ANATOMY
PHYSICAL EXAM
IMAGING
TREATMENT 1
MIX 1
MIX 2
100
The plantar plate is comprised of mainly...? (BE SPECIFIC)
Type 1 collagen (75%)
100
Signs of pre dislocation syndrome?
Rectus digit
Isolated plantar sulcus pain
100
This property of the 2nd metatarsal can be evaluated using plain film radiographs
Length of 2nd metatarsal
100
Osteotomy on metatarsal oriented dorsal distal to proximal plantar
Weil
100
Ford et al found transection of this structure markedly increased dorsal displacement of the digit by 74%
Plantar plate
100
Name 3 differential diagnoses for "pain in the ball of the foot"
- Neuroma
- Plantar plate pathology/predislocation syndrome
- Stress fracture
- Arthritis
- Capsulitis/synovitis
200
Name two anatomic structures that insert into the plantar plate.
- DTML
- Plantar fascia
- Capsular tissues
- Interossei tendons
- Flexor sheath
200
You need to assess plantar plate integrity, but patient has pain when you move the 2nd toe. Next step?
Local block
200
Gun barrel sign
200
Author's preferred treatment for plantar plate injury?
Dorsal approach for metatarsal osteotomy AND
Plantar approach for direct repair of plantar plate
200
Surgical treatment for end stage joint deformity at 2nd MPJ, especially after failed previous surgical treatment?
2nd MPJ fusion
200
Commonly accepted "normal" met parabola? (longest to shortest)
2 - 1 - 3 - 4 - 5
300
When repairing the plantar plate from plantar approach, these structures are retracted, revealing plantar plate directly underneath
Flexor tendons
300
Signs indicating there is a stress fracture in the metatarsal
Pinpoint tenderness to palpation of metatarsal shaft
Pain with tuning fork
300
Purpose of stress dorsiflexion during MRI?
To reduce false negative findings that may be seen by tear re-approximating in a relaxed position.
300
Type of osteotomy to treat Freibergs?
Dorsiflexory
300
When repairing plantar plate directly, is absorbable or non-absorbable suture preferred?
NON absorbable
300
How to prevent floating toes after central ray surgery?
Bandaging toes in plantarflexion/splinting
400
Name one EXTRINSIC and one INTRINSIC anatomic elements affecting the 2nd MPJ.
Extrinsic
- EDL
- FDL
Intrinsic
- Two dorsal interossei
- Lumbricals
400
How to perform Kelikian push up test? What is it testing?
Non weight bearing
Apply dorsally directed force to plantar surface of met head
Tests flexible vs rigid digital deformity
400
Best imaging modality to assess plantar plate? (BE SPECIFIC!)
T3 MRI
400
When transverse plane deformity exists at the lesser MTPJ, consider ___________ __________ in the direction of the digital deformity to mitigate forces.
Displacement osteotomies
400
Group of people most commonly affected by 2nd MPJ pathology
Young females
400
What XR view would you obtain to visualize metatarsal elevation?
Axial view
500
Name the TWO arterial sources of blood supply to met head?
Dorsalis pedis -> dorsal metatarsal arteries
Posterior tibial -> plantar metatarsal arteries
500
SPECIFIC steps to perform Lachman test?
What indicates a POSITIVE test?
Dorsiflex toe 20-25 degrees
Apply vertical stress to toe
Stabilize rest of forefoot
>5mm dorsal translation of joint = POSTIVE
500
There us a 2-5 times increased risk of plantar plate rupture if the following findings re observed on AP and lateral radiographs: (3 items)
1. IM > 12 degrees
2. Medial deviation of 2nd digit
3. Elongated 2nd metatarsal
500
Tendon used for interposition into the joint when treating Freiberg's surgically?
EDB
500
Name of this test and what is it testing?
Bouche paper pull out test
Toe purchase on WB/strength of flexors
500
Indications for simply a plantar condylectomy of metatarsal?
No significant angular deformity
Exostosis present
Osteopenic bone