Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

5. OITE > Foot & Ankle 2013 > Flashcards

Foot & Ankle 2013 Flashcards

1
Q
  1. A 49-year-old weekend athlete has a 4-week history of pain in his unilateral plantar heel that is most servere for the first 20 steps upon arising in the morning. He has an area of maximal tenderness 􀁕􀁈􀀃􀁉􀁒􀁕􀀃􀁗􀁋􀁈􀀃􀂿􀁕􀁖􀁗􀀃􀀕􀀓􀀃􀁖􀁗􀁈􀁓􀁖􀀃􀁘􀁓􀁒􀁑􀀃􀁄􀁕􀁌􀁖􀁌􀁑􀁊􀀃􀁌􀁑􀀃􀁗􀁋􀁈􀀃􀁐􀁒􀁕􀁑􀁌􀁑􀁊􀀑􀀃􀀃􀀫􀁈􀀃􀁋􀁄􀁖􀀃􀁄􀁑􀀃􀁄􀁕􀁈􀁄􀀃􀁒􀁉􀀃􀁐􀁄􀁛􀁌􀁐􀁄􀁏􀀃􀁗􀁈􀁑􀁇􀁈􀁕􀁑􀁈􀁖􀁖􀀃􀁒􀁑􀀃􀁗􀁋􀁈on the plantar medial aspect of the heel pad at the origin of the plantar fascia. He has only improved 30% after a 3-week course of physical therapy with toe intrinsic muscle strengthening and arch- and tendo-Achilles stretching. What is the best next treatment step?
  2. Release the plantar fascia.
  3. Inject the plantar fascia with platelet-rich plasma.
  4. Prescribe a night splint and continue physical therapy.
  5. Administer extracorporeal shockwave therapy to the heel.
  6. Perform a series of 3 steroid injections into the plantar fascia.
A
  1. Prescribe a night splint and continue physical therapy.

RECOMMENDED READINGS

Neufeld SK, Cerrato R. Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg. 2008 Jun;16(6):338-46. Review. PubMed PMID: 18524985.

League AC. Plantar heel pain. In: Pinzur MS, ed. Orthopaedic Knowledge Update: Foot and Ankle 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2008:341-349.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. Figures 16a and 16b are the radiographs of a 38-year-old carpenter with progressively worsening ankle pain; 14 years ago, he was involved in an all-terrain vehicle collision. Anti-inflammatory medication, corticostroid injections and bracing no longer effectively control his pain. The pain now interferes with his work and family responsibilities. Examination reveals an antalgic limp, varus deformity, limited ankle motion, limited eversion, and normal strength. Treatment should now consist of
  2. ankle arthrodesis.
  3. total ankle arthroplasty.
  4. distal tibia osteotomy.
  5. lateral ligament repair.
  6. deltoid ligament release.
A
  1. ankle arthrodesis.

RECOMMENDED READINGS

Saltzman CL. Ankle arthritis. In: Coughlin MJ, Mann RA, Saltzman CL, eds. Surgery of the Foot and Ankle. 8th ed. Philadelphia, PA: Mosby/Elsevier; 2007:923-983.

Easley ME, Adams SB Jr, Hembree WC, DeOrio JK. Results of total ankle arthroplasty. J Bone Joint Surg Am. 2011 Aug 3;93(15):1455-68. Review. PubMed PMID: 21915552.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  1. A 48-year-old woman had total knee arthroplasty. She is unable to “lift her toes or ankle to her nose.” After 2 months of physical therapy, she has a slapping gait. What is the best next treatment step?
  2. Ankle fusion
  3. Ankle-foot orthosis
  4. Sural nerve graft
  5. Medial heel post
  6. Laminectomy of L4/5
A
  1. Ankle-foot orthosis

RECOMMENDED READINGS

Yokoyama O, Sashika H, Hagiwara A, Yamamoto S, Yasui T. Kinematic effects on gait of a newly designed ankle-foot orthosis with oil damper resistance: a case series of 2 patients with hemiplegia. Arch Phys Med Rehabil. 2005 Jan;86(1):162-6. PubMed PMID: 15641008.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  1. Figures 46a through 46c are the CT scans of an 18-year-old who sustained an injury 3 weeks ago and now has ankle pain. Examination reveals an ankle effusion and painful range of motion. Recommended treatment should consist of
  2. transtalar drilling.
  3. fixation of the fragment.􀀃 􀀕􀀑􀀃􀀃􀀃􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁗􀁋􀁈􀀃􀁉􀁕􀁄􀁊􀁐􀁈􀁑􀁗􀀑
  4. osteochondral autograft.
  5. weight bearing in a boot with early range of motion.
  6. cast immobilization and nonweight-bearing activity for 6 weeks.
A
  1. fixation of the fragment.􀀃 􀀕􀀑􀀃􀀃􀀃􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁗􀁋􀁈􀀃􀁉􀁕􀁄􀁊􀁐􀁈􀁑􀁗􀀑

RECOMMENDED READINGS

Cuttica DJ, Smith WB, Hyer CF, Philbin TM, Berlet GC. Osteochondral lesions of the talus: predictors of clinical outcome. Foot Ankle Int. 2011 Nov;32(11):1045-51. PubMed PMID: 22338953.

