anatomy

Definition

Benign enlargement of the common digital branch

- usually 3rd webspace

Anatomy

Found at level of or just distal to MT heads

- deep to the deep transverse MT ligament

Epidemiology

Classically women between 40 and 60

Anatomy

Fascicles of long, spiraling bundles

- tenocytes & Type I collagen

- synovial cells & fibroblasts present

Endotenon 

- surrounds the individual collagen bundles

Epitenon

- fine fibrous outer layer, highly cellular, continuous with endotenon

- contains most of the blood vessels & capillaries

Anatomy

5 Annular pulleys

3 Cruciate pulleys

Pathology

A1 and A5 expendable

Loss of other annular pulleys can lead to bowstringing

- A2 & A4 +/- A3

Aetiology

Rock climbers

- usually when slipping

May hear or feel a pop

Develop swelling / tenderness / pain

Bowstringing

Anatomy

Osseous canal between talus and calcaneum

- interosseous talo-calcaneal ligament

- cervical ligament

- joint capsule

- nerve endings / arterial anastomoses

Aetiology

Flat foot / overpronation

Inversion / sprain

Pathology

Definition

Bunion

- medial prominence of head of 1st MT

Hallux Valgus

- medial deviation 1st MT

- lateral deviation of great toe

Anatomy

Metatarsal head

- has 2 grooves separating ridge (cristae)

Anatomy

3 facets

1.  Posterior facet (STJ)

2.  Middle facet (sustenaculum tali)

3.  Anterior facet (on distal medial aspect)

Anterior process 

- forms calcaneocuboid (CCJ) articulation

Thalamic portion 

- under lateral process talus

Tuberosities

Posterior tuberosity 

- posterior process / T Achilles attachment

Incidence

1 - 2 %

Anatomy

Medial Aspect of foot

- proximal to navicular

- part of T posterior tendon

Usually will fuse with navicular (50%)

Issues

1.  Probably not a cause of flat foot

- excising accessory navicular / rerouting / reattaching tibialis posterior

- will not help pes planus

2.  Pain

- may fracture

Definition

Repeated dislocation of patella with minimal trauma

- 15-20% of paediatric acute patella dislocations

- more common girls 

- often bilateral

Dislocation occurs unexpectedly when quadriceps contracted with knee in flexion 

Direction

Anatomy

Unusual anatomic convergence of ilium, pubis and ischium

- covered entirely by hyaline cartilage

- except at acetabular fossa, which is the site of attachment of the ligamentum teres

- deepened by peripheral fibrocartilage labrum

2 column theory (Letournel and Judet)

Anterior Column 

- superior pubic ramus

- anterior acetabular wall, anterior dome

Anatomy

Pelvis is a true ring

- any anterior fracture must have a posterior injury as well

- integrity of the posterior sacroiliac complex is key

Bony Anatomy

2 innominate bones + sacrum

Symphysis pubis < 5mm

SI joint 2-4 mm