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A 56-year-old male with uncontrolled diabetes presents for follow up of a recurrent midfoot ulceration. He has been placed into a total contact cast for extended periods without resolution of the ulcer. On physical examination the patient is unable to feel a 5.07 gm monofilament on the plantar aspect of his foot. He has an equinus contracture. A clinical photo of the patient and lateral radiograph of the foot are provided in Figures A & B. Radiographs are unchanged from prior evaluation. What is the next best option at this point?
Below the knee amputation
Exostectomy with placement into a protective brace
Exostectomy & achilles tendon lengthening with placement into a protective brace
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A 65-year-old male with insulin-dependent diabetes and chronic kidney disease presents for follow-up care for issues in his right lower extremity. He has been treated for the past four months with the modality seen in Figure A (Panel A) for the condition seen in Figure A (Panel B). He has currently has no ulcerations on his foot. Which shoe modification, shown in Figure B-F, is most appropriate to prevent potential future skin breakdown by offloading the affected area in this patient?
A 50-year-old male with long-standing type 1 diabetes presents with redness, swelling and crepitus in his foot two weeks after a twisting injury. Elevation of the extremity reduces the hyperemia. A radiograph is shown in Figure A. What is the most likely diagnosis?
You are seeing a 62-year-old male for ankle and foot swelling (Figures A-C). There is no history of trauma and he has never seen a physician before. In addition to his lower extremity care, what other medical condition should he be evaluated for?
A 62-year-old gentleman with a 10-year history of Type II diabetes complains of warmth, swelling, and pain in his right foot that has progressively worsened over the past 6 weeks. He denies fevers or chills, and states that the swelling and warmth dissipates each night after he sleeps with his foot elevated on pillows. A clinical photograph of the foot is provided in Figure A. The midfoot is hot to touch and mildly tender with palpation. A radiograph is provided in Figure B. Which of the following is the most appropriate management?
Custom orthotics with first ray recession and lateral heel posting
Total contact cast and non-weight bearing
Talonavicular and tarsometarsal arthrodeses
A 65-year-old diabetic female presents with a two-month history of mild ankle pain and subjective instability. She denies any specific injury and she does not have any foot ulcerations or wounds; her foot and ankle are edematous with erythema that resolves upon elevation. Her ESR, CRP, and WBC levels are within normal limits. Her radiographs are shown in Figures A and B. What is the most appropriate initial treatment?
Modification of shoe wear
Use of a total contact cast
Spanning external fixation of the ankle and hindfoot
A 57-year-old woman with type 2 diabetes presents with right foot pain resulting in gait disturbance for the past 6 months. Medical comorbidities include renal insufficiency and hypertension. A radiograph is provided in Figure A. What initial management is most appropriate?
Carbon fiber shank insole
Custom orthotic with Jones bar and medial posting
AFO (ankle foot orthosis) with posterior leaf spring
Total contact casting
Accomodative plastizote insole with depression cut into the midfoot and extra-depth shoes
A 43-year-old male presents with painless swelling and erythema of his ankle which resolves with elevation. He has begun to have trouble ambulating because he reports his ankle feels "floppy" since a fall several weeks ago. His x-ray is shown in Figure A. What physical exam test is most appropriate?
Syndesmosis squeeze test
Semmes-Weinstein monofilament testing
A 29-year-old male presents with left knee instability and progressive gait disturbance. He is only able to ambulate with the assistance of crutches or a walker. He has no pain with ambulation and has decreased vibratory sensation in the bilateral lower extremities. Radiographs are shown in Figures A-B. All of the following are possible etiologies for this condition EXCEPT:
A 54-year-old diabetic man complains of swelling and erythema throughout the midfoot for 2 weeks. He denies any known trauma. The midfoot is warm, red, and swollen with no skin disruptions on physical exam. The erythema diminishes with elevation of the foot for 15 minutes. He has a temperature of 100.3 degrees Fahrenheit. The patient's CRP is 2.6 (normal range of <6.0). Which of the following is the most likely diagnosis?
Navicular stress fracture
HPI - 39 y/o female presents to ER with red, hot, swollen foot. No history of trauma or open lesions/ulcers. Patient diagnosed with diabetes and admitted to hospital for cellulitic foot. Patient was re-admitted to the hospital twice over a one month period for treatment of unresolved cellulitis. During that one month period the patient's diabetes was managed by PCP. No imaging studies were ordered during this one month period by any specialists. Patient was referred to infectious disease to uncover the source of cellulitis. Infectious disease ordered radiograph which revealed charcot foot.
What would be your first line of treatment in this case?
HPI - deformity noticed at left ankle six months back , no h\o of trauma ,deformity gradually increasing,with instability of ankle &inability to attend his daily routine, pain at leg after walk for few meters.(5m)
what is treatment of choice?(pt demand is stable ankle)
HPI - Inability to walk, severe unstable hind foot with type 3 Charcot Foot underwent TTC fusion 6/12 back, failed with exposed tip of one calcaneal screw.