role of pre-tibial muscles at the contact period of gait cycle includes:
(pre-tibial muscles = TA, EDL, EHL)
- absorb impact loads from the floor
- provide an unstable midtarsal joint for shock absorption and adaptation (mobile/unstable adaptor)
- decelerate pronation & provide even weight-bearing from the lateral to the medial side of the foot
- decelerate plantarflexion of the ankle
major clinical feature of:
primary adrenal insufficiency → adrenal crisis
major clinical features of adrenal crisis from primary adrenal insufficiency:
- plasma volume depletion → increased serum urea
- hypotension
- hyponatremia - because of mineralocorticoid deficiency, and due to inappropriate secretion of ADH (vasopressin) that is caused by cortisol (NOT aldosterone) deficiency → urinary sodium loss
- hyperkalemia -
- (resulting mainly from mineralocorticoid deficiency)
major clinical features of:
secondary or tertiary adrenal insufficiency (isolated glucocorticoid deficiency) → adrenal crisis
- decreases vascular tone → hypotension
- increased blood volume
- dilutional hyponatremia
- less urinary sodium lsos
- NO hyperkalemia
adrenal crisis is rarer in these patients, but can be triggered during acute stress, or with acute cortisol deficiency due to pituitary infarction or after surgical cure of Cushing’s syndrome
Congenital Vertical Talus
- presents as the talus fixed in a vertical position with hypoplasia of the talar neck and head
- navicular is dislocated and articulates with the dorsal aspect of the talar neck
- the tibionavicular and dorsal talonavicular ligaments are contracted preventing reduction of the navicular.
what is a true Jones fracture?
Type I Stewart Classification:
supra-articular fracture occurring at the metaphyseal-diaphyseal junction
MOI: fracture of the styloid process of the fifth metatarsal?
(styloid process = avulsion fracture = Stewart Type II)
MOI: usually involves a strong force applied by peroneus brevis tendon
Recall: the peroneus brevis tendon inserts on the styloid process of the 5th met → can cause fracture of the process w/ excessive traction applied to the bone by tendon
hallmark of dominant sagittal plane pronatory compensation
- The greater the angle formed between the axis and the plane of motion, the more motion is available in that plane.
- As the calcaneal inclination angle decreases, the sagittal plane compensation becomes more significant.
State Practice Act
set of laws by the state legislature that determines the extent to which a podiatric physician can practice
best SERUM BLOOD test for detecting muscle disorders?
Creatine phosphokinase is an enzyme found in heart, brain, and skeletal muscle tissue
It is used to detect muscle disorders in serum blood testing.
what neurologic pathways carry the sensory nerve fibers for position, vibration, and proprioception?
posterior column of the spinal cord
what is the best casting technique to allow best visualization of the neutral STJ position and the forefoot-to-rearfoot relationship?
prone suspension technique
With the prone suspension technique, the forefoot-to- rearfoot relationship can be visualized from behind, allowing the subtalar joint to be manipulated through its range of motion to help determine the joint’s neutral position.
digitalis:
Digitalis toxicity (DT) occurs when you take too much digitalis (also known as digoxin or digitoxin), a medication used to treat heart conditions.
Signs of toxicity include arrythmias, nausea, vomiting, and an irregular heartbeat.
involucrum vs sequestrum
- involucrum: new bone formed beneath an elevated periosteum surrounding necrotic bone in osteomyelitis
- sequestrum: a piece of devitalized (dead) bone that has been separated from the surrounding bone during the process of necrosis.
cloaca
an opening in an involucrum which allows drainage of purulent and necrotic material out of the dead bone. If the tract extends to the skin surface, the portion extending beyond the involucrum to the skin surface is called a sinus tract
orientation of talus on lateral WB view
in flexible flatfoot
a plantarflexed attitude of the talus
purpose of ultrasound therapy
Ultrasound therapy is used to treat enthesopathy, which is inflammation at the site of attachment of muscle tendons and ligaments to bones or joint capsules.
Ultrasound therapy reduces tightness and spasms, decreases inflammation, and assists in healing.
how to calculate mortality rate:
e.g. infant mortality rate
Infant mortality rate in a population is defined as the:
- # of deaths of children < 1 y/o during a year / divided by
- # of live births that year.
The rate is expressed per 1,000 live births.
nail pathology associated with Lichen Planus?
Pterygium:
is a result of scarring of the nail unit and subsequent adherence of the proximal nail fold to the nail bed
Lichen Planus
band-like inflammation and destruction of keratinocytes at the dermoepidermal junction; associated w/ HEPATITIS C
- pruritic, purple, polygonal, papules
- coalescing into plaques
- common on wrists and hands, or oral or genital mucosa
Tx: potent topical steroids, antihistamines, oral steroids, mucosal involvement is bad
to assess tibial varum, where should rearfoot be placed?
rearfoot should be in the neutral calcaneal stance position (NCSP)
to evaluate the inward angulation of the distal ⅓ of the shaft toward the midline int he frontal plane
what is Pentoxifylline used for?
tx of arterial insufficiency
After surgery for a dislocated hammer toe, the digit is still slightly dorsiflexed at the metatarsophalangeal joint, despite the fact that
a complete sequential reduction was performed. At the time of surgery, the podiatric physician should have done which of the following?
A complete sequential reduction will reduce the deformity, but the position must be maintained with temporary fixation to prevent redislocation
for dislocated HT correction → stabilize the digit to the base of the proximal phalanx and across the MTPJ with a kirschner wire
how does Lidocaine control premature ventricular contractions?
helps suppress ectopic ventricular rhythms by depressing automaticity which decreases the slope of phase IV depolarization
McBride steps:
McBride procedure is an important historical procedure for hallux valgus correction in which the sequence of steps is:
- medial capsulotomy,
- exostectomy,
- section of the deep transverse intermetatarsal ligament,
- release of the conjoined adductor tendon, and
- removal of the fibular sesamoid.
