4.3 of 57 Ratings
Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 63-year-old female with right foot hallux rigidus that was treated with a 1st MTP hemiarthroplasty three years ago presents with worsening right hallux pain. Her pain is worse with weight-bearing and walking. Wearing stiff-soled shoes has not improved her symptoms. She denies any fevers or chills. On examination, there is a well-healed incision with no drainage or surrounding erythema. Pain is reproduced with flexion and extension of the 1st MTP joint. Current radiographs are depicted in figures A and B. What is the most reliable treatment for this patient?
In situ arthrodesis
Conversion to a silicone arthroplasty
Select Answer to see Preferred Response
A 62-year-old female presents with worsening left foot pain over the last year. Her pain is located mostly in her great toe and is worse with prolonged walking. She has noticed it is more difficult to wear her normal shoe wear due to medial sided great toe pain. Physical examination reveals hallux MTP dorsiflexion of 5° and plantarflexion of 20° with pain through the arc of motion. There is a positive grind test. Her current radiographs are demonstrated in figure A. What is the most reliable operative treatment for this patient?
Phalangeal dorsiflexion osteotomy
Dorsal cheilectomy with metatarsal osteotomy
You are performing an arthrodesis for the condition shown in Figure A. Following instrumentation, the tip of the toe is found to clear the footplate by 5mm (Figure B). Based on this information, the next best step would be to:
Perform a moberg osteotomy
Perform a superior capsulotomy
Add a medial-to-lateral compression screw
Revise to a plate with less dorsiflexion
Irrigate and close
Figure A demonstrates an arthroplasty technique commonly used for rheumatoid arthritis. This material has also been used in an attempt to alleviate the condition shown in Figure B. What has been shown to be a long term complication of this technique that complicates revision arthrodesis surgery?
A 48-year-old woman who runs marathons has been having worsening foot pain. Her AP radiograph is shown in Figure A. She has been wearing the orthotic shown in Figure B. What type of motion is this orthosis designed to limit?
Midfoot arch collapse
Hallux MTP dorsiflexion
Hallux MTP plantarflexion
Hallux MTP adduction
A 50-year-old recreational tennis player complains of increasing pain in his big toe. Radiographs are seen in Figure A. He has tried abstaining from sports for 1 year, and is using the orthotic shown in Figure B. He wishes to return back to sports. What is the most appropriate treatment plan?
Cheilectomy and Moberg procedure
Interpositional arthroplasty using joint capsule, and flexor hallucis brevis release
Total joint arthroplasty
A 35-year-old male, heavy laborer presents to your office 3 months following 1st metatarsal phalangeal fusion on the right for significant and symptomatic hallux rigidus. He states that since he began weight-bearing he has progressive lateral foot pain and developed calluses on the lateral side of his foot that have become painful. During the gait examination in the office, you notice that during the terminal stance phase he is standing on the outside of his foot. On shoe examination, you notice excessive lateral sole wear. The toe is most likely fused in what position?
Toe is fused is dorsiflexion
Toe is fused in valgus
Toe is fused in varus
Toe is fused in plantarflexion
Toe is excessively shortened
A 41-year-old male laborer presents with worsening left great toe pain, associated plantar lesser toe pain, and callosities. Examination reveals a well-healed incision with no erythema and 35° of dorsiflexion. Radiographs of the left foot are shown in Figure A. Laboratory testing reveals normal ESR, CRP, and white blood cell count from joint aspiration. He has failed all conservative measures and states he would like to proceed with surgical intervention. Which of the following is the next best step in surgical management?
Revision arthroplasty with a long-stemmed prosthesis
Removal of hardware and conversion to silastic implant
Removal of hardware, I&D, antibiotic spacer placement, and delayed reimplantation
Implant removal and synovectomy
Implant removal, synovectomy, structural bone grafting, and arthrodesis
A 32-year-old runner presents with persistent left great toe pain that has been ongoing for 6 months. She's tried a rigid-sole running shoe, anti-inflammatories, and orthotics with no relief. She has pain at extremes of dorsiflexion and with pushoff, but no midrange pain. She has 10 degrees of dorsiflexion. She decides to take time off running and undergo a dorsal cheilectomy. Figures A and B show her preoperative images. Intraoperatively the surgeon removes the dorsal 30% of the metatarsal head and is able to achieve 20 degrees of dorsiflexion. What is the next best step in management?
