Introduction Posterior tibial tendon insufficiency is the most common cause of adult-acquired flatfoot deformity Epidemiology demographics more common in women often presents in the sixth decade risk factors obesity hypertension diabetes increased age corticosteroid use seronegative inflammatory disorders Mechanism exact etiology is unknown acute injury (e.g., ankle fractures caused by pronation and external rotation) vs. long-standing tendon degeneration Pathoanatomy early disease early tenosynovitis progresses to PTTI leads to loss of medial longitudinal arch dynamic stabilization late disease PTTI contributes to attritional failure of static hindfoot stabilizers and collapse of the medial longitudinal arch spring ligament complex (e.g., superomedial calcaneonavicular ligament) plantar fascia plantar ligaments fixed degenerative joint changes occur at late stages foot deformity pes planus hindfoot valgus forefoot varus forefoot abduction Associated conditions inflammatory arthropathy young males with mild pes planus may have one of the following conditions tarsal coalition young person with rigid pes planus and/or recurrent ankle sprains Anatomy Muscle tibialis posterior originates from posterior fibula, tibia, and interosseous membrane innervated by tibial nerve (L4-5) Tendon posterior tibial tendon (PTT) lies posterior to the medial malleolus before dividing into 3 limbs anterior limb inserts onto navicular tuberosity and first cuneiform middle limb inserts onto second and third cuneiforms, cuboid, and metatarsals 2-4 posterior limb inserts on sustentaculum tali anteriorly Blood supply branches of the posterior tibial artery supply the tendon distally a watershed area of poor intrinsic blood supply exists between the navicular and distal medial malleolus (2-6 cm proximal to navicular insertion) Biomechanics PTT lies in an axis posterior to the tibiotalar joint and medial to the axis of the subtalar joint functions as a primary dynamic support for the arch acts as a hindfoot invertor adducts and supinates the forefoot during stance phase of gait acts as secondary plantar flexor of the ankle major antagonist to PTT is peroneus brevis activation of PTT allows locking of the transverse tarsal joints creating a rigid lever arm for the toe-off phase of gait Classification Deformity Physical exam Radiographs Stage I • Tenosynovitis • No deformity • (+) single-heel raise • Normal Stage IIA • Flatfoot deformity• Flexible hindfoot• Normal forefoot • (-) single-leg heel raise• Mild sinus tarsi pain • Arch collapse deformity Stage IIB • Flatfoot deformity• Flexible hindfoot• Forefoot abduction ("too many toes", >40% talonavicular uncoverage) Stage III • Flatfoot deformity• Rigid forefoot abduction• Rigid hindfoot valgus • (-) single-leg heel raise• Severe sinus tarsi pain • Arch collapse deformity• Subtalar arthritis Stage IV • Flatfoot deformity• Rigid forefoot abduction• Rigid hindfoot valgus• Deltoid ligament compromise • (-) single-leg heel raise• Severe sinus tarsi pain • Ankle pain • Arch collapse deformity• Subtalar arthritis• Talar tilt in ankle mortise Presentation Symptoms medial ankle/foot pain and weakness is seen early progressive loss of arch lateral ankle pain due to subfibular impingement is a late symptom Physical exam inspection & palpation pes planus collapse of the medial longitudinal arch hindfoot valgus deformity flexible stage II rigid stage III, IV forefoot abduction (Stage IIB disease) "too many toes" sign >40% talonavicular uncoverage forefoot varus place flexible heel in neutral position observe the relationship of metatarsal heads flexible = MT heads perpendicular to long axis of tibia and calcaneus fixed = lateral border of foot is more plantar flexed than medial border tenderness just posterior to tip of medial malleolus often associated with an equinus contracture range of motion single-limb heel rise unable to perform in stages II, III, and IV PTT power foot positioned in plantar and full inversion unable to maintain foot position when examiner applies eversion force determine whether deformity is flexible or fixed flexible deformities are passively correctable to a plantigrade foot (stage II) rigid deformities are not correctable (stages III and IV) Imaging Radiographs recommended views weight bearing AP and lateral foot ankle mortise findings AP foot increased talonavicular uncoverage increased talo-first metatarsal angle (Simmon angle) seen in stages II-IV weight bearing lateral foot