A 17-year-old tennis player sustained an ankle sprain 4 weeks ago and now complains of painful popping posterior to the lateral malleolus. What physical exam will reproduce his symptoms?
External rotation stress test
Resisted plantar flexion
Bump. I agree w Jones. Either the text or this question needs an edit.
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
Debride what? You have 2/3 chances of OM, but don't know the extension of it, so you will rush to the OR and resect pieces of bone blindly?MRI to confirm your suspected diagnosis AND see the extension --> select amount of Debridement/Level of amputation.
dear sir,this is from this topic in indication of operations indications moderate disease (HVA >40°, IMA >13°) indications severe disease (HVA 41-50°, IMA 16-20°)howwwwwwwwwwwwwwwwww?
A 38-year-old postal carrier complains of recurrent right ankle sprains and lateral ankle pain. A clinical photograph and radiograph are provided in Figures A and B. Coleman block testing demonstrates correction of the deformity. Custom orthotics, bracing, and NSAIDS have failed to provide pain relief or prevent recurrent sprains. Which of the following treatments should be pursued?
Steroid injection of the sinus tarsi and taping of the ankles before activity
Lateral ligament repair and augmentation with inferior extensor retinaculum
Lateral ligament reconstruction with peroneus brevis tendon grafting
First metatarsal osteotomy and lateral ligament reconstruction with peroneus brevis tendon grafting
Triple arthrodesis and split peroneus brevis tendon graft reconstruction of the lateral ligaments
I feel like a better answer would have been Brostrom + 1st metatarsal dorsal closing wedge + plantar facial release +/- PT/PL tendon transfers depending on exam.Additionally, could anyone shed some light on when to do a Brostrom vs a Watson-Jones in general for these lateral ankle injuries? I feel like the Brostrom is better in this case because the PB is likely already compromised, though, or maybe another tendon could be used?
J Bone Joint Surg Am. 2010 Dec;92(17):2767-75.
Is Operative Treatment of Achilles Tendon Ruptures Superior to Nonoperative Treatment?: A Systematic Review of Overlapping Meta-analyses.Erickson BJ, Mascarenhas R, Saltzman BM, Walton D, Lee S, Cole BJ, Bach BR JrOrthop J Sports Med. 2015 Apr 17. doi: 10.1177/2325967115579188. pii: 10.1177_2325967115579188. 3. (4). :2325967115579188PMID: 26665055 (Link to Abstract)
An 18-year-old male college student presents with a right ankle injury two weeks after slipping on a soccer ball. The skin is grossly intact and there is no evidence of neurovascular compromise. The provocative test demonstrated in Figure A is positive. Which of the following nonoperative treatment modalities have been shown to minimize recurrence of his injury?
Immobilization in a non weight-bearing cast
Immobilization in a weight-bearing boot
Immobilization in a splint
Functional bracing with early proprioceptive training
Neuromuscular training alone
What is the difference between neuromuscular and proprioceptive training?
Sesamoid Injuries of the Hallux
Just want to point out that the attachments of the Add H is the Fibular sesamoid and that of AbD H is the Tibial sesamoid. The text in in this topic is incorrect.
Move this question to Hallux Valgus topic?
bilateral navicular lesions (C2374)
45 / M - gradual onset progressive course now interfering with activities
What is the most likely diagnosis of the right foot condition?
calcaneonavicular coalition with subsequent arthritis and muller weiss. corrective fusion of all involved joints
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
Silfverskiold is misspelled in the answer choices and the text body.
A 48-year-old male complains of 5 years of heel pain while running. Initially the pain was relieved with Achilles tendon stretching, orthotics, and open-backed shoe wear. Over the past year these modalities are no longer helpful and he is beginning to have pain with walking. Clinical photograph and radiograph are provided in figures A and B. Which of the following treatment options is the best choice to relieve pain and improve function?
Arizona gauntlet brace
Achilles tendon debridement
Achilles tendon debridement, calcaneal exostectomy, and possible FHL transfer
Drs. Anonymous and Rothenberg - I agree with you both here. The FHL transfer option is more of a game-time call and the question does not show any intraoperative photos or give any other data that would help determine this. I've updated the answer choice to better reflect this.
agree, modify answer to say "with possible FHL transfer"
Is it just me or is the term "bunionectomy" in many of these questions too nonspecific?
Posterior Tibial Tendon Insufficiency (PTTI)
I would like to suggest that we consider redefining the differentiation between stage II A and B!The presence of forefoot abduction is certainly important, but does not significantly influence treatment options.More importantly the amount of Posterior tibial tendon strength and or damage is more impactful when discussing treatment options. In Stage II disease it is recommended that initial treatment be conservative which is appropriatein patients with mild or even moderate weakness. In patients with profound weakness there is more commonly a complete rupture of the tendon and the likelihood is that the deformity will progress even with aggressive conservativecare. I believe therefore we should separate stage II disease based on Inversion weakness which will be a decision pointfor accelerating care toward reconstruction over prolonged conservative care.
Injury. 2015 Apr;46(4):536-41. Epub 2014 Dec 10.
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Int Orthop. 2013 Sep;37(9):1845-50.
Foot Ankle Int. 2012 Jun;33(6):507-12.
Gastrocnemius recession is becoming a common procedure for recalcitrant plantar fasciitis as shown by DiGiovanni et al and shown to be more effective than plantar fasciotomy by Monteagudo et al. Maskill et al also show in their series good outcomes (better than previously reported outcomes of plantar fasciotomy) for gastroc recession in treating isolated foot pain, including recalcitrant plantar fasciitis. While nonoperative management is the primary treatment and other procedures like biologic injections and shock wave are becoming more popular, gastrocnemius recession is becoming much more common, particular in the setting of gastroc contracture with plantar fasciitis.Chronic plantar fasciitis: plantar fasciotomy versus gastrocnemius recession.Monteagudo M, Maceira E, Garcia-Virto V, Canosa RInt Orthop. 2013 Sep. doi: 10.1007/s00264-013-2022-2. 37. (9). :1845-50PMID: 23959221 (Link to Abstract)Preferred management of recalcitrant plantar fasciitis among orthopaedic foot and ankle surgeons.DiGiovanni BF, Moore AM, Zlotnicki JP, Pinney SJFoot Ankle Int. 2012 Jun. pii: 50062314. doi: 10.3113/FAI.2012.0507. 33. (6). :507-12PMID: 22735325 (Link to Abstract)Gastrocnemius recession to treat isolated foot pain.Maskill JD, Bohay DR, Anderson JGFoot Ankle Int. 2010 Jan. pii: 50035122. doi: 10.3113/FAI.2010.0019. 31. (1). :19-23PMID: 20067718 (Link to Abstract)