition
Two types
Avulsion (from calcaneo-cuboid joint ligament)
Compression |
|
|
Term
|
Definition
Osteochondral fracture (cartilage and bone attached to it in ankle joint)
Occurs in ankle fractures. |
|
|
Term
|
Definition
| Head, neck, body fractures |
|
|
Term
|
Definition
Vertical plane passing through the body from front to back.
Divides into right and left equal symmetrical halves. |
|
|
Term
|
Definition
| Vertical plane passing through body dividing into front and back assymetrical halves. |
|
|
Term
|
Definition
| Horizontal plane passing through the body dividing into upper and lower halves |
|
|
Term
|
Definition
Always perpindicular to the plane in which the motion takes place.
Axis in proximal part while motion takes place in distal part.
Line around which motion takes place |
|
|
Term
|
Definition
Vertical Axis perpindicular to ground.
Axis of transverse plane motion. |
|
|
Term
| Frontal-Sagittal Axis: Motion |
|
Definition
Abduction and adduction motions of the foot.
Internal and external motions of the leg. |
|
|
Term
|
Definition
Horizontal axis which passes from side to side in frontal and transverse plane.
Axis of sagittal plane motion. |
|
|
Term
| Frontal-Transverse Axis: Motion |
|
Definition
Dorsiflexion and plantarflexion of the foot
Flexion and extension of the leg. |
|
|
Term
|
Definition
Horizontal axis in sagittal and transverse planes and longitudinal axis of the foot.
Axis of frontal plane motion. |
|
|
Term
| Sagittal-Transverse Axs: Motion |
|
Definition
Inversion and eversion of the foot.
Abduction and adduction of the leg. |
|
|
Term
| Abduction: Axis terminology |
|
Definition
| Motion in the transverse plane around a vertical (frontal-sagittal) axis in which the distal aspect of the foot moves away from the midline of the body. |
|
|
Term
| Adduction: Axis terminology |
|
Definition
| Motion in the transverse plane around a vertical (frontal-sagittal) axis in which the distal aspect of the foot moves toward the midline of the body. |
|
|
Term
| Dorsiflexion: Axis terminology |
|
Definition
| Motion in the sagittal plane around a transverse-frontal axis in which the distal aspect of the foot moves dorsally or towards the tibia. |
|
|
Term
| Plantarflexin: Axis terminology |
|
Definition
| Motion in the sagittal plane around a transverse-frontal axis in which the distal aspect of the foot moves plantarly, or away from the tibia |
|
|
Term
| Inversion: Axis terminology |
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Definition
| Motion in the frontal plane around a transverse-sagittal axis in which the plantar surface of the foot moves toward the midline of the body. |
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Term
| Eversion: Axis Terminology |
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Definition
| A motion in which the frontal plane around a transverse-sagittal axis in which the plantar surface of the foot moves away from the midline of the body |
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Term
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Definition
Transverse plane motion is called internal and external rotation
Frontal plane motion is called abduction and adduction
Sagittal plane motion is called flexion and extension. |
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Term
| Open kinetic chain vs closed kinetic chain |
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Definition
Open: body is not bearing weight (swing face)
Closed: Weight bearing surface (hitting ground while walking) |
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Term
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Definition
Fixation of a part in position it would assume in adduction.
Transverse fixation with distal end displaced toward midline. |
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Term
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Definition
Fixation of a part in position it would assume in abduction.
Distal end displaced away from the midline. |
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Term
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Definition
Fixation of part in position it would assume if inverted.
Frontal plane fixation in which plantar surface it turned toward midline. |
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Term
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Definition
Fixation of part in position it would assume if everted.
Frontal plane fixation in which plantar surface is turned away from midline. |
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Term
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Definition
Fixation of foot or part in plantarflexed position.
Distal end farther away from tibia. |
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Term
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Definition
Fixation of foot or part in dorsiflexed position.
