4.2 of 102 Ratings
Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 65-year-old female well known to your clinic with painful bunions recalcitrant to nonoperative management. The decision is made to proceed with a corrective procedure. Pre-operatively you plan to make cut "B" labeled in Figure A for a medial eminence resection combined with a modified McBride procedure, but intraoperatively you make the cut labeled "A". What complication is associated with making cut "A" instead of "B"?
Post operative recurrence of hallux valgus
Cock up toe deformity
2nd metatarsal transfer metatarsalgia
Metatarsal head avascular necrosis
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Figure A is the preoperative radiographs of a 55-year-old female that underwent hallux valgus correction one year ago. She presents to the office today and notes that her toe has become progressively “too straight.” Performing which of the intraoperative techniques will result in increased risk for iatrogenic hallux varus?
Complete medial sesamoidectomy
Complete release of abductor hallucis
Post-operative inter metatarsal angle (IMA) of 15 degrees
Complete excision of medial eminence
Excessive lateral capsulorrhaphy
A 53-year-old woman has had progressive hallux valgus deformity of her right great toe for the last 12 years. She has failed nonoperative management including shoe modifications and padded inserts. Her surgeon recommends a Lapidus procedure (1st metatarsal cuneiform arthrodesis). Which of the following is an indication for this procedure?
Intermetatarsal angle: 12°
Hallux valgus angle: 40°
Age > 50-years-old
Flexible cavovarus deformity
1st tarsometatarsal arthritis
A 65-year-old female presents with persistent pain in the left great toe. She is interested in surgery as she has been seeing a podiatrist for many years who had prescribed wider shoewear and an unknown kind of orthotic. Her exam shows pes planus which reconstitutes with heel raise, calluses under the first MTP. The 1st TMT joint shows excessive passive plantar and dorsiflexion. While examining the rest of the lower extremity, both knees are able to hyperextend to about 15 degrees but show no other malalignment. Additionally, she shows she is able to reproduce the finding shown in Figure A. Her current radiographs are shown in Figure B. What is the best surgical option to address her deformity?
Double metatarsal osteotomy with sesamoidectomy
Double metatarsal osteotomy with modified McBride
Metatarsophalangeal joint arthrodesis with modified McBride
Modified McBride with Akin osteotomy
Tarsometatarsal joint arthrodesis with modified McBride
Which of the following pre-operative measurements would call for a surgical plan involving both a proximal 1st metatarsal osteotomy and a distal-medial closing wedge osteotomy?
HVA 30, IMA 10, HVI 8, congruent MTP
HVA 30, IMA 16, HVI 14, incongruent MTP
HVA 45, IMA 12, HVI 8, DMAA 8
HVA 30, IMA 16, HVI 8, DMAA 16
HVA 45, IMA 16, HVI 14, incongruent MTP
A 56-year-old male laborer presents with the deformity shown in Figure A and B. He complains of long standing pain and swelling over the medial aspect of his right forefoot only. There is minimal tenderness with full flexion and extension of the first metatarsophalangeal joint and no tarsometatarsal joint laxity bilaterally. What treatment is most appropriate for this patient?
Bilateral first metatarsalphalangeal arthrodesis
Bilateral first metatarsal osteotomy with distal bunionectomy
Distal biplanar Chevron osteotomy of right foot only
Proximal first metatarsal osteotomy combined with Akin osteotomy of right foot only
Bilateral Lapidus procedure combined with bilateral biplanar chevron osteotomy
A 45-year-old woman undergoes surgical treatment for hallux valgus. One year later she presents with the painless foot deformity shown in Figure A. All of the following variables can lead to the development of this deformity EXCEPT:
Resection of the fibular sesamoid
Resection of the tibial sesamoid
Avascular necrosis (AVN) of the first metatarsal head secondary to a distal osteotomy
Excessive postoperative bandaging
Excessive medial capsular reefing
A 42-year-old woman presents with pain localized to the dorsum of the great toe. She reports undergoing a bunion correction with limited internal fixation using a single screw 2 years prior, which initially helped her. She subsequently underwent implant removal one year later. She is now unable to properly fit shoes on that foot. Her current radiograph is depicted in Figure A. Of the following procedures below, which did she likely undergo?
First metatarsal proximal crescentic osteotomy
Modified McBride procedure
First cuneiform osteotomy
Keller resection arthroplasty
The procedure shown in Figure A would be most appropriate for which of the following scenarios?
HVA = 10, IMA = 6, DMAA= 7, congruent joint
HVA = 40, IMA = 20, DMAA = 8, advanced MTP arthritic changes
HVA = 20, IMA = 10, DMAA = 20, congruent joint
HVA = 16, IMA = 12, DMAA = 14, congruent joint, TMT hyper-mobility
HVA = 18, IMA = 12, DMAA = 9, congruent joint
A 47-year-old female presents with persistent left great toe pain. Two years prior, she underwent hallux valgus corrective surgery with a Chevron osteotomy. Figure A exhibits her most recent radiograph. What is the most likely diagnosis and appropriate treatment?
Post-traumatic arthritis of the metatarsal head and MTP arthrodesis
Osteonecrosis of the metatarsal head and intraarticular osteotomy
Osteonecrosis of the metatarsal head and MTP arthrodesis
Hallux varus and lateral capsular imbrication
Hallux valgus recurrence and conservative management
A 47-year-old woman that works as an attorney has a 3-year history of bilateral painful forefeet that is exacerbated with the dress shoes she wears for work. Physical examination reveals bursal inflammation and calluses at the medial eminence of the first metatarsal with a 1st metatarsalphalangeal (MTP)joint deformity that passively corrects. A clinical image is shown in Figure A and a radiograph is shown in Figure B. The hallux valgus angle (HVA) is measured at 23 degrees and the intermetatarsal angle (IMA) is measured at 12 degrees. Which of the following surgical interventions is most appropriate for correction of her deformities?
