-
Select a Community
- MB 1 Preclinical Medical Students
- MB 2/3 Clinical Medical Students
- ORTHO Orthopaedic Surgery
-
About Bullet Health
Please confirm topic selection
Are you sure you want to trigger topic in your Anconeus AI algorithm?
HPI
A 47 year-old male presents with chronic left foot pain and a flatfoot deformity. He attempted shoewear modifications, physical therapy, and custom orthotics (including medial posting with medial arch support) for an extended period of time. Despite this symptoms remain severe.
PMH
Unremarkable
PE
On physical exam on the left foot there is a pes planovalgus with "too many toes" sign. He is unable to perform a single leg heel rise on the affected side. The deformity is passively correctable. He otherwise has good strength. His neurovascular exam is normal.
1.
Would you obtain imaging in addition to the plain film weight-bearing radiographs to guide management?
No - plain film weight-bearing radiographs are sufficient
20%
156/752
Yes - Additonal radiographic views
4%
36/752
Yes - CT scan of the foot (CT)
10%
82/752
Yes - MRI scan of the foot (MRI)
38%
293/752
Yes - CT + Additional radiographs
1%
15/752
Yes - MRI + Additional radiographs
9%
70/752
Yes - MRI + CT
7%
56/752
Yes - MRI + CT + Additional radiographs
2%
21/752
Outside my area of expertise - best if I don't vote
3%
23/752
2.
Would you classify this pathology to guide management?
No - a classification system would not help me
7%
51/720
Yes - Stage I Posterior Tibialis Tendon Insufficiency (PTTI)
4%
32/720
Yes - Stage II PTTI
38%
279/720
Yes - Stage III PTTI
28%
204/720
Yes - Stage IV PTTI
9%
66/720
Yes - Other
1%
10/720
Outside my area of expertise - best if I don't vote
10%
78/720
3.
Given that the patient has exhausted at least 3 months of conservative management, how would you manage the patient at this time?
Nonoperative
6%
45/725
Operative
88%
642/725
Outside my area of expertise - best if I don't vote
5%
38/725
4.
If you choose Operative management, what surgery would you perform?
I would not choose Operative management
0%
4/700
Posterior tibial tendon debridement alone
0%
4/700
Soft tissue Reconstruction (STRecon) alone (includes tendon transfer, ligament repair/reconstruction, and percutaneous pinning)
15%
109/700
Bone Reconstruction (BoneRecon) alone (includes forefoot and/or hindfoot osteotomy, without arthrodesis)
10%
74/700
Arthrodesis alone
5%
36/700
BonyRecon + STRecon
41%
289/700
Arthrodesis + BoneRecon
4%
34/700
Arthrodesis + STRecon
4%
34/700
Arthrodesis + BoneRecon + STRecon
5%
38/700
Outside my area of expertise - best if I don't vote
11%
78/700
5.
If you choose Operative management with a Bone Reconstruction, which would you perform?
I would not choose Operative management with a Reconstructive Bony procedure
4%
30/655
Forefoot osteotomy only
3%
22/655
Hindfoot ostoeotmy only
42%
278/655
Hindfoot + Forefoot osteotomy
37%
246/655
Outside my area of expertise - best if I don't vote
12%
79/655
6.
If you choose Operative management with a Soft tissue Reconstruction, which would you perform?
I would not choose Operative management with a Reconstructive Soft tissue procedure
6%
37/602
Flexor tendon (FDL/FHL) transfer only
7%
47/602
Posterior tibialis tendon (PTT) advancement only
4%
28/602
Spring ligament (SL) repair/reconstruction only
3%
19/602
Flexor tendon transfer + SL repair/reconstruction
22%
133/602
PTT advancement + SL repair/reconstruction
12%
75/602
Flexor tendon transfer + PTT advancement
6%
38/602
Flexor tendon transfer + PTT advancement + SL repair/reconstruction
24%
148/602
Outside my area of expertise - best if I don't vote
12%
77/602
7.
If you choose Operative management, would you include a Tendon Achilles lengthening (TAL)?
I would not choose Operative management
0%
6/601
No
43%
264/601
Yes
46%
278/601
Outside my area of expertise - best if I don't vote
8%
53/601
8.
If you choose Operative management with an Arthrodesis, which would you perform?
I would not choose Operative management with an Arthrodesis
35%
196/555
1st TMT joint arthrodesis
2%
15/555
Medial column arthrodesis
5%
32/555
Hindfoot arthrodesis (includes single, double, and triple)
20%
114/555
Medial column + 1st TMT joint arthrodesis
5%
30/555
Hindfoot + 1st TMT joint arthrodesis
5%
28/555
Hindfoot + medial column arthrodesis
10%
60/555
Hindfoot + medial column + 1st TMT joint arthrodesis
3%
19/555
Outside my area of expertise - best if I don't vote
10%
61/555
9.
If you choose Operative management and achieved the construct shown below, what would you postoperative protocol be?
I would not choose Operative management
0%
2/501
Immediate WBAT in orthosis
0%
4/501
NWB x 2 weeks, WBAT in orthosis
2%
13/501
NWB x 4 weeks, WBAT in orthosis
13%
70/501
NWB x 6 weeks, WBAT in orthosis
53%
270/501
NWB x 8 weeks, WBAT in orthosis
16%
85/501
NWB >8 weeks
3%
16/501
Outside my area of expertise - best if I don't votede
8%
41/501
10.
If you choose Operative management and achieved the construct shown below, how long would you maintain the patient in an orthosis postoperatively?
I would not choose Operative management
0%
2/493
Indefinitely
6%
33/493
1 month
5%
29/493
2 months
14%
71/493
3 months
43%
212/493
6 months
10%
50/493
>6 months
11%
56/493
Outside my area of expertise - best if I don't votede
8%
40/493
PROCEDURE #1
Mediallizing calcaneal osteotomy, 1st metatarsal dorsal opening wedge osteotomy, temporary pinning of reduced talonavicular joint, spring ligament repair, posterior tibialis tendon advancement (in lieu of FDL transfer)
Intra-procedure P1
OUTCOMES
Post-procedure P1