Distal end is closer to tibia. |
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Term
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Definition
| Hereditary defects that change the position of the entire foot. |
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Term
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Definition
Deviated 15 or 20 degrees from frontal plane.
80 or 75 degrees from sagittal plane.
10 degrees from transverse
Most resembles sagittal plane axis of motion
Should be zero degrees of frontal plane motion. |
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Term
|
Definition
Medial and lateral malleolus shift 15 degrees from frontal plane due to rotation of the tibia.
Ankle joint not designed for frontal plane motion. |
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Term
|
Definition
42 degrees from transverse plane
16 degrees from sagittal lane |
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Term
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Definition
Longitudinal axis: 15 degrees from transverse plane and 9 degrees from sagittal plane
Oblique axis: 52 degrees from transverse plane and 57 degrees from sagittal plane |
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Term
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Definition
45 degrees from from frontal and sagittal planes.
dorsiflexes and inverts or plantarflexes and everts.
little to no transverse plane motion. |
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Term
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Definition
| Broken into swing and stance phase. |
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Term
| What are conservative wound treatment measures? |
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Definition
| Debridement and medication |
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Term
| Considerations for ideal management of foot ulcers? |
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Definition
Glycemic management
Nutrition management
Wound care
Foot mechanics
Surgical considerations |
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Term
|
Definition
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Term
| Radiographic findings of Charcot arthropody |
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Definition
| Fracture, fragmentation, bone washout, bone loss |
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Term
| Why would a low white blood cell count be present with an infection? |
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Definition
Diabetes
Immunocompromised |
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Term
| What should the sed rate be? |
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Definition
| 8-12 (sedimentation rate) |
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Term
| Charcot Arthropody vs Osteomyelitis |
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Definition
White blood cell count, sed rate
Bone biopsy |
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Term
| How does charcot arthropody occur? |
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Definition
| Due to autonomic neuropathy. Small vessels will open leading to specific bloodflow, causes bones and minerals to wash out and cause breakdown of soft tissue. |
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Term
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Definition
Occurs less often
Termed diabetic osteolysis
Usually restricted to forefoot
Osteoporosis
Destruction and disappearance of bone substance
Hourglass resorption of phalangeal diaphysis
can be confused with osteomyelitis |
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Term
|
Definition
More common osteoarthropathy with Charcot
Resembling an acute fracture or severe osteoarthritis
usually affects midfoot region
marked osseus overgrowth and osteophytes
eburnation
sclerosis of affected joints |
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Term
| What do Tc-99m scans look for? |
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Definition
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Term
| What do gallium scans look for? |
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Definition
|
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Term
| When is Ceretec can "WBC Tc-99m" positive? |
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Definition
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Term
| When are indium scans positive? |
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Definition
| Acute osteomyelitis and acute cellulitis |
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Term
| What is the goal of charcot treatment? |
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Definition
| Prevention of further trauma |
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Term
| Acute stage charcot treatment |
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Definition
Absolute non-weight bearing
Cast immobilization
Elevation of affected extremity
Proper management of infected neurotrophic ulcers
Must take precautions for the contralateral limb
drugs that inhibit bone resorption
weekly x-rays should be taken |
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Term
| Late stage charcot treatment |
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Definition
Lis franc's arthrodesis
Triple arthrodesis
Pan met head resection
exostectomy
Tendo-achilles lengthening |
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Term
| Bilateral ulceration flap |
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Definition
| Move seismoids and make flaps from portions. Keeps all soft tissue connected. |
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Term
| What do Serutex scans show? |
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Definition
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Term
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Definition
| Amputation of the tissues distal to the talonavicular and calcaneocuboid joints. |
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Term
| Why does chopart amputation have a high failure rate? |
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Definition
| Development of equinovarus deformity resulting in difficulty with shoe gear and bracing, skin breakdown, infection, and the development of a need for a more proximal amputation. |
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Term
| What has changed to make Chopart's amputation more successful? |
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Definition
Transfer of anterior tibial tendon to the anterolateral portion of the talus.
