Introduction Simple Deformities Deformity Strong Muscle Weak Muscle Equinus Gastroc-soleus complex Dorsiflexors Cavus Plantar fascia, intrinsics Dorsiflexors Varus Posterior tib, anteiror tib Peroneal brevis Supination Anterior tibialis Peroneus longus Flatfoot Peroneus brevis Posterior tibial tendon Complex Deformities Deformity Strong Muscle Weak Muscle Equinovarus + supination Gastroc-soleus complex, posterior tibialis, anterior tibialis Peroneus brevis & longus Equinovalgus Gastroc-soleus complex, peroneals Posterior tibialis, anterior tibialis Calcaneovalgus Foot dorsiflexors/evertors (L4 and L5) Plantar flexors /inverters (S1 and S2) Introduction Equinovarus foot most common deformity following stroke use AFO and physical therapy for at least 6 months to await for possible neuro recovery overactivity of the tibialis anterior, with contributions from the FHL, FDL, and tibialis posterior treatment nonoperative AFO fitting physical therapy Phenol or botox injections surgical split anterior tibial tendon transfer (SPLATT) flexor hallucis longus tendon transfer to the dorsum of the foot and release of the flexor digitorum longus and brevis tendons at the base of each toe gastrocnemius or achilles lengthening Foot drop Inability to dorsiflex at the ankle and/or toes Commonly result from peroneal nerve palsy Multiple etiologies central nervous system (brain, spinal cord, nerve roots) peripheral nervous system (sciatic nerve, peroneal nerve) traumatic (knee dislocation, laceration, blunt trauma) compressive (compressive mass, deformity correction) systemic (diabetic polyneuropathy, mononeuropathy) Iatrogenic (laceration, casting, positioning, surgical injury) Mechanical (muscle debridement, tumor excision, etc.) Presentation - variable depending on location of nerve injury Motor Loss of ankle/toe dorsiflexion (DPN) Loss of ankle eversion (SPN) Sensory Loss of first dorsal webspace sensation (DPN) Loss of lateral leg/dorsal foot sensation (SPN) Treatment Nonoperative Observation AFO bracing Therapy - stretching and supple joints Operative Acute injury Laceration - repair, grafting, or nerve transfer Chronic injury Tendon transfer Posterior tibial tendon transfer to lateral cuneiform +/- gastroc or Achilles tendon lengthening Physical Exam Silfverskiöld test improved ankle dorsiflexion with knee flexed = gastrocnemius tightness equivalent ankle dorsiflexion with knee flexion and extension= achilles tightness
QUESTIONS 1 of 25 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ16.130) A 32-year-old woman presents to the orthopedic clinic complaining of heel pain, especially with running. She has had 3 months of reduced physical activity over the winter months and is now returning to running in the spring. She has tried physical therapy for months along with NSAIDs with minimal improvement. On examination, she is noted to have a painful plantar callus under her 1st metatarsal head. In knee extension, the ankle dorsiflexes to -5 degrees, whereas in knee flexion the ankle dorsiflexes to 10 degrees. What procedure most appropriately addresses her pathology? QID: 8892 Type & Select Correct Answer 1 Flexor hallucis longus (FHL)-to-Achilles transfer 2% (35/1934) 2 Hoke triple-cut Achilles lengthening 10% (200/1934) 3 Gasctrocnemius recession (Strayer procedure) 83% (1607/1934) 4 First metatarsal extension osteotomy 3% (53/1934) 5 Posterior ankle capsule release 1% (18/1934) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ15.211) A 42-year-old male presents with chronic plantar foot pain. The pain is worst when he wakes up, and remains persistent throughout his workday. Which of the following findings is an indication for gastrocnemius recession? QID: 5896 Type & Select Correct Answer 1 A Silverskjold test demonstrates 10 degrees less than neutral with the knee in extension versus 10 degrees beyond neutral with the knee flexed 85% (3298/3871) 2 A Silverskjold test demonstrates 5 degrees of ankle dorsiflexion with the knee in extension, which does not change with the knee flexed. 