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26 Cards in this Set
- Front
- Back
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What does a claw toe develop in patients with Charcot-Marie-Tooth?
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Flexor spasticity
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Why does a claw toe develop in patients with head injury?
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Extensor spasticity
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Why does a claw toe develop in patients with no obvious pathologic cause?
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Volar plate laxity
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What is the most common cause leading to the development of volar plate laxity?
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Second MTP joint synovitis
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What are two common clinical signs of second MTP synovitis?
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Swelling
Positive drawer test |
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If caught at an early phase, what two treatment options are available?
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Metatarsal bar
Stiff shoe |
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If these conservative measures fail, what two treatment options are available?
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Synovectomy
Capsular reconstruction |
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Regardless of etiology, what is teh sequence of five events tha results in the clinical development of a claw toe?
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Metatarsophalangeal joint extension
Dorsal interosseous muscle subluxation Extensor digitorum longus hyperextends the MTTP and cannot extend the proximal interphalangeal (PIP) joint or distal interphalangeal (DIP) joint Intrinsics slide dorsally and cannot flex the MTP Flexors flex the PIP and DIP |
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What are the three preferred treatments if the MTP joint is reducible?
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Plantar plate release
Collateral release Flexor to extensor tendon transfer |
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What is the preferred treatment if the MTP joint is irreducible? During this procedure, which structures must be preserved?
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Weil osteotomy
Mus take care to preserve collaterals |
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What are the two primary complications associated with Weil procedures?
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Recurrent dorsal contracture
Floating toe (extended toe because intrinsics slip dorsally) |
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Are transfer lesions commonly associated with Weil procedures?
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No, rarely
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A claw toe associated with a mallet toe may result in which clinical deformity?
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Crossover toe
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What is the preferred treatment in tthat clinical situation?
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Same as reducible/irreducible algorithm above
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For isolated fifth toe clawing (cock-up deformity), what is teh preferred treatment?
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Proximal phalangectomy (Ruiz-Mora procedure)
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If conservative treatment of mallet toe fails, then which procedure preferred at the joint? At flexor digitorum longus (FDL)?
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Dip joint arthrodesis or arthroplasty
FDL tenotomoy |
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If conservative treatment of hammer toe fails, then which procedure is preferred at the joint? At FDL?
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PIP arthrodesis or arthroplasty
FDL flexor to extensor tendon transfer |
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What is the surgical treatment of choice for curly toe?
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Flexor tenotomy
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What 4,5 intermetatarsal (IM) angle is considered normal?
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5 to 6 degrees
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If a normal IM angle is present, what is the preferred treatment for fifth toe bunionette?
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Metatarsal osteotomy is required.
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If IM angle is abnormal, how does the treatment differ?
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Metatarsal osteotomy is required
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What is the preferred fifth metatarsal osteotomy?
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Oblique diaphyseal osteotomy
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What type of metatarsal osteotomy must be avoided?
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Proximal osteotomies
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Quick review: Proximal osterotomies of the first metatarsal must be avoided in what patients?
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Hallux valgus patients with open physes
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What is the treatment of choice for a crossover fifth toe?
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Proximal phalanx excision
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In idiopathic plantar kerarosis, a discrete callus is usually due to pressure form what structures?
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Lateral condyle of metatarsal head
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