Achilles tendon tenotomy or lengthening, and intramedullary nailing of th eankle and subtalar joints with or without arthrodesis. |
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Term
| When is Chopart's amputation a procedure of choice? |
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Definition
| When extensive forefoot gangrene or infection is associated with an intact hindfoot |
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Term
| Gold standard of treatment for osteomyelitis. |
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Definition
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Term
| What indicates a wound is most likely affected? |
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Definition
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Term
| How is necrotic tissue treated? |
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Definition
| Tissue resected and wound irrigated with sterile saline using pulsatile lavae. |
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Term
| What is a huge factor in determining where to amputate? |
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Definition
| Whether there are prosthetic devices available. |
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Term
| Why are antibiotic beads used? |
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Definition
| Gentamicin impregnated beads are used to treat area and prevent kidneys from being exposed to high doses of antibiotics. |
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Term
| How do you know when a Jackson-Pratt drain is working? |
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Definition
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Term
| What factors must a surgeon consider when making a decision on an amputation? |
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Definition
Adequacy of arterial perfusion
Extent and treatment of infection
Whether or not there will remain adequate soft tissue for coverage of wound stump.
Functional mechanics of amputation
Suitability of Specific orthoticic and/or prosthetic devices
Metabolic and cardiac benefits of a specific procedure
Individual psychological challenge |
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Term
| When does a frontal plane varus deformity occur in a Chopart amputation? |
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Definition
| When the rearfoot or ankle displays existing structural varus |
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Term
| What are the benefit's of Chopart's procedure in absence of varus deformity? |
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Definition
| Only the sagittal plane component needs to be addressed. |
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Term
| What occurs as the amputation level becomes more proximal? |
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Definition
The metabolic reserve has less capacity available to increase walking speed, walk uphill, or perform other tasks.
The reater the rate of oxygen consumption at normal walking speed |
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Term
|
Definition
Premature fusion of metatarsal physis
Most common in 4th metatarsal |
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Term
| Cause of brachymetatarsia |
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Definition
Idiopathic
Acquired (trauma, injury, surgery)
Congenital
Iatrogenic
Systemic syndromes |
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Term
| What gender is more affected by brachymetatarsia? |
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Definition
|
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Term
|
Definition
| Brachymetatarsia is more than one metatarsal involved |
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Term
| Clinical presentation of brachymetatarsia |
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Definition
Clinically sort metatarsal evident between ages of 4 and 15
Digit may dorsally displace over the adjacent metatarsal resulting in pain and tyloma formation.
Distressed about appearance.
Pain due to callus formation or incorrect weight bearing. |
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Term
| Treatment options for brachymetatarsia |
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Definition
Conservative: Accommodotative shoes, orthotics/padding, palliative care
Surgical: Amputation, syndactlylization, lengthening of shortened metatarsal, shortening of other metatarsals. |
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Term
| Surgical goals of brachymetatarsia surgery |
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Definition
Alleviate pain
Establish a cosmetically acceptable foot
Restore a functional metatarsal parabola. |
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Term
| Surgical options for brachy metatarsia |
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Definition
One-stage lengthening with autogenous or allogenic bone graft
Z-lengthening metatarsal osteotomy with screw fixation.
Callous distraction osteogenesis with external fixation (most common) |
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Term
| One-Stage Lengthening: Advantages |
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Definition
Shorter period of bony union (1.5 months/cm)
Less scar potential |
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Term
| One-stage Lengthening: Disadvantages |
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Definition
Donor site morbidity with autogenous graft
Possible neurovascular impairment (no matter how uninvasive)
Smaller length gain possible due to soft tissue tension
Longer NWB status (4 to 6 weeks) |
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Term
| Callus Distraction: Advantages |
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Definition
Early ambulation
No need for bone grafting
Easier tendon stretching
lesser neurovascular complications |
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Term
| Callus Distraction: Disadvantages |
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Definition
Scar potential
Longer time for bony consolidation
longer healing time
pin-tract infections (possible osteomyelitis) |
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Term
| Parameters for distraction |
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Definition
osteotomy versus corticotomy
level of osteotomies
latency period
rate and frequency o distraction
ossification period
postop management
complications |
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Term
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Definition
Corticotomy: Circumferentially drill holes around cortex, preserve the endosteum. Not much benefit.
