Foot Ankle Clin. 2011 Mar;16(1):1-12.
Plantar plate deficiency is most commonly associated with which of the following deformities shown in Figures A-E?
This is a poor question. The question states 'association' - claw toe is clearly associated with plantar plate insufficiency.
How does one get from heel strike to mid stance without hip extensor (glute max) concentric contraction? The subject portion of the topic suggests hip extensor contraction, yet the muscle activity table at the bottom states the glute max remains inactive? Could someone please comment? Thanks
What is the most appropriate management of the injury shown in Figures A and B?
Achilles tendon repair
Repair of superior peroneal retinaculum and deepening of the fibular groove
Posterior tibial tendon reconstruction with flexor hallucs longus transfer
Peroneus longus repair
Peroneus brevis repair
I thought it looked ruptured in that one view, but how can you know for sure that the next view won't show the subluxed PL a little more anterior than what is seen on this cut? Initially I thought rupture, then I overthought it with the subluxation answer saying to deepen the groove, which on this guy definitely looks shallow. So I convinced myself that the tendon was still intact but just not all present on this one view, sorta like ACL and PCL showing up on subsequent MRI views. I guess that why in practice we don't get one view MRI's!!!!!!!
Which of the following best describes the physical examination test demonstrated in Figure A?
Silfverskiöld test used to differentiate gastrocnemius tightness from achilles tendon contracture
Thompson test used to differentiate soleus tightness from achilles tendon contracture
Coleman test used to differentiate soleus tightness from achilles tendon contracture
Silfverskiöld test to differentiate soleus tightness from achilles tendon contracture
Thompson test to differentiate gastrocnemius tightness from achilles tendon contracture
I understand how to perform and interpret the test, but what is the clinical/ practicing difference? Are stretching ex better for one than the other. It seems the correct answer is always TAL. Has there ever be a question regarding the different lengthening techniques?
Hi AMR,The deformity is at the IP joint and most patients complain from callosities & corns at the IPJ together with tenderness and rubbing of the dorsal aspect of the toe against the shoe. In order to address this you need to excise the corn formed at the PIPJ, using the same incision you can Resect the HEAD & NECK of the proximal phalanx to correct the deformity. If you want to Resect the Base of the PP (which may work) but then you will need another incision which is totally unnecessary.
Peroneal tendon subluxation
Demonstrates the snapping/subluxation of a peroneal tendon
what a great video!
Main pathology at the MTPJ, so in surgical management why its resection of "head and neck" of proximal phalanx not the "base" , as for Stainsby procedure?
Medial Displacement Calcaneal Osteotomy
This is an osteotomy of the calcaneus for a flatfoot deformity to correct the hindfoot. This cutting of the heel bone allows the back half to be shifted back under the leg instead of being turned out. This is part one of two parts.
xr not clearly presented medializatiom technique not clear
Clin Podiatr Med Surg. 2017 Jan;34(1):53-67. Epub 2016 Sep 2.
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
Dr. Lescheid - thanks for the post. The question options do not include hindfoot arthrodesis, which would be necessary for this patient. The ankle joint itself is involved to a much more limited extent than the subtalar joint and inferior talus. This would be considered a late stage arthropathy per Pinzur's article, and total contact casting/AFO/CROW would be indicated as first line treatment. If this patient's case described plantar ulcers or significant instability, an attempt at hindfoot arthrodesis would be indicated in this patient.Surgical Treatment Options for the Diabetic Charcot Hindfoot and Ankle Deformity.Ögüt T, Yontar NSClin Podiatr Med Surg. 2017 Jan. pii: S0891-8422(16)30073-8. doi: 10.1016/j.cpm.2016.07.007. 34. (1). :53-67PMID: 27865315 (Link to Abstract)Charcot neuroarthropathy of the foot and ankle.Schon LC, Easley ME, Weinfeld SBClin Orthop Relat Res. 1998 Apr. (349). :116-31PMID: 9584374 (Link to Abstract)
From discussion on QID4727:"Rogers et al. reviewed the evaluation and management of Charcot foot in diabetes. They report indications for surgery include cases refractory to offloading and immobilization, recalcitrant ulcers, or severe Charcot neuropathic arthropathy of the ankle." "Pinzur (Aug 2007) reviewed the management of Charcot arthropathy. He recommends total contact casting for early stage arthropathy, and commercially available depth-inlay shoes with accommodative orthoses or rocker-bottom shoes combined with an AFO or CROW for late stage arthropathy. He recommends operative intervention for persistent plantar ulceration that cannot be managed nonoperatively, and unstable Charcot ankle arthropathy."I should read the articles myself, but the summaries above seem to indicate there is a role for early arthrodesis in "severe" or "unstable" cases, both of which would describe this case.Can you comment?