Wound closure and weight bearing as tolerated in a post op shoe
Flexor digitorum longus to extensor digitorum longus tendon transfer
Metatarsophalangeal joint arthrodesis
Which of the following foot conditions is most appropriately treated with the orthotic shown in Figure A?
Interdigital neuroma (Morton's)
A 45-year-old construction worker reports pain in the first toe with the maneuver found in Figure A. The radiographs in Figure B and C reveals mild osteoarthritis of the first metatarsophalangeal joint and a dorsal osteophyte. Orthotics have failed to provide relief. What surgical procedure is the most appropriate next step in management?
Modified chevron osteotomy
Metatarsal dorsal oblique osteotomy (Helal osteotomy)
Metatarsal plantar oblique osteotomy (Weil osteotomy)
Proximal phalanx closing wedge osteotomy (Moberg osteotomy)
An 80-year-old female presents with a painful great toe MTP joint. She is minimally ambulatory, and has failed conservative treatment. A physical exam reveals a plantar-flexed great toe which does not allow for comfortable shoe wear. AP and lateral radiographs of the foot are shown in Figures A and B. What is the most appropriate surgical treatment that will allow for the fastest rehabilitation?
Implantation of a double-stem silicone implant
Dorsiflexion osteotomy (Moberg) of the proximal phalanx
Resection arthroplasty (Keller) along with removal of osteophytes
Arthrodesis of the first metatarsophalangeal joint
A shoe orthotic with a Morton's extension is indicated for which of the following conditions?
2nd metatarsophalangeal joint synovitis
You are seeing a 60-year-old male for pain in his great toe that has increased in severity over the past year despite the use of an insole with a Morton's extension. His great toe plantar/dorsiflexion range of motion is limited to a 35 degree arc with pain at the extremes of motion. A radiograph is shown in Figure A. What treatment do you suggest?
Cheilectomy and joint debridement
1st MTP resection artrhoplasty (Keller procedure)
1st MTP fusion
A 70-year-old sedentary female underwent a silastic arthroplasty of the right 1st metatarsophalangeal joint 15 years ago. She now presents with pain, swelling and erythema of the MTPJ. She is afebrile, bloodwork reveals normal ESR, CRP and WBC, and her erythema resolves with elevation. NSAIDs and activity modification have failed to provide relief. What is the best option to treat her painful toe?
Steroid joint injection
Custom molded orthosis with recessed 1st metatarsal molding
Irrigation and debridement and IV antibiotics
Revision of silastic implant and synovectomy
Removal of implant and synovectomy
A Morton's extension orthotic is used for which of the following conditions?
Spring ligament rupture
A 45-year-old carpenter reports pain during terminal dorsiflexion and restricted range of motion of the great toe. An x-ray reveals mild osteoarthritis of the first metatarsophalangeal joint and a prominent dorsal osteophyte. Orthotics have failed to provide relief. What is the most appropriate intervention at this time?
First metatarsophalangeal arthrodesis
A 54-year-old male carpenter is having pain and stiffness in his great toe on the right foot that is exacerbated when he kneels down on his right knee. The skin over the dorsal surface of the 1st metatarsophalangeal joint reveals shoe-wear irritation. He has attempted wearing a carbon fiber shank in his shoe and a trial of meloxicam without relief of symptoms. Radiographs are shown in Figures A and B. What is the next most appropriate step in management?
Resection of dorsal osteophyte and 25% of the dorsal aspect of the metatarsal head
Proximal phalanx medial closing wedge osteotomy
First metatarsophalangeal joint arthrodesis
Medial eminence removal and resection of base of proximal phalanx
First tarsometatarsal joint arthrodesis and metatarsophalangeal capsular release