Choi WJ, Park KK, Kim BS, Lee JW. Osteochondral lesion of the talus: is there a critical defect size for poor outcome? Am J Sports Med. 2009 Oct;37(10):1974-80. Epub 2009 Aug 4. PubMed PMID:

19654429.

Choi WJ, Kim BS, Lee JW. Osteochondral lesion of the talus: could age be an indication for arthroscopic treatment? Am J Sports Med. 2012 Feb;40(2):419-24. Epub 2011 Oct 7. PubMed PMID: 21984689.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
  1. A 47-year-old woman has a closed, displaced, Weber C bimalleolar ankle fracture. Past medical history

includes diabetes mellitus for 7 years controlled with diet and an oral hypoglycemic agent. Semmes-Weinstein sensory testing reveals absence of sensation to the 5.08/10-gm monofilament on the plantar aspect of both feet. The skin is intact with 2+ pedal pulses. Treatment should include

  1. open reduction with limited internal fixation.􀀃 􀀔􀀑􀀃􀀃􀀃􀀃􀁒􀁓􀁈􀁑􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁚􀁌􀁗􀁋􀀃􀁏􀁌􀁐􀁌􀁗􀁈􀁇􀀃􀁌􀁑􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀑
  2. closed reduction and application of an internal fixator.􀀃 􀀕􀀑􀀃􀀃􀀃􀀃􀁆􀁏􀁒􀁖􀁈􀁇􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁄􀁓􀁓􀁏􀁌􀁆􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁄􀁑􀀃􀁈􀁛􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁒􀁕􀀑
  3. closed reduction and total contact cast immobilization.
  4. retrograde intramedullary rod fixation with ankle fusion􀀃 􀀗􀀑􀀃􀀃􀀃􀀃􀁕􀁈􀁗􀁕􀁒􀁊􀁕􀁄􀁇􀁈􀀃􀁌􀁑􀁗􀁕􀁄􀁐􀁈􀁇􀁘􀁏􀁏􀁄􀁕􀁜􀀃􀁕􀁒􀁇􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁚􀁌􀁗􀁋􀀃􀁄􀁑􀁎􀁏􀁈􀀃􀁉􀁘􀁖􀁌􀁒􀁑􀀑
  5. internal fixation and an extended period of immobilization􀀃 􀀘􀀑􀀃􀀃􀀃􀀃􀁌􀁑􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁄􀁑􀀃􀁈􀁛􀁗􀁈􀁑􀁇􀁈􀁇􀀃􀁓􀁈􀁕􀁌􀁒􀁇􀀃􀁒􀁉􀀃􀁌􀁐􀁐􀁒􀁅􀁌􀁏􀁌􀁝􀁄􀁗􀁌􀁒􀁑􀀑
A

RECOMMENDED READINGS

Castro MD, Maurer JP: Fractures of the ankle. In: Pinzur MS, ed. Orthopaedic Knowledge Update: Foot and Ankle 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2008:59-73.

Jani MM, Ricci WM, Borrelli J Jr, Barrett SE, Johnson JE. A protocol for treatment of unstable ankle fractures using transarticular fixation in patients with diabetes mellitus and loss of protective sensibility. Foot Ankle Int. 2003 Nov;24(11):838-44. PubMed PMID: 14655888.

Johnson JE: Surgical treatment for neuropathic arthropathy of the foot and ankle. In: Trepman E, ed. Instructional Course Lectures Foot and Ankle. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2009:51-59.

Costigan W, Thordarson DB, Debnath UK. Operative management of ankle fractures in patients with diabetes mellitus. Foot Ankle Int. 2007 Jan;28(1):32-7. PubMed PMID: 17257535.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. Figures 68a and 68b are the clinical photographs of a 55-year-old woman who had a right hindfoot fusion 3 years ago for a pes planovalgus deformity. Since the surgery, she has had lateral hindfoot pain and places most of the weight-bearing load on the lateral border of her foot when walking. What is the most likely cause of her symptoms?
  2. Deltoid insufficiency􀀃 􀀔􀀑􀀃􀀃􀀃􀀃􀀧􀁈􀁏􀁗􀁒􀁌􀁇􀀃􀁌􀁑􀁖􀁘􀁉􀂿􀁆􀁌􀁈􀁑􀁆􀁜
  3. Excessive forefoot abduction
  4. Residual heel valgus
  5. Residual Achilles tendon contracture
  6. Malposition of the transverse tarsal joint
A
  1. Malposition of the transverse tarsal joint