increased talo-first metatarsal angle (Meary angle) angles >4° indicate pes planus seen in stages II-IV decreased calcaneal pitch normal angle is between 17-32° indicates loss of arch height decreased medial cuneiform-floor height indicates loss of arch height subtalar arthritis seen in stages III and IV ankle mortise talar tilt due to deltoid insufficiency seen in stage IV MRI findings variable amounts of tendon degeneration and arthritic changes in the talonavicular, subtalar, and tibiotalar joints Ultrasound increasing role in the evaluation of pathology within the PTT Differential Pes planus secondary to midfoot pathology (osteoarthritis or chronic Lisfranc injury) treat with midfoot fusion and a realignment procedure incompetence of the spring ligament (primary static stabilizer of the talonavicular joint) in the absence of PTT pathology treat with adjunctive spring ligament reconstruction in addition to standard flatfoot reconstruction Treatment Nonoperative ankle foot orthosis indications initial treatment for stage II, III, and IV also for patients who are not operative candidates, sedentary/low demand (age > 60-70) technique AFO family of braces (Arizona, molded, articulating) AFO found to be most effective want medial orthotic post to support valgus collapse Arizona brace is a molded leather gauntlet that provides stability to the tibiotalar joint, hindfoot, and longitudinal arch immobilization in walking cast/boot for 3-4 months indications first line of treatment in stage I disease custom-molded in-shoe orthosis indications stage I patients after a period of immobilization stage II patients technique medial heel lift and longitudinal arch support medial forefoot post indicated if fixed forefoot varus is present UCBL with medial posting Operative tenosynovectomy indications indicated in stage I disease if immobilization fails FDL transfer, calcaneal osteotomy, TAL, ± forefoot correction osteotomy ± spring ligament repair ± lateral column lengthening ± medial column arthrodesis ± PTT debridement indications stage II disease lateral column lengthening for talonavicular uncoverage medial column arthrodesis if deformity is at naviculocuneiform joint contraindications hypermobility neuromuscular conditions severe subtalar arthritis obesity (relative) age >60-70 (relative) first TMT joint arthrodesis, calcaneal osteotomy, TAL ± lateral column lengthening ± PTT debridement indications stage II disease with 1st TMT hypermobility, instability or arthritis isolated subtalar arthrodesis indications absence of fixed forefoot deformity contraindications fixed forefoot supination/varus otherwise will overload lateral border of foot joint hypermobility hindfoot arthrodesis indications stage III disease typically triple arthrodesis stage II disease with severe subtalar arthritis subtalar and talonavicular arthrodesis can be considered triple arthrodesis and TAL + deltoid ligament reconstruction indications stage IV disease with passively correctable ankle valgus tibiotalocalcaneal arthrodesis indications stage IV disease with a rigid hindfoot, valgus angulation of the talus, and tibiotalar and subtalar arthritis Surgical Techniques FDL transfer indications FDL is synergistic with tibialis posterior and therefore transfer can augment function of deficient PT Stage II disease relative contraindications rigidity of subtalar joint (<15 degrees of motion) fixed forefoot varus deformity (>10-12 degrees) technique find FDL and FHL at knot of Henry insert FDL into navicular near insertion of PT vs. FHL transfer FHL is more complicated to mobilize and has not shown improved results in the midfoot, FHL runs under FDL Calcaneal osteotomy indicated to correct hindfoot valgus techniques include medial displacement calcaneal osteotomy (MDCO) used in stage IIA (insignificant forefoot abduction) Evans lateral column lengthening osteotomy used in stage IIB (significant forefoot abduction) may require additional MDCO to correct the deformity overlengthening may be corrected by a first TMT fusion or medial cuneiform osteotomy TAL or gastrocnemius recession indicated for equinus contracture Forefoot correction osteotomy indicated for fixed forefoot supination/varus (stage IIC) techniques plantarflexion (dorsal opening-wedge) medial cuneiform (Cotton) osteotomy used with a stable medial column (navicular is colinear with first MT) corrects residual forefoot varus after hindfoot correction is made surgically medial column fusion (isolated first TMT fusion, isolated navicular fusion, or combined TMT and navicular fusions) used with an unstable medial column (plantar sag at first TMT and/or naviculocuneiform joint) Spring ligament repair indicated with spring ligament rupture in some cases PTT debridement may also be required Triple arthrodesis triple arthrodesis includes calcaneocuboid, talonavicular, subtalar joints additional medial column stabilization may be required
