Cavovarus Foot Deformity Quiz & Flashcards

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Questions and Answers

What is the primary objective of the lecture on pes cavus?

To demonstrate the anatomic components of pes cavus deformity

To explain the etiologies of pes cavus foot (correct)

To provide an overview of the TEACH Act and Fair Use guidelines

To discuss the surgical options for pes cavus deformity

What is the purpose of the copyrighted material used in the presentation?

For commercial purposes

For educational purposes under the guidelines of Fair Use and the TEACH Act (correct)

For distribution to students not enrolled in the course

For personal use by the presenter

What is the consequence of unauthorized use of the presentation?

It is only a violation of the TEACH Act

It is permitted under Fair Use guidelines

It is a violation of the DMU Integrity Code and may also violate federal copyright protection laws (correct)

It is encouraged by the DMU Integrity Code

What is the role of Mathew Johnstone DPM, FACFAS, DABPM in the context of the lecture?

Assistant Professor at CPMS Des Moines University Signup and view all the answers

What is the name of the university associated with the lecture?

Des Moines University Signup and view all the answers

What is the primary function of the Peroneus Brevis muscle?

Plantarflexion and eversion of the foot Signup and view all the answers

What would be the result of a weakened Tibialis Anterior muscle?

Plantarflexion of the foot Signup and view all the answers

Which muscle is primarily responsible for plantarflexing the 1st metatarsal head?

Peroneus Longus Signup and view all the answers

What is the purpose of observing the locations of calluses on the foot?

To identify areas of high pressure and potential weakness Signup and view all the answers

How would you individually test the Tibialis Anterior muscle?

By dorsiflexing and inverting the foot against resistance Signup and view all the answers

What is the significance of watching the heels to see if they invert during a heel rise?

To assess the strength of the Triceps Surae muscle Signup and view all the answers

What is the primary goal of the STATT procedure?

To remove the inversion effect of the Tibialis Anterior Tendon Signup and view all the answers

In which type of patients is the STATT procedure particularly useful?

Post-CVA patients without functioning opposition muscle groups Signup and view all the answers

What is the purpose of the 'window' cut into the interosseous membrane during the PT transfer procedure?

To allow for the passage of the PT tendon through the IO membrane Signup and view all the answers

What is the result of transferring the PT tendon from a deforming inverter and plantarflexion force to a dorsiflexor force?

Conversion of the deforming force driving the cavus foot Signup and view all the answers

What is the primary goal of the PL to PB transfer?

To remove the PL as a deforming force Signup and view all the answers

What is the term for the PL to PB transfer procedure?

Anastomosis Signup and view all the answers

What is the primary indication for performing a lateralizing calcaneal osteotomy in the patient?

Prominent first metatarsal head and plantarflexed first ray Signup and view all the answers

What is the significance of the patient's ankle joint ROM being limited with the knee extended and flexed?

It is a sign of severe arthritis and nonreducible deformity Signup and view all the answers

What is the primary goal of performing a PL to PB transfer in the patient?

To correct the plantarflexed first ray and dorsiflexory deformity Signup and view all the answers

What is the significance of the patient's prominent first metatarsal head plantarly?

It is a sign of a plantarflexed first ray and dorsiflexory deformity Signup and view all the answers

What is the indication for performing a triple arthrodesis in the patient?

Severe arthritis and nonreducible deformity Signup and view all the answers

Which muscle compartment is weakened first in patients with CMT?

Anterior leg compartment Signup and view all the answers

What is the significance of the patient's inability to passively reduce the STJ to neutral?

It is a sign of severe arthritis and nonreducible deformity Signup and view all the answers

During which phase of gait is the extensor tendon most active?

Swing phase Signup and view all the answers

What type of osteotomy is shown in the image?

Cole osteotomy Signup and view all the answers

Which of the following is NOT a feature of CMT?

Weakness of the posterior leg compartment Signup and view all the answers

What is the name of the publication that discusses the clinical examination of children with cerebral palsy?

Indian Journal of Orthopedics Signup and view all the answers

What is the primary role of the extensor tendon substitution in CMT?

To aid in dorsiflexion of the foot Signup and view all the answers

What is the primary mechanism of flexor substitution in hammertoes?

Weakness of the triceps surae group leads to overpowered intrinsic toe stabilizer muscles Signup and view all the answers

What can be observed during the late-stance phase of gait in flexor substitution hammertoes?

Toe clawing due to flexor substitution Signup and view all the answers

What is the characteristic of extensor substitution hammertoes?

Overpowered extensor digitorum longus muscles leading to weakness of the intrinsic toe stabilizer muscles Signup and view all the answers

What is the significance of examining the metatarsal alignment in non-weight bearing?

To examine the forefoot for any abnormalities Signup and view all the answers

What is the characteristic of hammertoe subgroups?