RECOMMENDED READINGS

􀀭􀁒􀁋􀁑􀁖􀁒􀁑􀀃􀀭􀀨􀀏􀀃􀀼􀁘􀀃􀀭􀀵􀀑􀀃􀀤􀁕􀁗􀁋􀁕􀁒􀁇􀁈􀁖􀁌􀁖􀀃􀁗􀁈􀁆􀁋􀁑􀁌􀁔􀁘􀁈􀁖􀀃􀁌􀁑􀀃􀁗􀁋􀁈􀀃􀁐􀁄􀁑􀁄􀁊􀁈􀁐􀁈􀁑􀁗􀀃􀁒􀁉􀀃􀁖􀁗􀁄􀁊􀁈􀀃􀀬􀀬􀀃􀁄􀁑􀁇􀀃􀀬􀀬􀀬􀀃􀁄􀁆􀁔􀁘􀁌􀁕􀁈􀁇􀀃􀁄􀁇􀁘􀁏􀁗􀀃􀃀􀁄􀁗􀁉􀁒􀁒􀁗􀀃Johnson JE, Yu JR. Arthrodesis techniques in the managment of stage II and III acquired flatfoot deformity. Instr Course Lect. 2006;55:531-42. Review. PubMed PMID: 16958486.

Flemister AS Jr. Hindfoot osteoarthritis and fusion. In: Pinzur MS, ed. Orthopaedic Knowledge Update: Foot and Ankle 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2008:195-214.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  1. A 23-year old hiker experienced a twisting injury to his right ankle. 10 days ago. His dorsiflexion external rotation test is negative and he is able to hop on his right ankle, but he has pain over the anterior talofibular ligament. His peroneal strength is 4/5. What is the best next treatment step?
  2. A modified Bronstrom procedure􀀃 􀀔􀀑􀀃􀀃􀀃􀀃􀀤􀀃􀁐􀁒􀁇􀁌􀂿􀁈􀁇􀀃􀀥􀁕􀁒􀁖􀁗􀁕􀁒􀁐􀀃􀁓􀁕􀁒􀁆􀁈􀁇􀁘􀁕􀁈
  3. Rest, ice, compression, and elevation
  4. Physical therapy with proprioceptive training
  5. Casting of the right ankle in a neutral position
  6. Surgical arthroscopy of the right ankle with anterolateral ankle debridement
A
  1. Physical therapy with proprioceptive training

RECOMMENDED READINGS

Janssen KW, van Mechelen W, Verhagen EA. Ankles back in randomized controlled trial (ABrCt): braces versus neuromuscular exercises for the secondary prevention of ankle sprains. Design of a randomized controlled trial. BMC Musculoskelet Disord. 2011 Sep 27;12:210. PubMed PMID: 21951559.

Lin C. Proprioceptive training reduces the risk of ankle sprain recurrence in athletes. Aust J Physiother. 2009;55(4):283. PubMed PMID: 19929772.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. Abnormal gait attributable to deformity after partial-foot amputation through the talonavicular and calcaneocuboid joints is the result of the unbalanced pull of which structure?
  2. Achilles tendon
  3. Anterior tibialis
  4. Posterior tibialis
  5. Peroneus brevis
  6. Flexor digitorum longus
A
  1. Achilles tendon

RECOMMENDED READINGS

Ng VY, Berlet GC. Evolving techniques in foot and ankle amputation. J Am Acad Orthop Surg. 2010 Apr;18(4):223-35. Review. PubMed PMID: 20357231.

Early JS. Transmetatarsal and midfoot amputations. Clin Orthop Relat Res. 1999 Apr;(361):85-90. PubMed PMID: 10212600.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. Figures 92a and 92b are the current radiographs of a 47-year-old man with an 8-year history of diabetes mellitus treated for 3 months with total contact casting for an erythematous, swollen, warm foot without ulceration. He has had 2 episodes of plantar ulceration that have healed with repeat total contact casting. What is the best next treatment step?
  2. Midfoot osteotomy
  3. Reapplication of a total contact cast
  4. Achilles tendon lengthening procedure
  5. Needle biopsy for culture and sensitivity
  6. Application of an external bone growth stimulator
A
  1. Midfoot osteotomy

RECOMMENDED READINGS

Rogers LC, Frykberg RG, Armstrong DG, Boulton AJ, Edmonds M, Van GH, Hartemann A, Game F, Jeffcoate W, Jirkovska A, Jude E, Morbach S, Morrison WB, Pinzur M, Pitocco D, Sanders L, Wukich DK, Uccioli L. The Charcot foot in diabetes. Diabetes Care. 2011 Sep;34(9):2123-9. PubMed PMID: 21868781.

Pinzur MS. Current concepts review: Charcot arthropathy of the foot and ankle. Foot Ankle Int. 2007 Aug;28(8):952-9. Review. PubMed PMID: 17697664.

