Podiatry Boards Part 2
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Met adductus which limb is MC?
What is the term to describe a overly large medial cuneiform?
Atavistic medial cuneiform
What are some possible etiologies of met adductus (Unknown)?
- Atavistic medial cuneiform
- Intrauterine position
- Enviromental- sleeping on stomach
- Arrest in fetal development
- Muscle imbalance of abductor hallucis and insertion
- Tibialis anterior and posterior insertions
- absent medial cuneiform
What are some common subjective findings of met adductus?
- In toeing
- Lateral shoe wear
- Bunions and hammertoes
When do we see a skew foot?
Compensate met adductus foot
What else might we see with compensated met adductus?
What is the lichtblau test?
- Stabilize the heel
- Brace 5th met head
- Lateral pressure to the medial aspect of the 1st met head and will see a bowstring of the tight abductor hallucis
What is Engle's angle?
Bisection of the medial cuneiform and the 2nd met
What does the ankle of Kite do in Cavus foot and what does it do in a met adductus foot?
- Increases in a met adductus foot
- Decreases in a cavus foot
What is the clinical difference between met adductus and clubfoot?
Met adductus: Adducted FF, lateral navicular subluxation, hindfoot neutral/valgus, no equinus
Clubfoot: Adducted FF, medial navicular subluxation, hindfoot varus, equinus
When should you start stretching, casting and manipulation?
Immediantly up to until walking
What are some BIOMECHANICALLY SOUND braces that can be used?
- Ganley splint
- Bebax shoe
- Wheaton brace
What are some BIOMECHANICALLY UNSOUND braces?
- Reverse last shoe
- Denis-Brown Bar
- Fillauer Bar
When casting or conservatively fixing a met adductus, in what position should the heel be kept?
At what age is it too old to do a soft tissue procedure?
6 year old
What is the optimal age for ST procedure?
2 years old
What are some ST procedures?
LaPorta and Sokoloff: TP tendon lengthening with TN joint capsulotomy.
What was the ST procedure by Thomson?
Resect the abductor hallucis
What was the ST of lichtblau?
Modified thompson with complete or partial resection of the abductor hallucis muscle
What is the Berman and Gartland osseous procedure for met adductus?
- Crescentic osteotomy of the each met 6mm distal to the growth plate.
- Modified is abductory closing base wedge of all mets
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