9% (343/3871) 3 Persistent pain despite three months of rigorous physical therapy 5% (178/3871) 4 Flexible pes planovalgus 0% (19/3871) 5 A positive "too many toes" sign 0% (18/3871) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (SBQ12FA.35) A 21-year-old man suffered a traumatic laceration to his lateral right knee 2 years ago, causing a complete transection of the common peroneal nerve. Despite a nerve graft procedure at the time of injury, he has a persistent foot drop and an EMG showing no anterior or lateral compartment function. He has full strength in the deep and superficial posterior muscle compartments. He has been wearing an ankle-foot orthosis (AFO) but would like to discuss surgical methods to eliminate his need for an orthosis. Which of the following tendons in Figure A would be most optimal for a single-tendon transfer in this patient? QID: 3842 FIGURES: A Type & Select Correct Answer 1 A 4% (75/1774) 2 B 55% (983/1774) 3 C 14% (242/1774) 4 D 1% (18/1774) 5 E 25% (440/1774) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ10.193) Which of the following best describes the physical examination test demonstrated in Figure A? QID: 3285 FIGURES: A Type & Select Correct Answer 1 Silfverskiöld test used to differentiate gastrocnemius tightness from achilles tendon contracture 91% (3638/3977) 2 Thompson test used to differentiate soleus tightness from achilles tendon contracture 0% (14/3977) 3 Coleman test used to differentiate soleus tightness from achilles tendon contracture 1% (36/3977) 4 Silfverskiöld test to differentiate soleus tightness from achilles tendon contracture 6% (238/3977) 5 Thompson test to differentiate gastrocnemius tightness from achilles tendon contracture 1% (37/3977) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ04.112) A 54-year-old male with Protein C deficiency sustained a stroke 3 months ago with subsequent left sided weakness. The patient's skin is intact with no sign of ulcerations or callosities. His left foot is developing a varus deformity secondary to a spastic tibialis anterior. His ankle has a 5 degree plantar flexion deformity due to a gastrocnemius contracture which improves with knee flexion (positive Silverskiold test). The patient has an intrinsic minus foot with supple claw toes present. Which of the following is the most appropriate next step in management? QID: 1217 Type & Select Correct Answer 1 Gastrocnemius fascia lengthening (Strayer) procedure 16% (378/2367) 2 Split anterior tibial tendon transfer (SPLATT) 14% (342/2367) 3 Flexor hallucis longus tendon transfer to the dorsum of the foot and release of the flexor digitorum longus and brevis tendons at the base of each toe 10% (240/2367) 4 Fractional lengthening of the tibialis posterior 0% (11/2367) 5 Ankle foot orthosis (AFO) with physical therapy 58% (1384/2367) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (6) Podcasts (1) Login to View Community Videos Login to View Community Videos 30th Annual Baltimore Limb Deformity Course Equinus Correction with Hexapod Frame - Philip McClure, MD Philip McClure Foot & Ankle - Foot Muscle Forces & Deformities 4/11/2022 57 views 5.0 (1) Login to View Community Videos Login to View Community Videos 30th Annual Baltimore Limb Deformity Course Hyper-Equinus: Hexapod Long Bone Frame - John E. Herzenberg, MD John E. Herzenberg Foot & Ankle - Foot Muscle Forces & Deformities 4/11/2022 42 views 5.0 (1) Login to View Community Videos Login to View Community Videos 30th Annual Baltimore Limb Deformity Course Midfoot Deformity: Hexapod Butt Frame - John E. Herzenberg, MD John E. Herzenberg Foot & Ankle - Foot Muscle Forces & Deformities 4/11/2022 163 views 5.0 (3) Foot & Ankle⎪Foot Muscle Forces & Deformities Foot & Ankle - Foot Muscle Forces & Deformities Listen Now 19:27 min 11/5/2020 401 plays 4.5 (2) See More See Less
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