Pinzur MS, Sostak J. Surgical stabilization of nonplantigrade Charcot arthropathy of the midfoot. Am J Orthop (Belle Mead NJ). 2007 Jul;36(7):361-5. PubMed PMID: 17694183.

Philbin TM. The diabetic foot. In: Pinzur MS, ed. Orthopaedic Knowledge Update: Foot and Ankle 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2008:273-290.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. Figures 106a and 106b are the radiographs of a 36-year-old woman who had hallux valgus reconstruction 2 years ago. She has difficutly with shoe wear and pain with activity. Examination reveals moderate pain with range of motion and medial tightness at the hallux metatarsophalangeal joint. What is the recommended treatment?
  2. Keller resection arthroplasty
  3. Hallux metatarsophalangeal arthrodesis
  4. Distal metatarsal osteotomy
  5. Proximal metatarsal osteotomy with medial soft-tissue release
  6. Metatarsophalangeal reconstruction with extensor hallucis brevis transfer
A
  1. Hallux metatarsophalangeal arthrodesis

RECOMMENDED READINGS

Grimes JS, Coughlin MJ. First metatarsophalangeal joint arthrodesis as a treatment for failed hallux valgus surgery. Foot Ankle Int. 2006 Nov;27(11):887-93. PubMed PMID: 17144948.

Skalley TC, Myerson MS. The operative treatment of acquired hallux varus. Clin Orthop Relat Res. 1994 Sep;(306):183-91. PubMed PMID: 8070193.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. A 62-year-old woman with diabetes mellitus and neuropathy has had a plantar foot ulcer at the second metatarsal head for 2 months. Her dorsalis pedis pulse is palpable. Erythema surrounds the ulcer but there is no drainage. The metatarsal head is palpable with a cotton-tipped applicator placed in the wound. Treatment should consist of
  2. dressing changes.
  3. oral ciprofloxacin􀀃 􀀕􀀑􀀃􀀃􀀃􀀃􀁒􀁕􀁄􀁏􀀃􀁆􀁌􀁓􀁕􀁒􀃀􀁒􀁛􀁄􀁆􀁌􀁑􀀑
  4. total-contact casting.
  5. surgical debridement.
  6. transmetatarsal amputation.
A
  1. surgical debridement.

RECOMMENDED READINGS

Lavery LA, Armstrong DG, Peters EJ, Lipsky BA. Probe-to-bone test for diagnosing diabetic foot osteomyelitis: reliable or relic? Diabetes Care. 2007 Feb;30(2):270-4. PubMed PMID: 17259493.

Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW. Probing to bone in infected pedal ulcers. A clinical sign of underlying osteomyelitis in diabetic patients. JAMA. 1995 Mar 1;273(9):721-3. PubMed PMID: 7853630.

Pinzur MS, Slovenkai MP, Trepman E, Shields NN; Diabetes Committee of American Orthopaedic Foot and Ankle Society. Guidelines for diabetic foot care: recommendations endorsed by the Diabetes Committee of the American Orthopaedic Foot and Ankle Society. Foot Ankle Int. 2005 Jan;26(1):113-9. PubMed PMID: 15680122.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. Figures 146a and 146b are the MRI scans of a 67-year-old tennis player who has had intermittent pain in his posterior ankle for 15 years. He felt a “pop” while playing tennis 1 week ago and now has weakness and increased pain. What is the most appropriate surgical option?
  2. A mini-open primary Achilles repair
  3. An allograft reconstruction of the Achilles tendon
  4. A primary Achilles tendon repair reinforced with xenograft tissue
  5. A peroneus longus tendon transfer with Achilles tendon repair
  6. A flexor hallicus longus tendon transfer with Achilles tendon repair􀀃 􀀘􀀑􀀃􀀃􀀃􀀃􀀤􀀃􀃀􀁈􀁛􀁒􀁕􀀃􀁋􀁄􀁏􀁏􀁘􀁆􀁌􀁖􀀃􀁏􀁒􀁑􀁊􀁘􀁖􀀃􀁗􀁈􀁑􀁇􀁒􀁑􀀃􀁗􀁕􀁄􀁑􀁖􀁉􀁈􀁕􀀃􀁚􀁌􀁗􀁋􀀃􀀤􀁆􀁋􀁌􀁏􀁏􀁈􀁖􀀃􀁗􀁈􀁑􀁇􀁒􀁑􀀃􀁕􀁈􀁓􀁄􀁌􀁕
A
  1. A flexor hallicus longus tendon transfer with Achilles tendon repair􀀃 􀀘􀀑􀀃􀀃􀀃􀀃􀀤􀀃􀃀􀁈􀁛􀁒􀁕􀀃􀁋􀁄􀁏􀁏􀁘􀁆􀁌􀁖􀀃􀁏􀁒􀁑􀁊􀁘􀁖􀀃􀁗􀁈􀁑􀁇􀁒􀁑􀀃􀁗􀁕􀁄􀁑􀁖􀁉􀁈􀁕􀀃􀁚􀁌􀁗􀁋􀀃􀀤􀁆􀁋􀁌􀁏􀁏􀁈􀁖􀀃􀁗􀁈􀁑􀁇􀁒􀁑􀀃􀁕􀁈􀁓􀁄􀁌􀁕

