119 Questions
What is the result of articular damage on physical examination?
Crepitus
In which position are dorsiflexion and plantarflexion evaluated during physical examination of the 1st MTPJ?
Corrected position
What is the primary cause of tracking in the 1st MTPJ?
Lateral soft tissue contracture
What is the significance of hyperkeratotic lesions during physical examination of the foot?
They tell the story of how the foot is functioning
What is the anatomical characteristic of the first metatarsal head?
It has no tendinous attachments
What is the significance of the sub 1st metatarsal callus during physical examination?
It indicates plantarflexed first ray/hypertrophic sesamoid
What is the correlation between ballet dancing and forefoot pathology?
There is a strong correlation between ballet dancing and forefoot pathology
What is the ratio of male to female for elective surgical bunion correction?
1:15
What is the shape of the first metatarsal head that is most unstable?
Round
What is the primary reason for ligamentous laxity in females?
Hormonal changes
What is the typical age range for peak onset of bunion formation?
30-60 years
What is the relationship between excessive weightbearing and bunion formation?
There is no proven link between excessive weightbearing and bunion formation
What is the primary factor that contributes to first ray stability?
A congruent and stable 1st MTPJ during push off
Which of the following is an intrinsic factor that contributes to hallux abducto valgus?
Genetics
What is the relationship between shoe gear and hallux abducto valgus?
Shoe gear may speed up the progression of hallux abducto valgus
Which of the following is NOT a factor that contributes to first ray stability?
Footwear with a wide toe box
What is the significance of the metatarsal parabola in relation to hallux abducto valgus?
It is a risk factor for hallux abducto valgus
What is the role of excessive weightbearing in the development of hallux abducto valgus?
It is a contributing factor to the development of hallux abducto valgus
What is the term used to describe a modification of a biological structure where an ancestral genetic trait reappears after being lost through evolutionary change?
Atavism
Which of the following genetic factors contributes to the destabilization of the medial column and produces an elevation of the first metatarsal?
Pes planus
What is the term used to describe a short first metatarsal, which is often associated with hallux abducto valgus (HAV) deformity?
Morton foot
Which of the following genetic factors contributes to the loss of mechanical pull and locking mechanism in the foot?
Pes planus
What is the term used to describe the condition where the gastrocnemius muscle is tight, contributing to early and increased forefoot overload?
Equinus
Which of the following genetic factors is associated with a higher correlation of HAV deformity?
Morton foot
What is the initial stage of bunion formation?
Failure of the medial supporting structures of the metatarsophalangeal joint
What is the consequence of the metatarsal head sitting on the tibial sesamoid?
Erosion of cartilage and the median crista
What is the result of the balance between the abductor hallucis and the adductor hallucis being lost?
The plantomedial insertion of the abductor hallucis rotates inferiorly
What is the consequence of the weaker, dorsal capsule rotating medially?
Further joint instability
What is the final stage of bunion formation?
The metatarsal head elevates and transfers plantar pressures laterally
What is the staging of hallux abducto valgus based on?
First MTPJ alignment
What is the significance of crepitus during physical examination of the 1st MTPJ?
Articular damage
What is the primary cause of the inability to adduct the hallux during physical examination?
Lateral soft tissue contracture
In which plane of motion should the hallux interphalangeal joint be evaluated during physical examination?
Sagittal and transverse plane
What is the significance of pinch callus during physical examination?
Abnormal pronatory roll off
What is the anatomical characteristic of the first metatarsal head?
It has no tendinous attachments
In which position are dorsiflexion and plantarflexion evaluated during physical examination of the 1st MTPJ?
In the corrected position
What is the correlation between joint morphology and foot pathology?
They have a major role in the development of hallux abducto valgus
What is the primary reason for the correlation between age and bunion formation?
Biomechanical changes occur with age
What is the effect of ligamentous laxity on foot morphology?
It decreases the stability of the medial column
What is the shape of the first metatarsal head that is associated with stability?
Square
What is the correlation between pes planus and hallux abducto valgus?
They are directly correlated
What is the effect of relaxin and progesterone on ligamentous laxity?
They increase ligamentous laxity
Which of the following factors is NOT a primary contributor to first ray stability?
Excessive load
What is the role of footwear in the development of hallux abducto valgus?
