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DEX IOT DAY 4 TEST 2024 | MIDFOOT &
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What do you see during the single leg heel raise test that confirms flat foot? ------CORRECT ANSWER---------------Normally, the heel swings into varus position as it rises; when the PTT is insufficient, the heel fails to invert or the patient is unable to perform the maneuver. What happens to the heel in stage II disease during the test? ------ CORRECT ANSWER---------------Heel fails to invert or the patient is unable to perform the maneuver. What is the rotational deformity in stage II disease? ------CORRECT ANSWER---------------Hindfoot and heel valgus, mild in early stage II. What is the 'too many toes' sign in stage II disease? ------CORRECT ANSWER---------------Visualization of more than one lateral toe from behind during weight bearing. What are the three types of procedures for stage II disease? ------ CORRECT ANSWER---------------Soft tissue, bone, or both.
When are posterior tibial tendon débridement and reattachment options? --- ---CORRECT ANSWER---------------If the native tendon is functional and salvageable. What are the staples of soft-tissue repair in stage II disease? ------ CORRECT ANSWER---------------Tendon transfers using flexor hallucis longus or flexor digitorum longus tendon. What can the transferred tendon do in soft-tissue repair? ------CORRECT ANSWER---------------Work along with a diseased PTT or replace a completely torn one. What are other soft-tissue procedures for stage II disease? ------CORRECT ANSWER---------------Augmentation of the spring ligament and/or lengthening of the Achilles tendon. What is medializing calcaneal osteotomy? ------CORRECT ANSWER-------- -------A procedure used to treat AAFD by restoring Achilles alignment. Not usually done alone What is the goal of a medializing calcaneal osteotomy? ------CORRECT ANSWER---------------Restores Achilles alignment medial to the subtalar axis, allowing it to function as a hindfoot inverter, relieving strain on the native or reconstructed medial structures. What is subtalar hyperpronation? ------CORRECT ANSWER--------------- Excessive inward rolling of the foot.
What is an Evans osteotomy? ------CORRECT ANSWER---------------Lateral column lengthening procedure in the calcaneus What are the deformities found in stage III AAFD disease? ------CORRECT ANSWER---------------Irreducible deformities from stage II disease and the foot becomes inflexible leading to secondary midfoot arthrosis What is the result of fixed hindfoot valgus and lateral column shortening in stage III disease? ------CORRECT ANSWER---------------Symptoms shifting from medial to lateral foot. What is hindfoot impingement in stage III disease? ------CORRECT ANSWER---------------Deterioration of hindfoot valgus angle causing pain and osseous changes. What are the osseous changes in talocalcaneal impingement? ------ CORRECT ANSWER---------------Edema, cysts, and sclerosis where lateral talar process impacts calcaneus. What are the osseous changes in subfibular impingement? ------CORRECT ANSWER---------------Similar bone findings between distal fibula and lateral calcaneal wall.
What can subfibular impingement be associated with? ------CORRECT ANSWER---------------Soft-tissue fibrosis, bursa formation, and ligament/tendon entrapment. What can altered weight bearing lead to in stage III AAFD disease? ------ CORRECT ANSWER---------------Insufficiency fracture, commonly at distal fibula. What procedures may be needed in stage III AAFD disease? ------ CORRECT ANSWER---------------Lateral column-lengthening and medial stabilization. What do lateral column-lengthening procedures address in stage III AAFD disease? ------CORRECT ANSWER---------------Heel valgus and forefoot abduction. How do lateral column-lengthening procedures realign the foot? ------ CORRECT ANSWER---------------By derotating the hindfoot out of valgus. This relieves lateral impingement What are the two methods for lengthening in lateral column-lengthening procedures? ------CORRECT ANSWER---------------Opening calcaneal osteotomy with bone graft or calcaneocuboid distraction arthrodesis. What is triple arthrodesis used for in stage III AAFD disease? ------ CORRECT ANSWER---------------Fusing subtalar, talonavicular, and calcaneocuboid joints.
What procedure for stage IV AAFD becomes necessary if the foot is fixed in valgus or has substantial arthritis? ------CORRECT ANSWER--------------- Tibiotalar fusion What size screw kit is used for FDL transfer? ------CORRECT ANSWER----- ----------Either 4.75 or 5.5 x 15. What is done after marking the tendon during FDL transfer? ------ CORRECT ANSWER---------------Cut the extra suture and whipstitch the marked off area. What size drill is used during FDL transfer? ------CORRECT ANSWER------- --------5 or 5.5 mm. How should the tape be pulled during FDL transfer? ------CORRECT ANSWER---------------One limb dorsal to plantar and the other plantar to dorsal. Where should the button be loaded during FDL transfer? ------CORRECT ANSWER---------------On the dorsal aspect. What should be done after seating the tendon in the tunnel during FDL transfer? ------CORRECT ANSWER---------------Tie on top like distal bicep.