RECOMMENDED READINGS

􀀤􀁕􀁄􀁖􀁗􀁘􀀃􀀰􀀫􀀏􀀃􀀳􀁄􀁕􀁗􀁕􀁌􀁇􀁊􀁈􀀃􀀵􀀏􀀃􀀦􀁕􀁒􀁆􀁒􀁐􀁅􀁈􀀃􀀤􀀏􀀃􀀶􀁒􀁏􀁄􀁑􀀃􀀰􀀑􀀃􀀧􀁈􀁗􀁈􀁕􀁐􀁌􀁑􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁒􀁓􀁗􀁌􀁐􀁄􀁏􀀃􀁖􀁆􀁕􀁈􀁚􀀃􀁓􀁒􀁖􀁌􀁗􀁌􀁒􀁑􀁌􀁑􀁊􀀃􀁌􀁑􀀃􀃀􀁈􀁛􀁒􀁕􀀃Arastu MH, Partridge R, Croombe A, SolanM. Dermination of optimal screw positioning in flexor hallucis longus tendon transfer for chronic tendoachilles rupture. Foot Ankle Surg. 2011 Jun;17(2):74-8. Epub 2010 Mar 7. PubMed PMID: 21549976.

Mahajan RH, Dalal RB. Flexor hallucis longus tendon transfer for reconstruction of chronically ruptured Achilles tendons. J Orthop Surg (Hong Kong). 2009 Aug;17(2):194-8. PubMed PMID: 19721151.

Den Hartog BD. Flexor hallucis longus transfer for chronic Achilles tendonosis. Foot Ankle Int. 2003 Mar;24(3):233-7. PubMed PMID: 12793486.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  1. Figures 157a through 157c are the radiographs and MRI scan of a 53-year-old woman who has had medial ankle pain and swelling for 7 months. Examination reveals a pes planovalgus deformity. The hindfoot and forefoot deformities are passively correctable. A single-limb toe raise on the affected leg reproduces her pain. Surgical treatment should consist of
  2. posterior tibialis tendon repair.
  3. posterior tibialis tendon debridement.
  4. flexor digitorum longus tendon transfer.
  5. triple arthrodesis and flexor digitorum longus tendon transfer.
  6. corrective osteotomies and flexor digitorum longus tendon transfer.􀀃 􀀖􀀑􀀃􀀃􀀃􀀃􀃀􀁈􀁛􀁒􀁕􀀃􀁇􀁌􀁊􀁌􀁗􀁒􀁕􀁘􀁐􀀃􀁏􀁒􀁑􀁊􀁘􀁖􀀃􀁗􀁈􀁑􀁇􀁒􀁑􀀃􀁗􀁕􀁄􀁑􀁖􀁉􀁈􀁕􀀑

􀀃 􀀗􀀑􀀃􀀃􀀃􀀃􀁗􀁕􀁌􀁓􀁏􀁈􀀃􀁄􀁕􀁗􀁋􀁕􀁒􀁇􀁈􀁖􀁌􀁖􀀃􀁄􀁑􀁇􀀃􀃀􀁈􀁛􀁒􀁕􀀃􀁇􀁌􀁊􀁌􀁗􀁒􀁕􀁘􀁐􀀃􀁏􀁒􀁑􀁊􀁘􀁖􀀃􀁗􀁈􀁑􀁇􀁒􀁑􀀃􀁗􀁕􀁄􀁑􀁖􀁉􀁈􀁕􀀑

􀀃 􀀘􀀑􀀃􀀃􀀃􀀃􀁆􀁒􀁕􀁕􀁈􀁆􀁗􀁌􀁙􀁈􀀃􀁒􀁖􀁗􀁈􀁒􀁗􀁒􀁐􀁌􀁈􀁖􀀃􀁄􀁑􀁇􀀃􀃀􀁈􀁛􀁒􀁕􀀃􀁇􀁌􀁊􀁌􀁗􀁒􀁕􀁘􀁐􀀃􀁏􀁒􀁑􀁊􀁘􀁖􀀃􀁗􀁈􀁑􀁇􀁒􀁑􀀃􀁗􀁕􀁄􀁑􀁖􀁉􀁈􀁕􀀑

A
  1. corrective osteotomies and flexor digitorum longus tendon transfer.􀀃 􀀖􀀑􀀃􀀃􀀃􀀃􀃀􀁈􀁛􀁒􀁕􀀃􀁇􀁌􀁊􀁌􀁗􀁒􀁕􀁘􀁐􀀃􀁏􀁒􀁑􀁊􀁘􀁖􀀃􀁗􀁈􀁑􀁇􀁒􀁑􀀃􀁗􀁕􀁄􀁑􀁖􀁉􀁈􀁕􀀑