It speeds up the progression of hallux abducto valgus
Which of the following is an example of an intrinsic factor that contributes to hallux abducto valgus?
Joint morphology
What is the relationship between sexual dimorphism and hallux abducto valgus?
Females are more likely to develop hallux abducto valgus due to their joint morphology
What is the significance of the first tarsometatarsal joint in relation to hallux abducto valgus?
It is a contributing factor to first ray stability
Which of the following is NOT a common extrinsic factor that contributes to hallux abducto valgus?
Sexual dimorphism
In a stage 1 hallux abducto valgus, what is the characteristic of the radiographic angles?
They are all normal
What is the characteristic of the 1st MTPJ in a stage 4 hallux abducto valgus?
It is subluxed
In a stage 2 hallux abducto valgus, what is the characteristic of the first metatarsal alignment?
It is normal
What is the characteristic of the hallux in all stages of hallux abducto valgus?
It is abducted
In a stage 3 hallux abducto valgus, what is the characteristic of the radiographic angles?
The intermetatarsal angle and the hallux abductus angle are abnormal
What is the primary factor used to stage hallux abducto valgus?
Radiographic angles
What is the consequence of the peroneus longus losing its function in the foot?
Loss of mechanical pull and locking mechanism
What is the relationship between equinus and hallux abducto valgus?
Equinus contributes to the development of hallux abducto valgus
What is the effect of a 'Morton Foot' on the foot's function?
It increases the correlation of hallux abducto valgus
How does ligamentous laxity contribute to bunion formation?
It plays a large role in bunion formation of both adults and juveniles
What is the result of the first ray becoming hypermobile?
It produces an elevation of the first metatarsal
What is the effect of pes planus on the foot's function?
It causes the foot to pronate and destabilizes the medial column
What is the Proximal Articular Set Angle (PASA) defined as?
The angle formed by a line perpendicular to the longitudinal bisection of the 1st metatarsal and the line formed by marking the medial and lateral aspects of the 1st metatarsal head cartilage
What is the reference value for the PASA?
0 – 8°
What is the purpose of drawing the longitudinal bisection of the 1st metatarsal?
To determine the PASA
What is the next step after drawing the line perpendicular to the longitudinal bisection of the 1st metatarsal?
Measure the PASA
What is the importance of the PASA?
It is used to assess the alignment of the 1st metatarsal head
What is the value of the PASA in this context?
24°
What is the consequence of not considering metatarsus adductus during bunion correction?
Under-correction of the bunion deformity
What is the formula to calculate the true intermetatarsal angle (IMA) if the MAA is greater than 15°?
IMA = (MAA - 15) + IMA
What is the normal range for the intermetatarsal angle (IMA)?
8-12
What is the significance of the metatarsus adductus angle (MAA)?
It can hide the severity of the bunion deformity
What is the definition of the intermetatarsal angle (IMA)?
The angle formed by the longitudinal bisection of the 1st and 2nd metatarsal
Why is it important to consider the metatarsus adductus angle (MAA) during bunion correction?
Because it can hide the severity of the bunion deformity
What is the significance of an increased PASA in procedure selection and efficacy?
It indicates the degree of articular cartilage deviation, which affects the suitability of certain procedures.
What is the definition of the DASA?
The angle formed by the longitudinal bisection of the proximal phalanx of the hallux and the line perpendicular to the medial and lateral aspects of the cartilage.
Which of the following angles is evaluated from the proximal phalanx of the hallux?
DASA
What is the significance of the DASA in evaluating the 1st MTPJ?
It evaluates the distal articular cartilage of the 1st MTPJ.
What is the relationship between the PASA and procedure selection?
A high PASA indicates that some procedures will work, while others will not, or may need to be modified.
What is the role of the DASA in evaluating the 1st MTPJ?
It evaluates the articular cartilage of the 1st MTPJ.
What is the anatomical structure that the longitudinal bisection of the proximal phalanx of the hallux intersects with in order to form the DASA?
Medial and lateral aspects of the cartilage of the proximal phalangeal base
What is the normal range of the DASA?
7-12°
How is the DASA measured?
By drawing the longitudinal bisection of the proximal phalanx and the line perpendicular to the distal cartilage line
What is the significance of the DASA in evaluating the alignment of the hallux?