Osteotomy: Technically easier requiring less dissection |
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Term
| Diaphyseal vs Metaphyseal Osteotomy |
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Definition
Diaphyseal: Pin placement is relatively easier and a periosteal sleeve can be created and resutured following osteotomy. Less metabolically active bone.
Metaphyseal Osteotomy: Greater diameter, increased osteogenic potential and greater amount of soft tissue coverage. Difficult manipulation and pin placement. |
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Term
| What is the ideal level of osteotomy? |
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Definition
| Metaphyseal/diaphyseal junction |
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Term
| Latency period before callous distraction begins. |
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Definition
| 5-7 days no matter what type of bone |
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Term
| Rate and Frequency of distraction |
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Definition
0.5mm daily total for small bone
0.25 mm every 6 hours (1mm/day) for larger bone (tibia) |
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Term
|
Definition
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Term
| Post-op management and ambulation for callous distraction |
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Definition
Limited weight bearing until full consolidation or full weight bearing once skin coaptation has been obtained.
Risk i relative to the strength of the external fixation construct, facial compliance, and facial weiht. |
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Term
| Complications of Callous distraction |
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Definition
Loss of joint motion-MPJ stiffness
Malalignment
Subluxation/dislocation
Delayed union or nonunion
Chronic edema
Neurovascular compromise
Pin site irritation/infection |
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Term
| What angle are pins placed in for callous distraction? |
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Definition
| 45 degree angle to plantar surface of the foot. |
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Term
| At what point do you see new bone formation in callous distraction |
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Definition
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|
Term
| At what point did complete regeneration and consolidation occur? |
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Definition
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|
Term
| How many ER visits per year are caused by lawnmower injuries? |
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Definition
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Term
| Are men or women more likely to be hospitalized for lawnmower injuries? |
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Definition
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Term
| Do riding lawn mower injuries or push mower injuries cause more damage? |
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Definition
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Term
| What safety protocols reduced lawnmower injuries? |
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Definition
Not allowing mower blades to engage in reverse on riding lawn mowers.
Not allowing mower blades to engage on riding mowers when driver not in seat.
Automatic stop on push mowers. |
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Term
| How are children injured in lawn mower injuries? |
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Definition
Falling off riding lawn mowers
Not being seen and getting run over |
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Term
|
Definition
Zone I: Toes
Zone II: Dorsal
Zone III: Plantar
Zone IV: Calcaneus
Zone V: Lower Leg |
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Term
| What zone of the foot has the most lawnmower injuries? |
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Definition
|
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Term
| What did all Zone I injury patients receive? |
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Definition
| Debridement and at least 1 liter saline |
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Term
| Recommendations for Lawnmower injuries by zone |
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Definition
Zone I: Primary Closure
Zone II: Primary closure, flaps and grafts may be necessary
Zone III: Usually not involved but may need flap coverage
Zone IV: Tendon and bone juries need surgical repair, greatest complication due to soft tissue breakdown, split at 90 degrees to prevent contracture
Zone V: Splint at 90 degrees to prevent contracture, surgical reduction may be necessary |
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Term
| Which zone is most difficult to heal in lawnmower injuries? |
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Definition
|
|
Term
| Gustilo and Anderson fracture classification |
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Definition
Type I: Puncture wounds <1cm with minimal contamination and muscle damage
Type II: Laceration >1cm with moderate soft tissue injury. Bone coverage adequate, comminution minimal.
Type IIIa: Heavily contaminated wounds with severe comminution. Extensive soft tissue damage with adequate soft tissue coverage.