They describe the dynamic response of the muscles that are functioning Signup and view all the answers

What can be observed during the swing phase of gait in extensor substitution hammertoes?

Toe clawing due to extensor substitution Signup and view all the answers

What is the primary function of the Peroneus Longus muscle in relation to the first metatarsal?

Plantarflexion and eversion Signup and view all the answers

What would be the consequence of a weakened Tibialis Anterior muscle?

Overpronation of the foot Signup and view all the answers

What is the significance of observing the locations of calluses on the foot?

To identify areas of high pressure Signup and view all the answers

What is the purpose of the heel rise test during muscle testing?

To test the strength of the Triceps Surae muscle Signup and view all the answers

What is the primary indication for performing a muscle strength test on the Peroneus Brevis muscle?

To assess the contribution of the muscle to a cavus deformity Signup and view all the answers

What is the significance of noting the size and color of calluses on the foot?

To determine the severity of the deformity Signup and view all the answers

What is the main advantage of using the lateral half of the TA tendon in the STATT procedure?

It reduces the inversion effect of the TA Signup and view all the answers

What is the purpose of creating a 'window' in the interosseous membrane during the PT transfer procedure?

To guide the PT tendon subcutaneously to the lateral midfoot Signup and view all the answers

What is the outcome of transferring the PT tendon from a deforming inverter and plantarflexion force to a dorsiflexor force?

It converts the PT tendon to a dorsiflexor force Signup and view all the answers

What is the primary goal of the PL to PB transfer procedure?

To remove the PL as a deforming force Signup and view all the answers

What is the significance of transferring the PT tendon through the interosseous membrane in the OUT OF PHASE transfer?

It changes the direction of the PT tendon force Signup and view all the answers

What is the purpose of tagging the PT tendon with a long suture in the OUT OF PHASE transfer procedure?

To withdraw the PT tendon to the medial leg Signup and view all the answers

What is the primary indication for performing a Cole osteotomy?

Severely arthritic midfoot Signup and view all the answers

What is the function of the Dwyer calcaneal osteotomy?

To correct intrinsic varus of the calcaneus Signup and view all the answers

What is the purpose of the lateralizing calcaneal slide osteotomy?

To minimize the hindfoot moment arm Signup and view all the answers

What is the role of the triple arthrodesis procedure?

To correct severe combined cavovarus deformity with rigid deformity Signup and view all the answers

What is the significance of the Coleman block test?

To determine the need for calcaneal osteotomy Signup and view all the answers

What is the typical fixation method for the Cole osteotomy?

Traditionally, screws, but staples are also an option Signup and view all the answers

What is the primary goal of the Jones tenosuspension?

To restore the muscle balance in the foot Signup and view all the answers

In a patient with Charcot-Marie-Tooth disease, what is the primary goal of the Hibbs tenosuspension?

To restore the muscle imbalance Signup and view all the answers

What is the primary indication for performing a lateralizing calcaneal osteotomy?

To realign the calcaneus in a cavus foot Signup and view all the answers

Which of the following procedures is an in-phase tendon transfer?

Peroneus longus to Peroneus Brevis anastomosis Signup and view all the answers

What is the primary goal of the STATT procedure?

To restore the muscle balance in the foot Signup and view all the answers

In a patient with cavus foot, when would you expect the digital deformities to be most evident?

Just before heel off Signup and view all the answers

What is the primary characteristic of muscle weakness in patients with CMT?

Asymmetrical and affecting different muscle groups Signup and view all the answers

What is the primary functional consequence of intrinsic muscle weakness in the hand?

Long flexor and extensor act unopposed Signup and view all the answers

During a physical examination for pes cavus, what is the primary purpose of the 'peek-a-boo' heel sign?

To visualize the medial aspect of the heel Signup and view all the answers

What is the primary difference between muscle weakness in CMT and cerebral palsy?

CMT affects the peripheral nerves, while cerebral palsy affects the central nervous system Signup and view all the answers

What is the primary goal of tendon transfer procedures in patients with CMT or cerebral palsy?

To normalize muscle function and balance Signup and view all the answers

What is the primary indication for performing an osteotomy in patients with pes cavus?

To correct hindfoot varus Signup and view all the answers

What is the primary goal of the lateralizing calcaneal osteotomy in patients with CMT?

To realign the calcaneus and reduce the valgus deformity Signup and view all the answers

Which of the following tendon transfers is an in-phase transfer in patients with CMT?

Peroneus Longus to Peroneus Brevis anastomosis Signup and view all the answers

What is the primary goal of the Dwyer calcaneal osteotomy in patients with CMT?

To correct the calcaneal valgus deformity Signup and view all the answers

What is the primary mechanism of flexor substitution in hammertoes?