What is ProStop Arthroereisis? ------CORRECT ANSWER---------------An implant used to block displacement of the talus and reduce talonavicular joint valgus. What is flatfoot (pes planus)? ------CORRECT ANSWER--------------- Collapse of the medial longitudinal arch due to progression degeneration of the Posterior tibial tendon. If left untreated the deformity can advance into arthritis in the joints associated in the midfoot and hindfoot leading to fusion. What is the function of the Posterior tibial tendon (PTT)? ------CORRECT ANSWER---------------Maintain the talonavicular joint at the apex of the three arches. How does the foot change as the disorder progresses? ------CORRECT ANSWER---------------It becomes more rigid. What other structures can be damaged due to tendon dysfunction? ------ CORRECT ANSWER---------------Spring ligament, talocalcaneal ligaments, deltoid ligament, plantar fascia, and other soft-tissue structures. What is necessary for the development of the characteristic planovalgus deformity of AAFD? ------CORRECT ANSWER---------------Failure of multiple stabilizers, depressed plantar-flexed talus bone, hindfoot and/or midfoot valgus, and an everted flattened forefoot.
What is the talocalcaneal angle (kite angle)? ------CORRECT ANSWER----- ----------Angle between the line bisecting the head and neck of the talus and the line parallel to the lateral surface of the calcaneus What is the talus first metatarsal alignment axis? ------CORRECT ANSWER---------------Line drawn along the long axis of the talus, extended into the forefoot, its orientation compared with that of the first metatarsal shaft What is the talonavicular angle? ------CORRECT ANSWER--------------- Angle between the articular surface of the talar head and the articular surface of the proximal navicular bone What are the normal values for talocalcaneal angle (kite angle), talus first metatarsal alignment, talonavicular angle? ------CORRECT ANSWER--------
- ------>25 - 40, Talar axis angled slightly lateral to 1st met shaft, parallel (0). What starts the path towards flat foot deformity? ------CORRECT ANSWER---------------Swelling or slight tear of the PTT (Posterior Tibial Tendon). This is not enough to lead to substantial deformity on its own How does injury to a persons PTT lead to flat foot? ------CORRECT ANSWER---------------The injured PTT leads to increased strain on the other stabilizers of the ankle. This all combined can then lead to noticeable predictable deformity
What are the other stabilizers affected by flatfoot deformity? ------ CORRECT ANSWER---------------Spring ligament and talocalcaneal ligaments. What are the symptoms of stage I AAFD? ------CORRECT ANSWER--------- ------Posteromedial ankle pain, PTT tenderness, decreased endurance. Is alignment or function of the foot altered in stage 1 AAFD? ------ CORRECT ANSWER---------------No, there may be some swelling in patients with tenosynovitis however What is tenosynovitis? ------CORRECT ANSWER---------------Inflammation of a tendon and its synovial sheath Is tendon length normal in stage I AAFD? ------CORRECT ANSWER--------- ------Yes. What is the treatment for stage I AAFD? ------CORRECT ANSWER----------- ----Conservative treatment with medications, injections, and physical therapy. When is tenosynovectomy needed for stage I AAFD? ------CORRECT ANSWER---------------For recalcitrant disease.
What is used to fixate a medializing calcaneal osteotomy? ------CORRECT ANSWER---------------Two k wires and 7.0 compression screws. What is BioSync? ------CORRECT ANSWER---------------A porous titanium wedge that promotes bone and tissue ingrowth. In what procedures are Biosync wedges used? ------CORRECT ANSWER-- -------------Cotton or evans osteotomies How do you size the Biosync wedges ------CORRECT ANSWER--------------- There is a trial and it must be put in and fill the whole osteotomy without protrusion Features of Biosync wedges ------CORRECT ANSWER---------------Have screw holes in the center for fixation, Can add bone graft to center hole, can be used with plate Are their specific types of wedge for each type of osteotomy? ------ CORRECT ANSWER---------------Yes What are the platelet concentrations that the Angel System can deliver? ---- --CORRECT ANSWER---------------Platelet concentrations up to 18x baseline with custom leukocyte levels
What is the principle used by the Angel System to sort cells? ------ CORRECT ANSWER---------------Flow cytometry or light absorption by cells. How much blood can the Angel System process in one pass? ------ CORRECT ANSWER--------------- 40 - 180 ml. What are the components that the Angel System separates blood into? -----
- CORRECT ANSWER---------------PRP, PPP, and RBCs. What is the ratio of citrate anticoagulant used by the Angel System? ------ CORRECT ANSWER---------------1: What is the order in which the Angel System separates the components? -- ----CORRECT ANSWER---------------PPP - > PRP - > RBC. How long does it take for the Angel System to process 40 ml of blood? ------ CORRECT ANSWER---------------15 minutes. How long does it take for the Angel System to process 180 ml of blood? ---- --CORRECT ANSWER---------------26 minutes. How many 180 ml cycles can the Angel System do for one patient? ------ CORRECT ANSWER---------------3.