It helps to diagnose hallux abducto valgus
What is the DASA used to evaluate?
The alignment of the hallux
What is the correlation between the length of the 1st metatarsal and function?
Direct correlation
What is the characteristic of the joint lines in a congruous joint?
Parallel
What is the shape of the metatarsal head that is considered most unstable?
Round
What is the term used to describe a modification of a biological structure where an ancestral genetic trait reappears?
Atavism
What is the effect of shortening the 1st metatarsal length on plantar pressures?
Abnormal pressure
What is the significance of medial cuneiform obliquity in relation to stability?
Unstable
What is the corresponding IMA value for a severe deformity?
> 16°
What is the correct formula to calculate the True IMA?
(MAA - 15) + IMA
What is the significance of the Hallux Abductus Angle (HAA) in surgical procedure selection?
It determines the degree of deformity
What is the reference value for a normal Hallux Abductus Angle (HAA)?
< 15°
What is the order of angles measured on the AP view, from proximal to distal?
MAA, PASA, IMA, HAA, DASA
What is the significance of the True IMA in surgical procedure selection?
It determines the degree of deformity and guides surgical procedure selection
What is the significance of metatarsus adductus in relation to bunion deformity?
It hides the true severity of the bunion deformity
How is the true intermetatarsal angle (IMA) calculated when the metatarsus adductus angle (MAA) is greater than 15°?
IMA = (MAA - 15) + IMA
What is the significance of the intermetatarsal angle (IMA) in evaluating the bunion deformity?
It is used to evaluate the severity of the bunion deformity
What is the reference value for a moderate deformity of the intermetatarsal angle (IMA)?
14-16°
What is the purpose of evaluating the metatarsus adductus angle (MAA) in relation to the bunion deformity?
To consider the correction of the bunion deformity
What is the impact of metatarsus adductus on the correction of the bunion deformity?
It limits the correction of the bunion deformity
What is the significance of the hallux abductus angle in relation to the first MTPJ?
Measures the degree of hallux deviation from the midline
Which angle is used to evaluate the proximal cartilage of the 1st MTPJ?
Proximal articular set angle
What is the anatomical structure that the longitudinal bisection of the proximal phalanx of the hallux intersects with to form the DASA?
First metatarsal head
What is the primary factor that contributes to the significance of the PASA in procedure selection?
It confirms the presence of a deformity independent of the 1st MTPJ
What is the significance of the intermetatarsal angle in relation to the 1st MTPJ?
Measures the degree of deviation between the 1st and 2nd metatarsals
What is the significance of the tibial sesamoid position in relation to the 1st MTPJ?
Measures the degree of medial deviation of the sesamoid
What is the purpose of measuring the Tibial Sesamoid Position?
To understand the relationship of the sesamoid bones to the 1st metatarsal
What is the significance of the Distal Articular Set Angle (DASA)?
It indicates the deformity within the proximal phalanx
What is the normal range for the Tibial Sesamoid Position?
1-3
What is the purpose of measuring the Intermetatarsal Angle (IMA)?
To measure the alignment of the metatarsals
What is the significance of the Proximal Articular Set Angle (PASA)?
It influences procedure selection
What is the purpose of measuring the Metatarsal Protrusion Distance (MPD)?
To measure the length of the 1st metatarsal
What is the Metatarsal Protrusion Distance (MPD) defined as?
The distance between the length of the 1st and second metatarsals
What is the reference value for the Metatarsal Protrusion Distance (MPD)?
5 mm +/- 2mm
What is the purpose of using a compass to draw a parabola in measuring the Metatarsal Protrusion Distance (MPD)?
To use the angle vertex as the point to draw the parabola
What is the significance of the Metatarsal Protrusion Distance (MPD) in evaluating the foot?
It evaluates the alignment of the metatarsals
How is the Metatarsal Protrusion Distance (MPD) measured?
By measuring the distance between the length of the 1st and second metatarsals
What is the importance of the Metatarsal Protrusion Distance (MPD) in relation to hallux abducto valgus?
It evaluates the alignment of the metatarsals and its significance in hallux abducto valgus
Test your knowledge on the physical examination of the 1st Metatarsophalangeal Joint (MTPJ), including the assessment of crepitus, axis of motion, and tracking. Evaluate your understanding of structural adaptations and lateral soft tissue contracture.
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