Hershey Board Certification Review

Outline Study Guide

by
Jonathan M. Singer, D.P.M.
Diplomate American Board of Podiatric Surgery
Fellow American College of Foot and Ankle Surgeons
Diplomate American Board of Podiatric Orthopedics & Primary Podiatric
Medicine
Fellow American College of Foot & Ankle Orthopedics & Medicine

Edited by
James Lawton, D.P.M., Gene K. Potter, D.P.M., Ph.D.,
and Samuel L. Deitch, D.P.M.

Contributors
Peter F. Kelly, D.P.M., Gene K. Potter, D.P.M., Ph.D.,
Steven J. Berlin, D.P.M., Steven Kravitz, D.P.M., Guido
LaPorta, D.P.M., M.S., James Lawton, D.P.M., Arthur E.
Helfand, D.P.M., Fredrick E. Youngblood, M.D., Douglas
Glod, D.P.M., Christopher E. Attinger, M.D., Libby Cone,
M.D., Edwin J. Juda, D.P.M., William H. Simon, D.P.M.,
John Walter, D.P.M.
© 1998 Pennsylvania Podiatric Medical Association
 Acknowledgements
William Goldfarb D.P.M. and Nancy Sullivan, for
supporting me and believing this book could be done

James Lawton D.P.M., and Gene Potter, D.P.M. for their

invaluable contributions in the general editing these
review notes

Jordon Fersel, M.D., for editing the chapters on

Anesthesia, and Emergency Medicine,

Deborah Wozniak, M.D., for editing the chapters on

Perioperative Management, Fluid Management, and
Postoperative Complications

Warren Joseph, D.P.M., and Steven Maffei, D.P.M. for

editing the chapter on Infectious Diseases

Steven Kravitz, D.P.M., for editing the chapter on

Biomechanics

George Vito, D.P.M. for editing the chapter on Internal

Fixation

Peter F. Kelly, D.P.M. for writing the chapter on Lasers

and Laser Physics

Gene K. Potter, D.P.M., Ph.D. and Steven Berlin, D.P.M.

for editing the chapters on Dermatology, Bone Tumors,
and Soft Tissue Tumors

Gene K. Potter, D.P.M., Ph.D., for proof reading, editing,

and adding his phenomenal talent to this book

Guido LaPorta, D.P.M., M.S. for writing the chapter on

Ankle Arthroscopy
 The Hershey Board Certification
Review Outline Study Guide
is prepared for distribution by the
Hershey Surgical Seminars Committee
Pennsylvania Podiatric Medical Association
Guido La Porta, D.P.M., General Chairman

Author: Jonathan M. Singer, D.P.M.

General Editor: James Lawton, D.P.M.
Copy/Content Editor: Gene K. Potter, D.P.M., Ph.D.
Cover Design: Marissa Singer
Coordinator: Nancy Sullivan
Published by the Pennsylvania Podiatric Medical Association
ISBN # 0-9639030-04

Copyright © 1998
Pennsylvania Podiatric Medical Association 757 Poplar Church
Road Camp Hill, Pennsylvania 17011 (800)-841-3668
All rights reserved

This book is protected by copyright. No part of this book may be reproduced

in any form or by any means, including photocopying, or utilized by any
information storage or retrieval system without written permission from the
copyright owner.

Accurate indications, adverse reactions, and dose schedules for drugs are
provided in this book, but It is possible that they may change. The reader is
urged to review the package information data of the manufacturers of the
medications mentioned.

The author has made every effort to ensure the accuracy of the information
herein. However, appropriate information sources should be consulted,
especially for new or unfamiliar procedures. It is the responsibility of every
practitioner to evaluate the appropriateness of a particular opinion in the
context of actual clinical situations and with consideration to new
developments. The author, editors, and publisher cannot be held responsible
for any typographical or other errors found In this book.

Printed in the United States of America.