RECOMMENDED READINGS

􀀧􀁈􀁏􀁄􀁑􀁇􀀃􀀭􀀷􀀑􀀃􀀤􀁇􀁘􀁏􀁗􀀐􀁄􀁆􀁔􀁘􀁌􀁕􀁈􀁇􀀃􀃀􀁄􀁗􀁉􀁒􀁒􀁗􀀃􀁇􀁈􀁉􀁒􀁕􀁐􀁌􀁗􀁜􀀑􀀃􀀭􀀃􀀤􀁐􀀃􀀤􀁆􀁄􀁇􀀃􀀲􀁕􀁗􀁋􀁒􀁓􀀃􀀶􀁘􀁕􀁊􀀑􀀃􀀕􀀓􀀓􀀛􀀃􀀭􀁘􀁏􀀞􀀔􀀙􀀋􀀚􀀌􀀝􀀖􀀜􀀜􀀐􀀗􀀓􀀙􀀑􀀃􀀵􀁈􀁙􀁌􀁈􀁚􀀑􀀃Deland JT. Adult-acquired flatfoot deformity. J Am Acad Orthop Surg. 2008 Jul;16(7):399-406. Reveiw PubMed PMID: 18611997.

Haddad SL, Myerson MS, Younger A, Anderson RB, Davis WH, Manoli A II. Symposium: Adult acquired flatfoot deformity. Foot Ankle Int. 2011 Jan;32(1):95-111.PubMed PMID:21288442

􀃀􀁄􀁗􀁉􀁒􀁒􀁗􀀃􀁇􀁈􀁉􀁒􀁕􀁐􀁌􀁗􀁜􀀑􀀃􀀩􀁒􀁒􀁗􀀃􀀤􀁑􀁎􀁏􀁈􀀃􀀬􀁑􀁗􀀑􀀃􀀕􀀓􀀔􀀔􀀃􀀭􀁄􀁑􀀞􀀖􀀕􀀋􀀔􀀌􀀝􀀜􀀘􀀐􀀔􀀔􀀔􀀑􀀃􀀳􀁘􀁅􀀰􀁈􀁇􀀃􀀳􀀰􀀬􀀧􀀝􀀃􀀕􀀔􀀕􀀛􀀛􀀗􀀗􀀕􀀑

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. Figures 175a and 175b are the radiographs of a 68-year-old man who has had hallux pain for several years. Corticosteroid injections and orthotics no longer provide relief. He wants to continue his daily 2-mile walk. What is the best next treatment step?
  2. Arthrodesis
  3. Cheilectomy
  4. Implant arthroplasty
  5. Proximal phalanx osteotomy
  6. Keller resection arthroplasty
A
  1. Arthrodesis

RECOMMENDED READINGS

Deland JT, Williams BR. Surgical management of hallux rigidus. J Am Acad Orthop Surg. 2012 Jun;20(6):347-58. Review. PubMed PMID: 22661564.

Yee G, Lau J. Current concepts review: hallux rigidus. Foot Ankle Int. 2008 Jun;29(6):637-46. Review. PubMed PMID: 18549766.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. Figures 191a and 191b are the radiographs of an 18-year-old man who had an ankle fracture requiring open reduction and internal fixation 2 years ago. He has a progressive symptomatic ankle deformity.Surgical intervention should consist of
  2. ankle arthrodesis.
  3. total ankle arthroplasty.
  4. supramalleolar tibial osteotomy.
  5. valgus-producing calcaneal osteotomy.
  6. epiphyseodesis of the distal tibial physis.
A
  1. supramalleolar tibial osteotomy.

RECOMMENDED READINGS

Becker AS, Myerson MS. The indications and technique of supramalleolar osteotomy. Foot Ankle Clin. 2009 Sep;14(3):549-61. Review. PubMed PMID: 19712889.

Pagenstert, GI; Hintermann B; Barg A; Leumann A;Valderrabano V. Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res. 462:156-68,2007. PubMed PMID: 17563701.

