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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
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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