Flexor digitorum longus substitution Signup and view all the answers

Which muscle is primarily responsible for plantarflexing the 1st metatarsal head?

Peroneus Longus Signup and view all the answers

What is the result of transferring the PT tendon from a deforming inverter and plantarflexion force to a dorsiflexor force?

Correction of the muscle imbalance in the foot Signup and view all the answers

What is the primary mechanism of muscle weakness in patients with Charcot-Marie-Tooth disease?

Muscle weakness due to demyelination of peripheral nerves Signup and view all the answers

What is the primary goal of the Dwyer osteotomy in the treatment of cavus foot deformity?

To correct the varus alignment of the heel Signup and view all the answers

Which of the following muscle deficits is commonly seen in patients with cerebral palsy?

Weakened ankle dorsiflexors Signup and view all the answers

What is the primary indication for performing a PL to PB transfer in patients with CMT?

To improve ankle dorsiflexion strength Signup and view all the answers

What is the primary mechanism of flexor substitution in hammertoes?

Overactive flexor digitorum longus muscle Signup and view all the answers

What is the primary goal of the plantar fasciotomy procedure in the treatment of cavus foot deformity?

To lengthen the plantar fascia Signup and view all the answers

Study Notes

Etiologies and Clinical Examination

Cavus foot deformities arise from various etiologies requiring thorough evaluation.
Recognize symptoms like callusing, typically forming under the first and fifth metatarsal heads.
Assess calluses for size, color (hemorrhagic staining vs. uniform tan), and texture (nucleated or diffuse).
Muscle testing should guide identification of weaknesses, particularly of the peroneus brevis and tibialis anterior.
Use manual resistance to test muscle strength in plantarflexion, eversion, dorsiflexion, and inversion.

Muscle Weaknesses

Common weakness in pes cavus includes impaired function of the peroneus brevis, which opposes ankle inversion.
Tibialis anterior weakness results in poor dorsiflexion and supports an assessment of function in isolation.
The peroneus longus is another muscle to evaluate as it impacts the first metatarsal position.

Surgical and Conservative Treatments

Midfoot tendon transfers are integral in addressing muscle imbalances, particularly with surgical interventions like Hibbs tenosuspension or STATT.
Posterior tibial tendon transfer through the interosseous membrane corrects dorsiflexor deficits.
Cole osteotomy focuses on midfoot deformities; effective when the deformity apex is identified at the midfoot, often needing adjunct procedures like plantar fascia release.

Gait and Clinical Features

Observe gait patterns, noting if the patient struggles with toe clearance or exhibits significant hip drop.
Pay attention to metatarsal alignment during examination, especially when the heel is in neutral alignment.
Identify claw toes, hampered by muscle weaknesses leading to extensor or flexor substitutions.

Radiographic Analysis

Employ radiographic tools to quantify cavus foot deformities and guide surgical decisions.
Determine if surgical procedures such as the lateralizing calcaneal osteotomy or Dwyer procedure are necessary based on structural assessments.

Neuromuscular Associations

Recognize that cavus foot conditions are frequently linked to neuro-muscular diseases, with varying presentations.
Collect comprehensive patient histories to appreciate the nexus of symptoms in muscle function and deformities.
Intrinsic muscle function and its deterioration contribute significantly to overall foot mechanics and stability.

Surgical Decision Making

Analyze patient presentations and identify appropriate conservative treatments for types of cavus deformities.
Understand 'in phase' versus 'out of phase' tendon transfers - crucial for effective surgical correction.
Determine the specific goals of each surgical procedure, such as realigning or stabilizing joints, based on the patient's condition.
Develop a surgical plan by assessing all joint functionalities and necessary adjunctive procedures for optimal outcomes.

Key Questions for Clinical Evaluation

Identify and assess specific procedures based on visual cues from clinical examinations and radiographic imaging.
Recognize and evaluate the symptoms of neurogenic cavus and their manifestation throughout different phases of a patient's gait cycle.

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Description

Test your knowledge of pes cavus foot deformity, including its etiologies, clinical examination, anatomic components, and conservative and surgical treatment options. Learn about the diagnosis and management of this condition. Explore the basics of pes cavus foot and its treatment approaches.

Pes Cavus Foot Deformity: Etiology, Examination, and Treatment

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Questions and Answers

What is the primary objective of the lecture on pes cavus?

What is the purpose of the copyrighted material used in the presentation?

What is the consequence of unauthorized use of the presentation?

What is the role of Mathew Johnstone DPM, FACFAS, DABPM in the context of the lecture?

What is the name of the university associated with the lecture?

What is the primary function of the Peroneus Brevis muscle?

What would be the result of a weakened Tibialis Anterior muscle?

Which muscle is primarily responsible for plantarflexing the 1st metatarsal head?