Posterior Tibial Tendon Insufficiency (PTTI)
in foot and ankle deformity the next joint moves into oposite direction, compensating , thus in planus you have supination and in cavovarus the forefoot is pronated. if the deformity is fixed you have to take care of it after your hindfoot correction, usualy with plantifkexion of the first ray in planus and dorsiflexion in cavus
A 37-year-old man was involved in a high velocity motor vehicle accident 6 months ago. He spent 4 months in the ICU recovering from a severe head injury. He has now transitioned to a rehabilitation hospital and complains of left foot pain that becomes severe with weightbearing and attempted ambulation. Radiographs are provided in figures A-C. Which of the following is the best management?
Custom orthotics and physical therapy
Closed reduction and percutaneous screw fixation of 1st through 3rd tarsometatarsal joints
Open reduction internal fixation of 1st through 3rd tarsometatarsal joints
Arthrodesis of 1st through 3rd tarsometatarsal joints
Tarsometatarsal arthrodesis and triple arthrodesis
Dr. Johnston - there looks like a nondisplaced fracture of the anterior process may have been there at the time of the original injury as well. To further delineate this as well as any question regarding the CC joint, you could obtain a CT to evaluate, or even obtain contralateral images to assess the CC joint.
That was about as simple and clear as it gets!! Great explanation.Thanx!
Forefoot varus and valgus are deformities in the coronal plane, just like hindfoot varus and valgus. If you are looking at a pes planovalgus from the toes to the heel and the foot is plantigrade (1st met head, 5th met head, and heel are all on the ground), the hindfoot will be in excessive valgus. To determine the forefoot position, you derotate the hindfoot into normal valgus. Effectively, you are supinating the foot, moving the heel from more valgus to less valgus (in a varus direction). If there is a fixed deformity of the forefoot, you will be moving it from plantigrade to varus when you put the heel in normal valgus.Hope that is not too confusing. Look at a flexible foot model from the toes to the heel and it will make more sense.
A 65-year-old diabetic male presents with the foot ulcer shown in Figure A. There is no exposed bone, and no signs of infection. Pulses are palpable. What additional information should be obtained next to help guide this patient's treatment?
MRI scan with contrast
Results of Silverskiold test
Transcutaneous oxygen measurements of the toes
Hemoglobin A1C level
I am at a loss throughout all of these Diabetic questions. Of course you want to know if the plantar flexors are tight. You also would want to know whether or not an abcess is present with--- an MRI. I guess "A 65 yo male presents..." suggests to me that I am seeing the patient and doing the PE. So I know the results of the SK test!!! The next ADDITIONAL info (not available to me during my PE) would be the MRI-- or one of the other tests!! But i see that 57% of the people weren't thinking like that GRRRRRRelse would need to be obtained
A 44-year-old male with long standing insulin dependent diabetes complains of a non-healing plantar foot ulcer. The ulcer is shown in Figure A. The second metatarsal head can be probed at the base of the wound, and he lacks plantar sensation. Laboratory work-up for infection is negative. Which of the following is the best initial treatment?
Ray resection and primary wound closure
Oral antibiotics and local wound care
Local wound care and non-weight bearing in a removable boot
Surgical debridement, dressing changes, and IV antibiotics
MRI of the foot to evaluate for underlying osteomyelitis
Question 5589 give exactly the opposite answer. "Next step" vs "best initial" is semantics, not orthopedics. At 61yo my english/grammar is not going to get any better, so y'all are making this tougher than it needs to be!!!!
DJD & Hallux Rigidus
Surgical management of hallux rigidus.Deland JT, Williams BRJ Am Acad Orthop Surg. 2012 Jun. pii: 20/6/347. doi: 10.5435/JAAOS-20-06-347. 20. (6). :347-58PMID: 22661564 (Link to Abstract)
Is there a fx of the ant process of the calcaneus, and does it not look like the calc-cuboid jt is subluxed on the lateral?