How can Interfyl be used? ------CORRECT ANSWER---------------As a flowable form or particulate form. What is the ratio of Interfyl to saline when rehydrating for the flowable form? ------CORRECT ANSWER---------------1:1. What does Interfyl promote when its used? ------CORRECT ANSWER------- --------Supports the transition from inflammatory stage to healing stage What does Biovance retain from the amniotic membrane? ------CORRECT ANSWER---------------The native collagen structure. What extracellular proteins does Biovance contain? ------CORRECT ANSWER---------------Collagen (I, III, IV, V, VII), elastin, glycosaminoglycans, fibronectin, laminin, and proteoglycans. What response does Biovance suppress and support? ------CORRECT ANSWER---------------Suppresses inflammatory response and supports anti- inflammatory response. How can Biovance be used? ------CORRECT ANSWER---------------As a cover, wrap, or barrier at surgical sites. What is SynoJoynt®? ------CORRECT ANSWER---------------High molecular weight sodium hyaluronate for knee pain.
What is the indication for SynoJoynt®? ------CORRECT ANSWER------------- --Treatment of knee pain from osteoarthritis for those who have failed to respond adequately to conservative nonpharmacologic therapy and simple analgesics. What is the composition of SynoJoynt®? ------CORRECT ANSWER---------- -----Non-crosslinked sodium hyaluronate derived from bacterial fermentation. What are the properties of SynoJoynt®? ------CORRECT ANSWER----------- ----Excellent safety, tolerability, lubrication of joint, and resistance to compression forces. What is the Achilles tendon? ------CORRECT ANSWER---------------Tendon formed by the gastrocnemius and soleus muscles attaches on the calcaneal tuberosity What is the function of the gastrocnemius muscle? ------CORRECT ANSWER---------------Flex the knee and plantar flex the ankle. What is the function of the soleus muscle? ------CORRECT ANSWER-------- -------Plantar flex the ankle. Where does the Achilles tendon attach? ------CORRECT ANSWER----------- ----Calcaneal tuberosity.
What is the order of suture colors in the PARS to Midsubstance speedbridge technique? ------CORRECT ANSWER---------------White - > Blue - > Green - > Green - > White Black. What should be done with the first needle in the PARS to Midsubstance speedbridge technique? ------CORRECT ANSWER---------------Leave it in the jig to secure the construct. What should be done while passing the needle in the PARS to Midsubstance speedbridge technique? ------CORRECT ANSWER------------- --Push on the tendon to ensure the needle goes through it. What should be present on either side in the PARS to Midsubstance speedbridge technique? ------CORRECT ANSWER---------------A green loop. How to form a krackow in the PARS to Midsubstance speedbridge technique? ------CORRECT ANSWER---------------Pass the blue suture under and around the two green twice and then through the loop on each side. Where should the incisions for calcaneal anchors be made in the PARS to Midsubstance speedbridge technique? ------CORRECT ANSWER------------- --1cm below the superior aspect of the posterior calcaneal tuberosity. What is the drill angle in the sagittal plane in the PARS to Midsubstance speedbridge technique? ------CORRECT ANSWER---------------45 degrees (move hand away from tendon).
What is the drill angle in the coronal plane in the PARS to Midsubstance speedbridge technique? ------CORRECT ANSWER---------------45 degrees (move hand up). What is the recommended range of plantar flexion for secure anchors? -----
- CORRECT ANSWER---------------10 to 15 degrees What are the steps for PARS to PARS? ------CORRECT ANSWER------------ ---Repeat passing steps, tension and tie sutures. What is the color coding for tying sutures in PARS to PARS? ------ CORRECT ANSWER---------------White back to white black, blue to blue, white to white. What is the technique for tying for the PARS to PARS technique ------ CORRECT ANSWER---------------First side is the stay stitch and will slide make sure to lock this down before tying the other side How many surgeon knots are needed for each side in PARS to PARS? -----
- CORRECT ANSWER---------------3 to 4. What is the ultimate load of the 1.3 Suture Tape in the PARS technique ---- --CORRECT ANSWER---------------59.8N.
