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A 19-year-old military recruit complains of 7 weeks of right heel pain. He notes the pain is worse with jumping and long distance running. He has completed a course of plantar fascia and Achilles tendon stretching with no significant improvement in his symptoms. He denies constitutional symptoms. On examination, his body mass index is 22, he has a normal foot posture and can perform a single leg heel rise without difficulty. There is no pain with palpation of the lateral border of the foot or with external rotation stress to the midfoot. There is tenderness with medial and lateral compression of the hindfoot and there is a negative syndesmosis squeeze test. There is a negative Tinel's sign at the tibial nerve. Axial and lateral radiographs are shown in Figures A and B. What is the most appropriate next step in management?
Heel pad cortisone injection
Platelet rich plasma injection and 6 weeks of physical therapy
Restricted weight bearing and magnetic resonance imaging of the foot
Release of the first branch of the lateral plantar nerve
ASTYM or Graston physical therapy techniques to the achilles and plantar fascia
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A 25-year-old, training for a marathon, presents with persistent heel pain over the past several weeks. He has difficulty with ambulation and has an antalgic gait. A squeeze test of the heel is positive. A lateral foot radiograph is shown Figure A. Of the options listed below, what is the most appropriate next step in management?
Heel pad cortisone injection
Physical therapy with Graston techniques to plantar fascia
MRI of the foot
Non-weight bearing cast for 4-6 months
A 47-year-old male presents with a one month history of heel pain after starting marathon training. The heel is tender when squeezed. A foot radiograph is shown in Figure A, and an MRI is obtained which is shown in Figures B and C. What is the most likely diagnosis?
A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. He subsequently develops the post-traumatic condition shown in Figure A. All of the following would be indications for a subtalar distraction arthrodesis using a bone graft instead of an in-situ subtalar arthrodesis EXCEPT:
Decreased calcaneus height
Decreased talocalcaneal angle
Decreased talar declination angle
Presence of a collapsed subtalar joint from AVN
Presence of full ankle dorsiflexion with no tibiotalar impingement
A 26-year-old male sustains a comminuted, intra-articular calcaneus fracture and subsequently undergoes operative intervention as shown in Figure A. Postoperatively in the recovery room, he presents with an isolated, fixed flexed great toe. What is the most likely etiology of this finding?
Use of a lateral extensile approach to the calcaneus
Calcaneal tuberosity varus malalignment
Use of screws in the constant fragment that are too long
Missed foot compartment syndrome
Plantar nerve palsy
A 42-year-old male sustains the injury seen in figure A. What negative sequelae would occur with displacement of this fracture in the characteristic fashion?
Post-traumatic subtalar arthrosis
Stress fracture of the fibula
Reflex sympathetic dystrophy
Achilles tendon rupture
Posterior skin necrosis
A patient sustains a comminuted calcaneus fracture. Three months after the injury the patient complains of shoewear problems secondary to clawing of the lesser toes. What is the most likely explanation for this deformity?
Sural nerve injury
Tethering of the flexor hallucis longus by fracture fragments
Medial plantar nerve neuropathy
Weakness of the tibialis posterior
Unrecognized foot compartment syndrome
A 28 year-old-male presents with the injury pattern seen in Figure A. Which of the following is a risk factor for wound complications following operative treatment?
Workers' Compensation involvement
Adjunct use of allograft
Contralateral calcaneus fracture
The flexor hallucis longus tendon is at greatest risk of injury with a lateral-to-medial drill or screw during fixation of what structure?
Navicular body fracture
Intra-articular calcaneus fracture
Nutcracker cuboid fracture
Talar neck fracture
A 55-year-old male sustained a Sanders IV intra-articular calcaneus fracture two years ago that was treated nonoperatively. He presents to your office with a mechanical block preventing his ankle from dorsiflexing to neutral, continued severe pain and a widened heel. Radiographs show significant loss of calcaneal height and an incongruous subtalar joint. What is the most appropriate surgical treatment at this time?
Arthroscopic debridement of the subtalar joint and subfibular recess with in situ subtalar joint arthrodesis
Distraction bone block subtalar arthrodesis
Corrective intra-articular osteotomy of the calcaneus
Arthroscopic debridement of the subtalar joint and subfibular recess with lateral distraction opening wedge calcaneal osteotomy
In the treatment of intra-articular calcaneal fractures, surgical reduction and fixation has been shown to have improved outcomes over nonoperative treatment in all of the following patient groups EXCEPT:
Sanders IIb fractures
Younger age (<29 years old)
Previous calcaneus fracture
Which of the following patients who sustained a calcaneal fracture will most likely undergo an eventual subtalar fusion?
Male worker's compensation patient who participates in heavy labor work with an initial Böhler angle less than 0 degrees
Female worker's compensation patient who participates in heavy labor work with an initial Böhler angle >15 degrees
Male non-worker's compensation patient who participates in heavy labor work with an initial Böhler angle less than 0 degrees
Male worker's compensation patient who participates in heavy labor work with an initial Böhler angle >15 degrees
Female non-worker's compensation patient who participates in heavy labor work with an initial Böhler less than 0 degrees
A 42-year-old female undergoes a subtalar bone block distraction arthrodesis as sequelae of a nonoperatively treated calcaneus fracture ten years prior. This procedure improves which of the following issues?
Subtalar joint stiffness
Sinus tarsi impingement
Anterior ankle impingement
A 27-year-old male sustains closed injuries to his right foot in a motor vehicle collision. He is a nonsmoker. A radiograph and computed tomography scan are provided in Figures A and B. All of the following are prognostic of a superior outcome with operative treatment EXCEPT:
Works as an attorney
Twenty-seven years old
He was injured while off his job
A 48-year-old female sustains the injury seen in Figure A. Which of the following preoperative variables has been shown to be associated with improved outcomes following surgical treatment of this injury pattern?
Patients with a heavier workload
Patients receiving Worker's Compensation
Gissane angle of 140°
Böhler angle of > 15°
Comminuted posterior facet
A 42-year-old male sustains the closed injury shown in Figure A. Which of the following factors is associated with improved outcomes with open reduction and internal fixation?
Age > 40
No worker's compensation involvement
Career as construction worker
A 35-year-old patient sustains a left calcaneus fracture. Which of the following fractures has the highest risk of post-traumatic arthritis?
Male patient, Sanders Type III fracture, treated with ORIF
Male patient, Sanders Type II fracture, treated with ORIF and bone graft
Female patient, workers compensation, Sanders Type I fracture, treated non-operatively
Female patient, Sanders Type II fracture, treated non-operatively
Female patient, workers compensation, Sanders Type II fracture, treated with ORIF
Which of the following statements is true regarding the superomedial fragment of an intra-articular calcaneus fracture?
Fragment typically does not move due to its attachment to the Achilles tendon
Fragment has the flexor hallucis longus wrap inferiorly around it
Fragment typically does not move due to its attachment to the navicular
Fragment typically displaces superior and laterally
Fragment has the tibialis posterior wrap inferiorly around it
Title: Session 6: Panel 2 Presenter: PanelColumbia University OrthopedicsNew Yor...
Title: Session 6: Panel 1 Presenter: PanelColumbia University OrthopedicsNew Yor...
Title: Calcaneal Fractures- What's New? Presenter: Justin Greisberg, MDColumbia...
HPI - 35 y/o male with left heel pain after a fall from an 8 ft ladder.
HPI - 1 hrs PTA , MCA with right foot injury , he could not bear weight with severe deformity , swelling , painful .
what should we for treatment?
HPI - history of fall from height of about 20 feet.
only single case experienc sharing with you. pls comment and give your valuable opinion.