What is the purpose of observing the locations of calluses on the foot?

How would you individually test the Tibialis Anterior muscle?

What is the significance of watching the heels to see if they invert during a heel rise?

What is the primary goal of the STATT procedure?

In which type of patients is the STATT procedure particularly useful?

What is the purpose of the 'window' cut into the interosseous membrane during the PT transfer procedure?

What is the result of transferring the PT tendon from a deforming inverter and plantarflexion force to a dorsiflexor force?

What is the primary goal of the PL to PB transfer?

What is the term for the PL to PB transfer procedure?

What is the primary indication for performing a lateralizing calcaneal osteotomy in the patient?

What is the significance of the patient's ankle joint ROM being limited with the knee extended and flexed?

What is the primary goal of performing a PL to PB transfer in the patient?

What is the significance of the patient's prominent first metatarsal head plantarly?

What is the indication for performing a triple arthrodesis in the patient?

Which muscle compartment is weakened first in patients with CMT?

What is the significance of the patient's inability to passively reduce the STJ to neutral?

During which phase of gait is the extensor tendon most active?

What type of osteotomy is shown in the image?

Which of the following is NOT a feature of CMT?

What is the name of the publication that discusses the clinical examination of children with cerebral palsy?

What is the primary role of the extensor tendon substitution in CMT?

What is the primary mechanism of flexor substitution in hammertoes?

What can be observed during the late-stance phase of gait in flexor substitution hammertoes?

What is the characteristic of extensor substitution hammertoes?

What is the significance of examining the metatarsal alignment in non-weight bearing?

What is the characteristic of hammertoe subgroups?

What can be observed during the swing phase of gait in extensor substitution hammertoes?

What is the primary function of the Peroneus Longus muscle in relation to the first metatarsal?

What would be the consequence of a weakened Tibialis Anterior muscle?

What is the significance of observing the locations of calluses on the foot?

What is the purpose of the heel rise test during muscle testing?

What is the primary indication for performing a muscle strength test on the Peroneus Brevis muscle?

What is the significance of noting the size and color of calluses on the foot?

What is the main advantage of using the lateral half of the TA tendon in the STATT procedure?

What is the purpose of creating a 'window' in the interosseous membrane during the PT transfer procedure?

What is the outcome of transferring the PT tendon from a deforming inverter and plantarflexion force to a dorsiflexor force?

What is the primary goal of the PL to PB transfer procedure?

What is the significance of transferring the PT tendon through the interosseous membrane in the OUT OF PHASE transfer?

What is the purpose of tagging the PT tendon with a long suture in the OUT OF PHASE transfer procedure?

What is the primary indication for performing a Cole osteotomy?

What is the function of the Dwyer calcaneal osteotomy?

What is the purpose of the lateralizing calcaneal slide osteotomy?

What is the role of the triple arthrodesis procedure?

What is the significance of the Coleman block test?

What is the typical fixation method for the Cole osteotomy?

What is the primary goal of the Jones tenosuspension?

In a patient with Charcot-Marie-Tooth disease, what is the primary goal of the Hibbs tenosuspension?

What is the primary indication for performing a lateralizing calcaneal osteotomy?

Which of the following procedures is an in-phase tendon transfer?

What is the primary goal of the STATT procedure?

In a patient with cavus foot, when would you expect the digital deformities to be most evident?

What is the primary characteristic of muscle weakness in patients with CMT?

What is the primary functional consequence of intrinsic muscle weakness in the hand?

During a physical examination for pes cavus, what is the primary purpose of the 'peek-a-boo' heel sign?

What is the primary difference between muscle weakness in CMT and cerebral palsy?

What is the primary goal of tendon transfer procedures in patients with CMT or cerebral palsy?

What is the primary indication for performing an osteotomy in patients with pes cavus?

What is the primary goal of the lateralizing calcaneal osteotomy in patients with CMT?

Which of the following tendon transfers is an in-phase transfer in patients with CMT?

What is the primary goal of the Dwyer calcaneal osteotomy in patients with CMT?

What is the primary mechanism of flexor substitution in hammertoes?

Which muscle is primarily responsible for plantarflexing the 1st metatarsal head?

What is the result of transferring the PT tendon from a deforming inverter and plantarflexion force to a dorsiflexor force?

What is the primary mechanism of muscle weakness in patients with Charcot-Marie-Tooth disease?

What is the primary goal of the Dwyer osteotomy in the treatment of cavus foot deformity?

Which of the following muscle deficits is commonly seen in patients with cerebral palsy?

What is the primary indication for performing a PL to PB transfer in patients with CMT?

What is the primary mechanism of flexor substitution in hammertoes?

What is the primary goal of the plantar fasciotomy procedure in the treatment of cavus foot deformity?