Distal metatarsal osteotomy (Chevron)
Closing wedge osteotomy of the proximal phalanx (Akin) combined with distal soft tissue release (Modified Mcbride)
Resection of medial eminence (Silver bunionectomy)
Proximal metatarsal osteotomy and first MTP arthrodesis
Metatarsal cuneiform fusion (Lapidus)
A 38-year-old woman has a 2-year history of left greater than right foot pain. Physical examination demonstrates full 1st metatarsalphalangeal (MTP)joint dorsiflexion and plantarflexion with a deformity that passively corrects. A clinical image is shown in Figure A and a radiograph is shown in Figure B. The hallux valgus angle (HVA) is measured at 31 degrees and the intermetarsal angle(IMA) is measured at 16 degrees. Which of the following surgical interventions is most appropriate for correction of her deformities?
Keller resection arthroplasty
Distal first metatarsal osteotomy (Chevron) with lateral metatarsophalangeal joint soft-tissue release (modified Mcbride)
Proximal first metatarsal osteotomy (Scarf) with lateral metatarsophalangeal joint soft-tissue release (modified Mcbride)
Metatarsal cuneiform fusion (Lapidus) with lateral metatarsophalangeal joint soft-tissue release (modified Mcbride)
Lateral metatarsophalangeal joint soft-tissue release (modified Mcbride)
A 57-year-old administrative assistant complains of pain over the bunion on her right foot. Physical exam is notable for tenderness over the medial prominence of the first metatarsophalangeal joint and hypermobility of the first ray. Shoe modifications have failed to provide relief. A clinical photograph and radiograph are provided in figures A and B. Surgical treatment with metatarsocuneiform arthrodesis is chosen. Each of the following are associated with a better clinical outcome EXCEPT:
Multiple screw fixation across the metatarsocuneiform arthrodesis
Augmentation of the metatarsocuneiform arthrodesis with bone grafting
Dorsiflexion unloading of the first metatarsal
Correction of the first intermetatarsal angle
Failure of conservative treatments prior to surgery
A 67-year old female presents with the bilateral foot deformity shown in Figures A and B. All of the following contribute to the risk of recurrence after surgery EXCEPT:
Resection of the lateral sesamoid
Lack of lateral capsular release
Lack of medial metatarsophalangeal joint capsule closure
Use of an Akin procedure alone for a moderate to severe deformity
Undercorrection of the widened 1-2 intermetatarsal (IMA) angle
A 55-year-old female attorney complains of progressive pain and deformity of the great toe. The pain is localized to a prominence of the medial metatarsal head. A clinical image is provided in figure A. Which of the following best describes the hallux deformity?
Valgus and supination
Valgus and pronation
Valgus and hyperextension
Varus and supination
Varus and pronation
A 57-year-old female underwent surgery for severe hallux rigidus. Postoperative radiographs are shown in Figure A. One year later she complains of pain at the 2nd metatarsal head and her exam shows a plantar callosity under the 2nd metatarsal head. What procedure could have been combined with her initial operation to prevent this outcome?
Second metatarsalphalangeal joint arthrodesis
Second metatarsal osteotomy (Weil) with extensor tendon and dorsal capsular release
Flexor to extensor tendon transfer (Girdlestone-Taylor)
Second metatarsal osteotomy (Helal) with extensor tendon and dorsal capsular release
Second metatarsal head resection with extensor tendon and dorsal capsular release
A 14-year-old girl has a painful hallux valgus deformity that has not responded to shoe modifications. Figure 21 shows a standing AP radiograph. What is the most appropriate surgical procedure?
Distal soft-tissue realignment
Distal first metatarsal osteotomy with distal soft-tissue realignment
Proximal first metatarsal osteotomy with distal soft-tissue realignment
Proximal and distal first metatarsal osteotomy
Osteotomy of the proximal phalanx
Which of the following clinical scenarios regarding hallux valgus could be appropriatley treated with a modified McBride procedure?
35-year-old female with a 20 degree HVA, a 11 degree IMA, and an incongruent 1st MTP joint
40-year-old male with a 30 degree HVA, and a 15 degree IMA, and a congruent 1st MTP joint
70-year-old female with a 35 degree HVA, and a 13 degree IMA with a hypermobile 1st ray
65-year-old female with a 25 degree HVA, a 14 degree IMA, and severe hallux rigidus
85-year old minimally ambulatory male with a 45 degree HVA, and a 20 degree IMA
A 34-year-old woman presents with right foot pain and a callus over the 1st metatarsalphalangeal joint. A clinical image is shown in Figure A. Accommodative shoewear has failed to relieve symptoms. Images displaying key radiographic angles in the evaluation of this disorder are shown in Figures B and C. This distal metatarsal articular angle (DMAA) is measured at 15 degrees. Which of the following operative procedures is most appropriate for this deformity?
Closing wedge osteotomy of the proximal phalanx (Akin)
Distal soft-tissue release
Medial eminence resection and exostectomy (Silver)
A 14-year-old female presents for evaluation of painful hallux valgus deformity of her left great toe. She has attempted modifying her footwear and wearing orthotic inserts, however her pain has progressed and she is now having difficulty with ambulation. Current radiographs demonstrate a hallux valgus angle of 36º, an intermetatarsal angle of 16º, and a distal metatarsal articular angle of 21º with closed first metatarsal physis. Which of the following is the best next step in treatment?
Double first metatarsal osteotomy
Proximal Ludloff osteotomy with distal soft tissue procedure
Distal biplanar chevron osteotomy