QUESTIONS 1 of 34 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ16.1) A 65-year-old female returns to the office with continued medial and lateral hindfoot pain. She has attempted bracing, physical therapy and non-steroidal anti-inflammatories with limited relief. The patient is unable to perform a single-leg heel rise. The position of her right hindfoot and talonavicular joint are not passively correctable. She has pain with attempted inversion against resistance. Figures A-C are weight-bearing foot radiographs. Which of the following is the most appropriate treatment option? QID: 8763 FIGURES: A B C Type & Select Correct Answer 1 Charcot resistant orthotic walker 1% (35/2818) 2 Medializing calcaneal osteotomy, posterior tibial tendon debridement 2% (57/2818) 3 Medializing calcaneal osteotomy, posterior tibial tendon debridement with flexor digitorum longus transfer 7% (198/2818) 4 Medializing calcaneal osteotomy, lateral column lengthening, posterior tibial tendon debridement with flexor digitorum longus transfer 44% (1236/2818) 5 Talonavicular and subtalar arthrodesis 45% (1258/2818) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.68) A 58-year-old female with a history of acquired flatfoot deformity is taken to the operating room for surgical intervention. Representative radiographs are shown in Figures A and B. The position of the forefoot after the subtalar joint is aligned is shown in Figure C. What maneuver is indicated to prevent the development of weight-bearing based lateral border foot pain in this patient? QID: 4703 FIGURES: A B C Type & Select Correct Answer 1 Dorsiflexion osteotomy of the medial cuneiform 19% (887/4561) 2 Isolated talonavicular fusion 6% (263/4561) 3 No further maneuvers are indicated 5% (208/4561) 4 Derotation of the forefoot through the transverse tarsal joints 55% (2530/4561) 5 Derotation of the forefoot through the calcaneocuboid alone 14% (632/4561) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept (OBQ13.157) A 48-year-old woman complains of progressive medial sided foot pain and sinus tarsi pain for 2 years. She has achieved minimal relief with an Arizona brace and physical therapy. Examination reveals forefoot abduction with "too many toes" sign, passively correctable hindfoot valgus, passive correctable forefoot abduction, and inability to perform a single-leg toe raise. Standing radiographs are shown in Figures A and B. Percutaneous Achilles tendon lengthening is performed in the operating room. What is the best next step in treatment? QID: 4792 FIGURES: A B Type & Select Correct Answer 1 Plantigrade casting for 6-8 weeks 1% (32/2667) 2 Posterior tibial tendon debridement 2% (56/2667) 3 Flexor digitorum longus tendon transfer and medial slide osteotomy 13% (351/2667) 4 Flexor digitorum longus tendon transfer, medial slide osteotomy and lateral column lengthening 75% (1989/2667) 5 Triple arthrodesis 8% (206/2667) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept (SBQ12FA.61) A 59-year-old woman presents for initial evaluation of medial-sided right foot pain that has been present for 18 months and has not responded to extensive physical therapy and ankle foot orthosis treatment. On exam, she is unable to perform a single leg heel raise. She has pes planus with a 'too many toes' sign but her hindfoot is supple. With her talonavicular joint held in a reduced position she can be passively dorsiflexed to negative 10 degrees. This does not correct when her knee is flexed. Her radiographs show arch collapse, with 50% uncoverage of the talus but no subtalar or tibiotalar arthritis. What is the most appropriate stage and treatment for her condition? QID: 3868 Type & Select Correct Answer 1 Stage I: debridement of the posterior tibial tendon 1% (19/2504) 2 Stage IIA: transfer of flexor digitorum longus (FDL) to the medial navicular with medializing calcaneal osteotomy (MCO) 12% (288/2504) 3 Stage IIB: transfer of FDL to the medial navicular with MCO, lateral column lengthening and tendo-Achilles lengthening (TAL) 82% (2051/2504) 4 Stage