Type IIIb: Periosteal stripping and exposed bone
Type IIIc: Extensive arterial injury |
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Term
| Antibiotics in lawnmower injuries |
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Definition
Should be given as soon as possible
Combo therapy (1st gen cephalosporin and aminoglycoside)
Farm injuries or anaerobic infcetions (Ampicillin, penicillin, or clindamycin should be included to prevent severe infection) |
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Term
| Use of cipro as antibiotic in lawnmower injuries |
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Definition
Effective as a single agent in type I and II to prevent against staph and strep.
Doesn't work alone in type III |
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Term
| Wound management in lawnmower injuries |
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Definition
Irrigation with at least 1 liter of saline
Debridement of nonviable contaminated soft tissue
Removal of free cortical bone fragments with no soft tissue attachments.
If wounds aren't irrigated and debrided within 6-8 hours then wait or 3-7 days to wait for bacteria to die. |
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Term
| What do you do when you see purple or dark tissue? |
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Definition
| Recognize that it is not healthy. Take it out. |
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Term
|
Definition
| Due to lack of intrinsic factor. Atrophied gastric mucosa will not be able to liberate B12 rom food due to a decrease of pepsin and acid, will cause decrease in DNA synthesis. Most common type of anemia. |
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Term
| What type of B12 deficiency is common in the elderly? |
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Definition
Atrophy of the gastric musoca called food-cobalamin malabsrption.
Clinical signs and symptoms are less severe due to its slow development.
Lack of B12 will lead to a defect in DNA synthesis, especially in cells with rapid turnover, like blood cells, which leads to anemia. |
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Term
| Why does B12 deficiency cause nerve damage? |
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Definition
It is an important cofactor in converting homocysteine to methionine. Methionine is needed for production of choline-containing phospholipids which are formed in the myelin sheath of nerves.
Without phospholipids, nerve transmission is impaired. |
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Term
| Spinal Cord and B12 deficiency |
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Definition
Lack of phospholipids in myelin sheaths causes "subacute combined degeneration of the spinal column", affects the posterior and lateral columns of the spinal cord.
Posterior column transmits vibration and position sense.
Lateral column coordinates voluntary movement-disorders and will cause stroke-like symptoms. |
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Term
| Treatment of B12 deficiency |
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Definition
Monthly IM injections 1000 micrograms of B12 or daily oral crystalline B12 at a dose of 1000-2000 micrograms.
Nromal daily requirement is 3 micrograms/day. Oral is effective because 1-5% of cobalamin absorbed passively along the intestine and does not need an intrinsic factor. |
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Term
| Goals of treating open fractures |
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Definition
Converting a contaminated wound into a clean wound
Restore function
Obtain cosmetic result if possible |
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Term
| Golden period for an open fractures. |
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Definition
| Less than six hours for the wound to be contaminated. Get to the OR immediately |
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Term
|
Definition
| Bone comes down throuh the skin |
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Term
|
Definition
Gas gangrene
Necrotizing fasciitis
Foot burns
Compartment syndrome (when fractures or injuries increase pressure due to inflammation or bleeding and cut off circulation.
Any fracture with a neurovascular compromise. |
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Term
| How are antibiotics currently treated |
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Definition
| For two or three days and then stop immediately when wound is clean |
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Term
|
Definition
Atraumatic technique: Get in, get out
Anatomic reduction: trying to put bone's back together anatomically
Rigid internal compression: Two different types of bone healing primary healing (rigidly fix with screws and plates to prevent callous formation) and secondary bone healing |
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Term
| What does callous formation with bones and plates indicate? |
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Definition
| Surgeon did not know what he was doing or the patient was noncompliant and walked all over the place |
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Term
|
Definition
Debride and irrigate wound
Remove bullet fragments that are easily visible, near neurovascular structures or in joints.
Stabilize any fractures.
Will need to be cleaned out. |
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