Foot & Ankle (2008-2019)

Question 1

1. 5 causes of adult cavovarus foot (2012, 2014)

Answer 1

(JAAOS - Adult Cavovarus Foot)

• CNS: CP, TBI, Stroke, MS, Tumors
• Spine/PNS: Myelomeningocele, syrinx, Diastematomyelia, polio, tumor, SMA, Hereditary neuropathy (CMT)
• Other: MD, Arthrogryposis, Compartment Syndrome, Burns
• Post traumatic
• Clubfoot residual
• Idiopathic

Question 2

2. What orthotic will you prescribe for a 16yo boy with a subtle cavus foot (4 points)? (2015)

Answer 2

o JAAOS 2014 - Subtle cavus foot: diagnosis and management

· Custom, full length, semi-rigid orthotic

· Recessed first ray

· Lateral hindfoot wedge or post

· Lowered medial arch

· Heel cushion

Question 3

3. List 6 clinical / pathoanatomic findings in the flexible adult flatfoot. (2016)

Question 4

4. List 4 inverters of the subtalar joint. (2014)

Answer 4

o Tib post

o Tib Ant

o FDL

o FHL

o Achilles

Question 5

5. Patient with flatfoot, 10 degree equinus contracture with knee straight, able to dorsiflex to 10 degrees with knee flexed

A) Achilles tendon is tight

B) Tibialis posterior is tight

C) Gastrocnemius is tight

D) Subtalar joint is stiff

Answer 5

ANSWER: C (Gastroc tight)

· 2008, 2013, 2016

· JAAOS 2014 - Triceps surae contracture

· The Silverskiold test differentiates an isolated gastrocnemius contracture from combine gastrocnemius and soleus contractures by assessing passive ankle dorsiflexion with the knee both flexed and extended

Question 6

6. Flexible Pes Planovalgus with no abduction. She is unable to do a single stance heel raise. What operation:

A) TN fusion

B) Triple fusion

C) FDL transfer with medializing calcaneal osteotomy

D) TP advancement

Answer 6

ANSWER: C (FDL transfer with med calc osteotomy)

· 2013

· JAAOS 2008 - Adult Acquired Flatfoot Deformity

Question 7

7. Middle age female with severe flat foot deformity acquired over last 2 years. What is the cause?
   a. Tarsal coalition
   b. Posterior tibial tendon dysfunction
   c. Charcot foot
   d. Ryan operated on it 2 years ago

Question 8

8. A patient with flexible flat feet undergoes lateral column lengthening through the anterior calcaneus. Which of the following is a complication of lateral column lengthening?
   a. Calcaneocuboid arthritis
   b. Subtalar instability
   c. Increased pressures and stress fracture of the sesamoids
   d. Pronation of the forefoot Lateral Column Lengthening Osteotomies.

Answer 8

ANSWER: A

· 2014, 2016

· JAAOS - Adult Acquired Flatfoot

· Lateral column lengthening provides correction to the abducted talonavicular joint and raises the arch

· It also decreases eversion and increases the pressure along the plantar lateral border of the foot

· Lengthening may result in lateral foot overload, fifth metatarsal stress fracture and significant stiffness

· Roche and Calder. Foot Ankle Clin N Am. 2012.

· Evans suggested preserving the joint through his osteotomy; however, studies have shown that the contact pressure generated across the calcaneocuboid joint after lengthening may actually rise, raising concerns that this may predispose to early degenerative change…They found that joint contact pressures were increased from baseline levels after Evans procedures by 111%. The addition of a medializing calcaneal osteotomy reduced this pressure increase to 93%.

§ Lots of biomechanical evidence for CC arthritis, little clinical evidence

· Neufeld SK (Foot and Ankle Clin 2001)

· Calcaneal lengthening osteotomies can results in over correction and result in excessive and fixed SUPINATION, thought to be a cause of lateral foot pain

· Overlengthening can cause metatarsocuboid arthritis or instability

· Moseir-LaClair S, Pomeroy G, Manoli II A. Intermediate follow-up on the double osteotomy and tendon transfer for stage II posterior tibial tendon insufficiency. Foot Ankle Int 22:283-291, 2001

· 14% CC arthritis (but 50% of cases had pre-existing arthritis)