III: triple arthrodesis and TAL 5% (123/2504) 5 Stage IV: tibiotalocalcaneal arthrodesis 0% (7/2504) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept (SBQ12FA.18) A 57-year-old male undergoes the procedure exhibited in Figure A. He reports a long history of painful, flat feet which failed conservative measures. Which stage of posterior tibial tendon insufficiency is likely for this patient? QID: 3825 FIGURES: A Type & Select Correct Answer 1 Stage I 0% (3/2123) 2 Stage IIA 1% (19/2123) 3 Stage IIB 4% (84/2123) 4 Stage III 65% (1387/2123) 5 Stage IV 29% (621/2123) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.222) A 54-year-old female has a painful flatfoot that has not improved with over 8 months of conservative management with orthotics. Preoperatively, she was unable to perform a single-heel rise and her hindfoot was passively correctable. Figures A and B are radiographs of the affected left foot. She undergoes FDL tendon transfer to the navicular, medial slide calcaneal osteotomy, and tendoachilles lengthening procedures. Following these procedures, the appearance of the foot is demonstrated in Figure C. What is the next most appropriate intraoperative procedure to be performed during her foot reconstruction? QID: 3645 FIGURES: A B C Type & Select Correct Answer 1 Dorsiflexion closing wedge medial cuneiform osteotomy 14% (353/2450) 2 In-situ 1st-3rd tarsometatarsal joint arthrodesis 3% (71/2450) 3 Plantarflexion opening wedge medial cuneiform osteotomy 64% (1575/2450) 4 Lateral column closing wedge shortening osteotomy 14% (336/2450) 5 Subtalar arthrodesis 3% (85/2450) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept (OBQ10.70) A 44-year-old female has a Stage 2B acquired flat foot deformity that does not improve over 6 months of conservative management. She undergoes FDL tendon transfer to the navicular, calcaneal osteotomy, and tendoachilles lengthening. After this correction, it is thought that she would benefit from a opening wedge first cuneiform (Cotton) osteotomy. Which of the following best describes the Cotton osteotomy? QID: 3156 Type & Select Correct Answer 1 Plantarflexion osteotomy to correct residual forefoot varus 43% (1099/2551) 2 Medial opening wedge osteotomy to correct residual forefoot abduction 15% (390/2551) 3 Plantarflexion osteotomy to correct residual forefoot valgus 26% (651/2551) 4 Medial opening wedge osteotomy to correct residual hindfoot abduction 4% (111/2551) 5 Plantarflexion osteotomy to correct residual hindfoot valgus 11% (282/2551) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept (OBQ10.222) A 53-year-old female has a 20 month history of left hindfoot pain that has failed to respond to AFO bracing and physical therapy. She has a unilateral planovalgus deformity, shown in Figure A, which is flexible. She is unable to do a single leg-heel rise. Which of the following surgical options is most appropriate? QID: 3321 FIGURES: A Type & Select Correct Answer 1 Triple arthrodesis 2% (61/2961) 2 Isolated FDL transfer to the navicular 8% (226/2961) 3 Dorsiflexion osteotomy of the 1st ray with peroneus longus-to-brevis transfer 2% (68/2961) 4 Lateralizing calcaneal osteotomy with FDL to navicular transfer 6% (178/2961) 5 Lateral column lengthening, medializing calcaneal osteotomy, and FDL transfer to the navicular 82% (2417/2961) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ09.114) A 56-year-old woman comes to your office with foot pain after a 9 month trial of orthotics. Your examination reveals the hindfoot is in valgus, the arch is depressed, and the forefoot is abducted when the foot is viewed posteriorly. She is unable to perform a single heel rise on the affected side. The hindfoot is flexible and there is an equinus contracture. What combination of surgical interventions is most appropriate QID: 2927 Type & Select Correct Answer 1 Tenosynovectomy followed by UCBL orthotic use 1% (25/2863) 2 Dwyer closing wedge calcaneal osteotomy, 1st metatarsal closing wedge osteotomy, and plantar fasica release 1% (26/2863) 3 Medial calcaneal displacement osteotomy, lateral column lengthening, FDL tendon transfer, and tendoachilles lengthening 86% (2448/2863) 4 Arthrodesis of the subtalar, talonavicular, and calcaneocuboid 1% (42/2863) 5 Lateral calcaneal displacement osteotomy, FDL tendon transfer, and tendoachilles lengthening 11% (310/2863) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept (OBQ09.113) The lower limb orthosis shown in Figure A is the most