17
Q
  1. What is the foot orthosis/footwear prescription for management of the passively correctable deformity seen in Figure 217?
  2. Solid ankle cushion heel with lateral flare􀀃 􀀔􀀑􀀃􀀃􀀃􀀃􀀶􀁒􀁏􀁌􀁇􀀃􀁄􀁑􀁎􀁏􀁈􀀃􀁆􀁘􀁖􀁋􀁌􀁒􀁑􀀃􀁋􀁈􀁈􀁏􀀃􀁚􀁌􀁗􀁋􀀃􀁏􀁄􀁗􀁈􀁕􀁄􀁏􀀃􀃀􀁄􀁕􀁈
  3. 3/8” heel lift with firm heel counter􀀃 􀀕􀀑􀀃􀀃􀀃􀀃􀀖􀀒􀀛􀂴􀀃􀁋􀁈􀁈􀁏􀀃􀁏􀁌􀁉􀁗􀀃􀁚􀁌􀁗􀁋􀀃􀂿􀁕􀁐􀀃􀁋􀁈􀁈􀁏􀀃􀁆􀁒􀁘􀁑􀁗􀁈􀁕
  4. Lateral heel and lateral forefoot posting
  5. Medial heel wedge with lateral forefoot posting
  6. Metatarsal pad for global metatarsal head offloading􀀃 􀀘􀀑􀀃􀀃􀀃􀀃􀀰􀁈􀁗􀁄􀁗􀁄􀁕􀁖􀁄􀁏􀀃􀁓􀁄􀁇􀀃􀁉􀁒􀁕􀀃􀁊􀁏􀁒􀁅􀁄􀁏􀀃􀁐􀁈􀁗􀁄􀁗􀁄􀁕􀁖􀁄􀁏􀀃􀁋􀁈􀁄􀁇􀀃􀁒􀁉􀃀􀁒􀁄􀁇􀁌􀁑􀁊
A
  1. Lateral heel and lateral forefoot posting

RECOMMENDED READINGS

Jeng CL, Logue J. Shoes and orthotics. In: Pinzur MS, ed. Orthopaedic Knowledge Update: Foot and Ankle 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2008:15-24.

Perry MD, Manoli A II. Foot and ankle reconstruction. In: Flynn JM, ed. Orthopaedic Knowledge Update 10. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011:523-535.

Alexander IJ. Pes cavus. In: Nunley JA, Pfeffer GB, Sanders RW, Tripmen E, eds. Advanced Reconstruction Foot and Ankle. Rosemont, IL: American Academy of Orthopaedic Surgeons. American Orthopaedic Foot and Ankle Society. 2004:495-502.

18
Q

231.

A 67-year-old woman has a persistent foot drop 18 months after right total hip arthroplasty. Examination reveals passive ankle joint dorsiflexion to 0 degrees. Muscle strength testing results are listed below. Which treatment will provide the highest level of function?

R L

Anterior tibialis 0/5 5/5

EHL/EDLa 0/5 5/5

Peroneal 2/5 5/5

Posterior tibialis 3/5 5/5

FHL/FDLb 3/5 5/5

Gastrocsoleus 4/5 5/5

aExtensor hallucis longus/extensor digitorum longus

b􀀩􀁏􀁈􀁛􀁒􀁕􀀃􀁋􀁄􀁏􀁏􀁘􀁆􀁌􀁖􀀃􀁏􀁒􀁑􀁊􀁘􀁖􀀒􀃀􀁈􀁛􀁒􀁕􀀃􀁇􀁌􀁊􀁌􀁗􀁒􀁕􀁘􀁐􀀃􀁏􀁒􀁑􀁊􀁘􀁖􀀃Flexor Hallicus longus/flexor digitorum longus

  1. Ankle foot orthosis
  2. Gastrocsoleus lengthening
  3. Jones extensor hallucis longus tendon transfer
  4. Posterior tibialis tendon transfer to the dorsum of the foot
  5. Flexor hallucis longus tendon transfer to the dorsum of the foot
A
  1. Ankle foot orthosis

RECOMMENDED READINGS

Prahinski JR, McHale KA, Temple HT, Jackson JP. Bridle transfer for paresis of the anterior and lateral compartment musculature. Foot Ankle Int. 1996 Oct;17(10):615-9. PubMed PMID: 8908487.

Posterior tibial and anterior tibial tendon transfers for rebalancing the foot in neuromuscular disorders. In: Hsu JD, ed. Techniques in Foot and Ankle Surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2009;8(4):172-177.

19
Q
  1. Figures 245a through 245e are the radiographs and MRI scans of a 50-year-old ice hockey referee with a 3-year history of progressive anterolateral ankle pain, a history of multiple ankle sprains, and a fibular fracture he sustained 30 years ago. Examination reveals mild bilateral pes planovalgus feet with passive ankle joint dorsiflexion range of motion of 10 degrees and plantarflexion of 45 degrees without pain. The physician should recommend
  2. ankle joint arthrodesis.
  3. ankle ligament reconstruction.
  4. supramalleolar osteotomy.
  5. total ankle joint arthroplasty.
  6. corticosteroid injection into the ankle.
A
  1. ankle joint arthrodesis.

RECOMMENDED READINGS

Abidi NA, Neufeld SK, Brage ME, Reese KA, Savharwal S, Paley D. Ankle arthritis. In: Pinzur MS, ed. Orthopaedic Knowledge Update: Foot and Ankle 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2008:159-193.

