First ray deformity

pod2ndyear's version from 2015-07-21 22:17

Hallux Abducto Valgus

Question Answer
Plane of deformityFrontal and transverse
genderwomen predisposition
describe deformityprogressive subluxion of first MPK during propulsion in G. 1st MTP inverts relative to hallux, and hallux moves in a valgus position
5 Etiologies1 hypermobile first ray (pronation)
2 RA (displace extensors and flexors tendon creates an ABDUCTORY force on hallux)
3 neuromuscular disease (abnormal pronation and intrinsic imbalance at 1st MTP)
4 Latrogenic (removal of medial sesamoid ruins pulley system)
5 shoe gear
structural HAV
positional HAV
MTP is congruent but ARTICULAR SURFACES are cause of deformity
4 stages of HAV development1-minor L sesmoid movment, lateral sublux of base of 1st prox phalanx visible AP x
2-MEDIAL BUMP, 1st presses on 2nd toe, unstable sesamoids L, tendon becomes L displaced
3-Widening of foot between 1st and 2nd met on APx, NEUROPATHY
4-dislocation of hallux, hallux overlaps 2nd, apropulsive gait, RA,
HAV treatmentNSAID
wider shoe
bunion spints
orthosis (beyond 12-13 orthoses isnt effective)
osteotomy and soft tissue repair (earliest in stage 2)
Hallux varusopposite to HAV

Metatarsas primus elevatus

Question Answer
Define MPElacking 1st ray PFion=inadequate 1st MPJ DFion=leaves 1st ray DFed
aquired MPE
5 Etiogies of MPE1 compensated RF varus
2 FF supinatus
3 Abnorm STJ pro
4 TA spasm and PL paresis
5 Latrogenic
3 clinical signs and symtoms with MPE1 w/ hallux limitus
2 dorsal prom/exostosis on 1st met head
3 HPK on 2nd met, IPJ hallux
compensations for MPESTJ pronation to get medial side to ground=cancaneus will end everted.

Hallux limitus/rigitus

Question Answer
Hallux limitus vs rigituslimitus-limited motion at 1st MTPJ and base of prox halux is subluxed platarly.
rigitus-no motion at 1st MTPJ
4 stages of hallux limitus/rigitus1 pre-hallux limitus (no DJD, normal ROM, no pain) NO
2 structural adaptation (pain, flat 1st met head dorsal exostosis and perpendicular lipping)
3 bone destruction (crepitus, joint space narrowing, osteophyte formation)
4 end stage (obliteration, osteophyte framentation, min ROM/total ankyloysis)
5 etiologies1 hypermobile first ray
2 excessively long first ray
3 DFed first ray
4 arthritis
5 paralysis of PL or TAspasm
7 clinical signs1st MPJ is SQUARE
COMPENSATION at joint most distal
decreased lenght in propulsion
HPK at platnar aspect of IPJ of hallux
toenail changes
compensationSTJ pronation
hyperextension of IPJ of hallux

PFed first ray

Question Answer
definea form of hypermobile first ray such that the first ray neutral position is PFed
5 etiologies1 congenital process
2 uncompensated RF varus
3 FF valgus
4 spastic PLand paralysis TA and GS
5 overcorrection of DFed first ray
symptomHPK submet 1-5
compensation1 DFion of first ray (flexible PFFR)
2 LMJA sup (rigid PFFR)
3 STJ sup can lead to pes cavus and OMJA sup
mechanical treatment for first ray deformitis in generalfunctional orthoses

5th ray deformities

Question Answer
pathomechanics of 5th rayuniaxial, triplanar, deviates mostly from frontal and sagittall planes
pronationDFion and ev
supinationPfion and in
axisproximal plantar lateral to distal dorsal medial

tailors bunion

Question Answer
causesabnormal pronation, abnormal foot types, congenital DF 5th ray, Congenital PFed 5th ray, idiopathic
clinical signsprom met head, adventitous bursa, HPK on met head, prom
x ray fidingsincreased angle, incrased deviation, dumbell, arthritic changes, rotation of lateral tubercle

PFed, DFed 5th ray, Splay foot

Question Answer
symtoms of PFed 5th rayfoot abnorm pronates, GFR against 5th met head increases and will DF 5th met head,
symptoms of DF 5th raymet head is above the transversr plane vs other mets (STJNP and MTJ max pro)=shear force between met head and inteior shoebox. X shoes saft of congenital DF 5th rya is not curved Lat
describe splay footprogressive abnorm transverse plane spreading of mets, large intermet angle b/t 1-2 and 4-5
etiology of splay footabnorm STJ pro ( sublux of rays at thier basal joints that articulate with navicular and cuboid)
pathomechanics of splaySTJ pro causes-decreased transverse arch, talus is med and plant, all mets are less stable
clinical findings vs X raywide forefoot, prom both bunions, digital deformities vs increased angles, 5th ray is more DFed and lat bowing of shaft
treatment for splayshoes, orthoses, surgery, bunion surgery

central ray disorders

Question Answer
normal vs abnormal parabola21345 vs long 23
abnormal parabola signslong mets lead to hallux limitus, digital deformities and HPK with nucleation
brachymetatarsashortening of mets b/c of closed growthplate
etiologiesmetabolic (ricktes) and endocrine (hypo thyroid and pituitiary trauma
define PFed and DFed lesser mets defomitiesPFed-met equinus associated with pes cavus. DFed-lesser mets
cause of abnomral lesser met head shapeavascular necrosis-locaized jnt pain, flate met head, flat prox phal base and hyertrophy of plantar condlyes-

digital disorders

Question Answer
Defineloss of nom balance of toe m. sagittal plane deformity. leads to hammer, mallet or claw
hammertoeDF prox phal, PF middle phal and extened distal phal
etiologies with HTPF defomrity of an met, loss of lumbrical, EDB, DEL, brachmetatarsia, FF valgus, abduction pressure from hallux, sublux pron 5th met, MPJ trauma
symtoms of HTHPK sup distal phal, ulcer lesion dorsal PIPJ
mallet toePF distal phal only
claw toeDF prox phal and PF middle and distal phal
hallux Interphalengeusdistal phal of hallux is deviated lat, can occur with HAV or alone, can be agrevated with valgus rot of hallux and shoes
digiti abductus and adductus deformtrasnversplane found at MPJ, PIPJ or DIPJ, congenital-at DIPJ or aquired. found with a sag plane deform
digit quinti varusloss of fxn of interossie and lumbricals from overstim of flexor tendons=overlaping og 5th and depressed met heads (just a congenital overlap
curly toe deformityflexors take over=curled and underlapping toe, 3-5 toes