 Table of Contents
Chapter 1: Emergency Medicine
Cardiopulmonary Resuscitation: page 2-3
Advanced Life Support: page 3-4
Office Emergencies: page 5-7
Medical Emergencies (Cardiac
Dysrhythmias): page 7-9
Summary of CPR: page 9
Other Medical Emergencies: page 9-12
Shock: page 12-13
Blood and Blood Products for Emergency
Use: page 13-17
Chapter 2: Anesthesia
Anesthesia Classifications: page 20
General Anesthesia: page 20-23
Intravenous Anesthesia: page 23
Local Anesthesia: page 23-26
Special Cases for Lowering the Maximum
Allowable Dose: page 26
Pediatric Anesthesia: page 26-27
Lumbar Epidural and Caudal
Anesthesia: page 27-28
Complications of Endotracheal Intubation:
page 31
Nerve Injury During Anesthesia: page 31-
32
Other Medical Compliccations From
Anesthesia: page 32-34
Chapter 3: Perioperative Management
The Healthy Patient: page 36
The Diabetic Patient: page 36-38
The Hypertensive Patient: page 38-39
The Patient on Steroid Therapy: page 39-
40
The Asthmatic Patient: page 40-41
The Alcoholic Patient: page 41
The Patient on Anticoagulant Therapy:
page 41-42
The Patient With Clotting Abnormalities:
page 42
The Rheumatoid Patient: page 43
The Sickle Cell Patient: page 43-44
The Cardiac Patient: page 44-45
The Pulmonary Disease Patient: page 45
Perioperative Management of the Infant
and Child: page 45-47
Mitral Valve Prolapse patient: page 47-48
The Gouty Arthritis Patient: page 48
Chapter 4: Preoperative Evaluation
Screening Procedures: page 50-61
Summary of Perioperative Lab testing:
page 61-62
Chapter 5: Postoperative Care &
Complications
Fever: page 64-65
Altered Mental States: page 65
Water and Electrolyte Imbalance: page 65-
66
Oliguria: page 66
Chest Pain: page 67
Postoperative Hypertension: page 67
Postoperative Infection: page 67-68
Anxiety and Pain Management: page 68-
69
Nausea: page 69
Constipation: page 69
Shivering: page 69
DVT: page 69-70
Compartment Syndrome: page 70-73
Hemorrhage: page 72-73
Septic Syndrome: page 73
Thyroid Storm: page 73-74
Chapter 6: infectious Diseases
Specific Diseases: page 76-81
Principles of Antiinfective Therapy: page
81-84
Antibiotics: page 84-90
Drug Fever: page 90-91
Specific Antimicrobial Therapy: page 91-92
Surgical Considerations: page 92-93
Necrotizing Infections: page 93-94
Osteomyelitis: page 94-102
Septic Arthritis: page 102
Mycology: page 102-103
Viral Diseases: page 104
Rickettsial Diseases: page 104
Protozoan and Metazoan Infections: page
104-105
Chapter 7: Wound Healing
Repair of Skin: page 108-111
Factors That Interfere With Wound
Healing: page 111-113
Growth Factors in Wound Repair: page 113
Surgical Approaches: page 113-114
Wound Dressings: page 114
Suture Materials and Needles: page 115-
116
Tourniquets: page 116-118
Chapter 8: Plastic Surgery
Skin Grafting: page 120-122
Local Cutaneous Flaps: page 122-124
Local Muscle and Cutaneous Flaps: Page
124
Fasciocutaneous Flaps: page 124-125
Microsurgery and Free Flaps: page 125-
126
Diagrams of Skin Flaps: page 126-130
Chapter 9: Bone Healing
Primary Bone Healing: page 132
Complications of Bone Healing: page 133-
135
Treatment of Nonunions: page 135
Fusion: page 135
Bone Grafting: page 135-137
Aseptic Necrosis Following 1st Metatarsal
Osteotomy: page 138-139
Electrical Bone Stimulation: page 40
Cartilage Healing: page 140
Chapter 10: Burns and Frostbite
Assessment and Treatment of Burns: page
142-145
Burn Deformities: page 145-146
Other Types of Burns: page 146
Frostbite: page 146-147
Chapter 11: Fluid Management and
Replacement in the Surgical Patient
Fluid Management: page 150-152
Complications of Total Parenteral
Nutrition: page 152
Replacement Therapy: page 152-153
Blood Products and Indications for Use:
page 153-156
Composition of IV Fluids: page156-157
Chapter 12: Bone Tumors
Introduction: page 160
Staging Techniques: page 160-161
Surgical Staging System: page 161
Radiology of Bone Tumors: page 161-162
Bone Tumors: Page 163-168
Cystic Lesions of Bone: page 168-169
Other Tumors and Cancers: page 169-170
Bone Tumors: A Quick Reference Chart:
page 170-171
Phases in Cancer Development: page 171
Benign vs. Malignant: page 172
Chapter 13: Dermatology
The Skin: page 174
Dermatological Lesions: page 175-182
Chapter 14: The Arthropathies
Causes of Joint Pain: A Summary: page
184
The Arthropathies: page 184-195
Lab Testing for the Arthropathies: page
195
Articular Disorders Affecting the Heel:
page 195-196
Synovial Fluid Analysis: page 197
Charcot Foot: page 198-199
Chapter 15: Peripheral Vascular Disease
Patient Evaluation: page 202-212
The Vascular Diseases: page 212-215
Chapter 16: Internal & External Fixation
Objectives of Fixation Devices: page 218
Requirements of Implant Materials: page
218
Principles Affecting Internal Fixation: page
218
Internal Fixation Devices: page 219-229
AO Objectives: page 229
AO Principles: page 229-230
AO Technique: page 230-235
Jumping Screws: page 235-236
Other Techniques: page 236-238
Complications of Fixation Devices: page
238
External Fixation: page 239
Large Bone Fixation: page 239-252
Small Bone External Fixation: page 253-
254
Chapter 17: Nail Disorders & Surgery
Nail Entities: page 256-260
Nail Anatomy: page 260
Surgical Nail Procedures: page 262-263
Chapter 18: Neurology
Neurological Pathways: page 266
Presenting Features: page 266-270
Assessment of Clinical Problems: page
270-278
Innervation of the Lower Extremity: page
278-281
Tarsal Tunnel Syndrome: page 282-284
Classification of Nerve Injuries: page 284-
285
Neuromuscular Causes of Cavus Foot:
page 285
Types of Nerve Surgery: page 285-288
Chapter 19: Pediatrics
Evaluation of the Pediatric Patient: page
290-293
Pedicatric Biomechanics-Normal Values:
Newborn to Adult: page 293
Congential Deformities: page 293-302
Pediatric Radiology: page 302-304
Pediatric Gait Patterns: page 304-305
Intoe Gait: page 306-307
Pediatric Fractures: page 307-318
The Limp in Childhood: page 318-319
Juvenile Hallux Valgus: page 319-320
Biomechanical Examination of the Child:
page 320-323
Corrective Casting Techniques in Infants:
page 323-324
The Toe-Walking Child: page 324-326

Chapter 20: Drugs and Drug Interactions
Introduction to Drug Interactions: page
328
Antibiotic Drug Interactions: page 328-329
Anticoagulant Drug Interactions: page 330
Antihypertensive Drug Interactions: page
330-331
Antipsychotic Drug Interactions: page 331
Cardiac Drug Interactions: page 331-332
Diuretic Drug Interactions: page 332
Non Steroidal Anti-Inflammatory Drug
Interactions: page 332-333
Oral Contraceptive Drug Interactions:
page 333
Mechanisms of Drug Interactions: page
333-335
Specific Drugs: page 335-344
Chapter 21: Surgery of the Congenital Foot
Flatfoot Surgery (flexible): page 346-355
Subtalar Joint Blocking Procedures:
(Arhroereises and Arthrodesis): page 355-
356
Flatfoot Surgery (rigid): Convex Pes Plano
Valgus: page 356-358
Metatarsus Adductus Surgery: page 358-
362
Cavus Foot Surgery: page 362-367
Clubfoot Surgery: page 368-373
Chapter 22: Generalized Disease
Conditions of Bone
Soft Tissue Overgrowth: page 376
Abnormalities of Alignment: page 376-377
General Increased Bone Density: page 377
Osteopenia: page 377-378
Marrow Abnormalities: page 378-
379
The Dysplasias: page 379-380
Chapter 23: Radiology
Standard Radiographic Techniques
of the Foot and Ankle: page 382-
383
Specific Radiographic Studies: page
383-391
Anatomic Angles: page 391-396
Common Structural Measurements
(Diagrams): page 396-402
Pediatric Radiology: page 402-406
The Osteochondritities: page 406-407
The Accessory Bones of the Foot:
page 407
Chapter 24: Hallux Valgus &
Related Disorders
Goals of HAV Surgery: page 410
Anatomical Facts of the 1st MPJ:
page 410-411
Predisposing Factors: page 412
Biomechanics: page 412-414
Etiology of HAV: page 414-415
Deformity Types: page 416-417
Radiological Measurements for HAV:
page 417-418
Physical Examination: page 418-419
Preoperative Considerations: page
419
Arthroplasty Procedures: page 419
420
Capsule-Tendon Balancing
Procedures: page 421-422
Implant Arthroplasty Procedures:
page 422-426
Arthrodesing Procedures: page 426
429
Proximal Phalangeal Osteotomies:
page 429-431
Distal Metatarsal Osteotomies: page
432-436
Proximal Metatarsal Osteotomies:
page 436-438
Shaft Osteotomies: page 438-439
Combination Procedures: page 439
Other Procedures: page 439-440
Hallux Rigidus and Limitus: page
440-445
Hallux Varus: page 445-446
Hallux Hammertoe: page 446
Diff. Diagnosis of Pain In the
Sesamoid Area: page 446
Complications of HAV Surgery: page
447
HAV Procedure Chart and Their
Indications: page 448
Chapter 25: Trauma
Medical Management and General
Assessment of the Trauma Patient:
page 450-451
Assessment of Lower Extremity
Injury: page 451
General Evaluation and Treatment
of Fractures: page 451-452
Calcaneal Fractures: page 452-460
Talar Fractures: page 460-463
Osteochondral Fractures: page 463
465
Navicular Fractures: page 466-470
Cuboid Fractures: page 470-472
Cuneiform Fractures: page 472
Fifth Metatarsal Base Fractures: page
472-474
Metatarsal Fractures: page 474-480
Ankle Fractures: page 480-493
Midtarsal Joint Dislocations: page 494
Tarsometatarsal Joint
Dislocations/Fractures: page 494-498
Ankle Inversion Sprain: page 498
505
Deltoid Ligament Ruptures: page
506-507
Compartment Syndrome: page 507
508
Open Fracture Classification System
and Tx: page 508-510
Soft Tissue Injuries: page 510-511
Crush, Gunshot, and Lawnmower
Injuries: page 511-512
Puncture Wounds: page 512
Epiphyseal Plate Injuries: page 512-514
Digital Fractures and Dislocations:
page 514-515
1st MPJ Trauma: page 516-517
Nail Bed Trauma: page 517-518
Toe Tip Injuries With Tissue Loss:
page 518-519
Dog and Cat Bites: page 519
Chapter 26: Digital Deformities
and Surgery
Hammertoe Syndrome: page 522-
528
Mallet Toe Syndrome: page 528-529
Claw Toe Deformity: page 529
Overlapping 5th Toe: page 529-532
Hallux Hammertoe: page 532-533
Lesser Digital Arthrodesis: page 533
Hallux Interphalangeal Arthrodesis:
page 533
Lesser Digital Arthrodesis: page 533-
534
Overlapping 2nd Toe: page 534
Syndactylization: page 534-535
Digital Implants: page 535-537
Floating Toe Syndrome: page 537
Blue Toe Syndrome: page 538-539
Polydactylism: page 539-541
Chapter 27: Muscle and Tendon
Pathology
Muscle Physiology: page 544-548
Principles of Tendon Repair: page
548-552
Tendon Lengthening and
Tenotomy: page 552-554
Tendon Transfers: page 554-556
Tendon Grafts: page 556-557
Posterior Tibial Tendon Rupture:
page 557-559
Posterior Tibial Tendon Dysfunction
(Acquired Adult Flatfoot Syndrome):
page 559-560
Peroneal Tendon Pathology: page
560-562
Achilles Tendon Rupture: page 562-
566
Lateral Ankle Stabilization
Procedures: page 566-571
Postoperative Care and Training
Following Tendon Transfer: page
571-572
Tenosynovitis: page 572
Chapter 28: Lesser Metatarsal
Surgery
Anatomy (Metatarsals 2-3-4): page
574-575
Differential Diagnosis of
Metatarsalgia: page 575
Surgical Treatment of the IPK: page
575-578
Lesser Metatarsal Joint Replacement:
page 578-579
Panmetatarsal Head Resection: page
579-581
Metatarsus Adductus: page 581-585
Freiberg's Disease: page 585-587
Tailor's Bunion: page 587-589
Splayfoot: page 589
Brachymetatarsia
(Brachymetetopody): page 589-591
Skewfoot: page 591-592
Chapter 29: Ankle Conditions
Differential Diagnosis of Chronic
Ankle Pain: page 594
Tarsal Tunnel Syndrome: page 594-
597
Sinus Tarsi Syndrome: page 597-
599
Peroneal Subluxation: page 599-
600
Ankle Arthrodesis: page 600-602
Lateral Ankle Instability: page 603
Chronic Lateral Ankle Instability:
page 604-607
Chronic Medial Ankle Instability:
page 607
Ankle Equinus: page 607-611
Malunion and Nonunion of the
Malleolei: page 611-614
Chapter 30: Heel Conditions
Anatomy of the Heel: page 616-617
Radiological Evaluation of the Calcaneus:
page 617-618
The Heel in Systemic Disease:
page 618-621
Seronegative Arthritis and Heel Pain:
page 621-622
Heel Spurs and Heel Spur
Syndrome: page 622-623
Tumors of the Heel: page 623-626
Tarsal Coalitions: page 626-629
Sever's Disease: page 629-630
Causes of Heel Pain (a summary):
page 630-631
Haglund's Deformity: page 631-632
Chapter 31: Amputations
General Surgical Technique: page
634
Digital Amputations: page 634-635
MPJ Amputations: page 635
Transmetatarsal Amputations: page
635-636
Tarsometatarsal Amputations
(Lisfranc's): page 637
Midfoot Amputations (Chopart's):
page 638
Amputation of the Ankle (Syme's,
Boyd, Pirogoff): page 638-639
Below Knee Amputation: page 639-
640
Physical Modalities and Diseases:
page 718-720
Therapeutic Modalities and
Procedures: page 720-730
Chapter 36: Arthroscopy
Ankle Arthroscopy: page 731-740
Chapter 37: Laser Applications in
Podiatric Surgery
Laser and Laser Physics:
page 741-751
Clinical Applications in Podiatric
Surgery: page 751-775
Chapter 38: Specific Radiological
Pathology
MRI Pathology: page 777-800

Chapter 32: Biomechanics

Normal Values: page 641
Criteria of Normalcy in the Lower
Extremity: page 642-643
Adult Biomechanical Examination:
page 643-645
Common Structural Variations: page
646-648
Planes of Motion: page 648-649
Axes of Joint Motion: page 649-653
Angular and Axial Deformities in
Children: page 654-656
Anatomy of Gait: Activity of Muscles:
page 656-663
Observation of Gait: page 663-664
Subtalar Joint Measurements: page
664-666
Subtalar Joint Function: page 666-
667
Midtarsal Joint Function: page 667-
668

Chapter 33: Anatomy

Neuroanatomy: page 670-676
Angiology: page 676-680
Myology: page 680-695
Arthrology: page 695-704

Chapter 34: Soft Tissue Tumors

Soft Tissue Tumors: page 706-715

Chapter 35: Physical Medicine

and Rehabilitation