Pagenstert GI, Hintermann B, Barg A, Leumann A, Valderrabano V. Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res. 2007 Sep;462:156-68. PubMed PMID: 17563701.

20
Q
  1. Figures 264a and 264b are the radiographs of a 55-year-old woman who has pain at the first metatarsophalangeal joint that has not responded to a change in footwear and she desires surgery. The deformity has been present for 40 years, and she has painless passive range of motion at the metatarsophalangeal joint. The first metatarsophalangeal joint has 70 degrees of dorsiflexion and 20 degrees of plantarflexion and the deformity is partially passively correctable. Whiehc procedure(s) should be recommended to correct her deformity?
  2. First metatarsophalangeal arthrodesis
  3. Lapidus procedure with Akin osteotomy
  4. Distal Chevron osteotomy with Akin phalanx osteotomy
  5. Proximal first metarsal osteotomy with modified McBride bunionectomy􀀃 􀀗􀀑􀀃􀀃􀀃􀀃􀀳􀁕􀁒􀁛􀁌􀁐􀁄􀁏􀀃􀂿􀁕􀁖􀁗􀀃􀁐􀁈􀁗􀁄􀁗􀁄􀁕􀁖􀁄􀁏􀀃􀁒􀁖􀁗􀁈􀁒􀁗􀁒􀁐􀁜􀀃􀁚􀁌􀁗􀁋􀀃􀁐􀁒􀁇􀁌􀂿􀁈􀁇􀀃􀀰􀁆􀀥􀁕􀁌􀁇􀁈􀀃􀁅􀁘􀁑􀁌􀁒􀁑􀁈􀁆􀁗􀁒􀁐􀁜
  6. Double metatarsal osteotomy with proximal and distal metatarsal correction
A
  1. Double metatarsal osteotomy with proximal and distal metatarsal correction

RECOMMENDED READINGS

Coughlin MJ, Mann RA: Hallux valgus. In: Coughlin MJ, Mann RA, Saltzman CL, eds. Surgery of the Foot and Ankle. 8th ed. St Louis, MO: Mosby Elsevier; 2007:183-362.

Chou LB, Dieter AA, Aronson J, Kelly DM. Hallux valgus. In: Pinzur MS, ed. Orthopaedic Knowledge Update: Foot and Ankle 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2008:233-244.

21
Q
  1. Figures 273a through 273c are the clinical photograph, radiograph, and coronal MRI scan through the forefoot of a 24-year-old otherwise healthy man with a 1-week history of increasing pain, fevers, and swelling of his right foot. Examination reveals right groin tenderness and adenopathy. Laboratory studies show a peripheral blood leukocyte count of 22.5X109 cells/L (reference range, 4.5 to 11X 109 cells/L), C-reactive protein of 60.3 mg/L (reference range 0.08-3.1 mg/L), and erythrocyte sedimentation rate of 15 mm/h (reference range 0-20 mm/h). What is the best next treatment step?
  2. Transmetatarsal amputation
  3. Wound culture and intravenous antibiotics
  4. Incision, debridement, and fifth toe amputation􀀃 􀀖􀀑􀀃􀀃􀀃􀀃􀀬􀁑􀁆􀁌􀁖􀁌􀁒􀁑􀀏􀀃􀁇􀁈􀁅􀁕􀁌􀁇􀁈􀁐􀁈􀁑􀁗􀀏􀀃􀁄􀁑􀁇􀀃􀂿􀁉􀁗􀁋􀀐􀁗􀁒􀁈􀀃􀁄􀁐􀁓􀁘􀁗􀁄􀁗􀁌􀁒􀁑

􀀃4. Incision, debridment and partial fifth-ray resection 􀀗􀀑􀀃􀀃􀀃􀀃􀀬􀁑􀁆􀁌􀁖􀁌􀁒􀁑􀀏􀀃􀁇􀁈􀁅􀁕􀁌􀁇􀁈􀁐􀁈􀁑􀁗􀀏􀀃􀁄􀁑􀁇􀀃􀁓􀁄􀁕􀁗􀁌􀁄􀁏􀀃􀂿􀁉􀁗􀁋􀀐􀁕􀁄􀁜􀀃􀁕􀁈􀁖􀁈􀁆􀁗􀁌􀁒􀁑

  1. Incision, soft-tissue debridement, and open packing
A
  1. Incision, soft-tissue debridement, and open packing

RECOMMENDED READINGS

Farber DC, Henry S: Nondiabetic foot infections. In: Pinzur MS, ed. Orthopaedic Knowledge Update: Foot and Ankle 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2008:331-340.

Cayce KO IV, Galloway MT. Infection. In: Fischgrund JS, ed. Orthopaedic Knowledge Update 9. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2008:241-257.

22
Q
A

5. OITE (41 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions