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A 43-year-old female presents with a painful right 2nd toe. On examination, she has a rigid flexion contracture of the second proximal interphalangeal (PIP) joint, with neutral position of the metatarsophalangeal (MTP) joint. The deformity does not correct with foot plantarflexion. What is the most appropriate sequence of treatment options?
Dorsal PIP joint padding, shoe modification, PIP resection arthroplasty
Plantar PIP joint padding, PIP resection arthroplasty, MTP capsular release
Dorsal PIP joint padding, shoe modification, extensor tenotomy, metatarsal head excision
Plantar PIP joint padding, shoe modification, PIP resection arthroplasty
Dorsal PIP joint padding, extensor tenotomy, PIP resection arthroplasty
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A 57-year-old woman complains of pain and deformity of the second toe that is limiting ambulation. Shoe accomodations and NSAIDs have failed to provide relief. She has a fixed flexion deformity of 40 degrees at the PIP joint, but the MTP joint is not involved. The hallux is normal, but painless PIP flexion contractures are present in the other lesser toes. Which of the following is an indication for PIP resection arthroplasty as opposed to soft-tissue balancing and realignment?
Pain with shoe wear
Presence of hammertoe deformity in all lesser toes
Absence of metatarsophalangeal joint deformity
Absence of a concomitant hallux valgus deformity