effective method for nonsurgical management in which of the following conditions? QID: 2926 FIGURES: A Type & Select Correct Answer 1 Hallux valgus 1% (15/2463) 2 Midfoot arthritis 20% (499/2463) 3 Hallux rigidus 4% (101/2463) 4 Diabetic foot neuropathy 16% (385/2463) 5 Acquired flexible flatfoot deformity 59% (1447/2463) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept (OBQ09.248) A 70-year-old female complains of progressive pain of the medial ankle and foot over the past 10 years. Orthotics no longer provide relief of her pain. The hindfoot deformity is unable to be passively corrected on physical exam. Figure A is a posterior view of the patient's foot upon standing and a current radiograph is provided in Figure B. Which of the following is the best treatment option? QID: 3061 FIGURES: A B Type & Select Correct Answer 1 Posterior tibialis tendon debridement 0% (7/2660) 2 FDL transfer to navicular and calcaneal slide osteotomy 3% (92/2660) 3 FDL transfer to navicular, calcaneal slide osteotomy, and lateral column lengthening through the cuboid 19% (493/2660) 4 Talocalcaneal arthrodesis 5% (125/2660) 5 Triple arthrodesis 72% (1927/2660) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ07.258) A 54-year-old laborer presents with 4 months of progressive left foot pain. Figures A and B are clinical photographs of the patient in single and double leg stance. Figure C is a clinical photograph of the patients fixed forefoot deformity with the supple hindfoot passively corrected to neutral by the examiner. What is the most appropriate next step in treatment? QID: 919 FIGURES: A B C Type & Select Correct Answer 1 First tarsometatarsal joint arthrodesis (Lapidus), lateral column lengthening, and spring ligament repair 15% (307/2111) 2 Medial heel lift, longitudinal arch support, and medial forefoot posting 55% (1155/2111) 3 Short period of immobilization in walker boot with lateral heel wedge 4% (79/2111) 4 Triple arthrodesis 4% (90/2111) 5 Flexor digitorum longus tendon transfer and medial calcaneal displacement osteotomy 22% (465/2111) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept (OBQ07.229) A 46-year-old obese female presents with foot pain and the radiographs shown in Figures A and B. Which of the following physical findings will most likely be present? QID: 890 FIGURES: A B Type & Select Correct Answer 1 Achilles tendon contracture 64% (1846/2896) 2 Hallux varus 3% (87/2896) 3 Forefoot adduction 19% (541/2896) 4 Hindfoot varus 10% (298/2896) 5 Clawing of the toes 4% (114/2896) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept (OBQ07.37) What is the preferred surgical treatment for painful acquired flatfoot deformity with stage III posterior tibial tendon insufficiency? QID: 698 Type & Select Correct Answer 1 FDL transfer to the navicular, medial displacement calcaneal osteotomy, and tendoachilles lengthening 31% (593/1918) 2 Pantalar arthrodesis 2% (35/1918) 3 FDL transfer to the navicular with lateral column lengthening through the anterior calcaneus 9% (172/1918) 4 Posterior tibial tendon debridement and tenodesis to FDL 3% (52/1918) 5 Arthrodesis of calcaneocuboid, talonavicular, and subtalar joints 55% (1055/1918) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept (OBQ07.72) An obese 65-year-old woman has a chronic painful flatfoot with a rigid valgus hindfoot deformity. Radiographs reveal subtalar joint degenerative changes but no signs of ankle joint degenerative changes or abnormal talar tilt. She is unable to single-leg heel raise and has a "too many toes" sign. What stage of posterior tibial tendon dysfunction is she best classified as? QID: 733 Type & Select Correct Answer 1 V 2% (36/1970) 2 IV 26% (503/1970) 3 III 69% (1359/1970) 4 II 3% (60/1970) 5 I 0% (4/1970) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept (OBQ06.48) A healthy 42-year-old male has a 2-year history of worsening hindfoot pain that is refractory to therapy and orthotics. Physical exam reveals a flexible planovalgus foot with an equinus contracture. He is unable to perform a single limb heel rise on the affected side. In addition to a flexor digitorum longus tendon transfer to the navicular, which of the following operative procedures is indicated? QID: 159 Type & Select Correct Answer 1 Gastrocnemius lengthening only 11% (208/1906) 2 Triple arthrodesis and gastrocnemius lengthening 1% (21/1906) 3 Subtalar arthrodesis and gastrocnemius lengthening 1% (22/1906) 4 Lateralizing calcaneal osteotomy, medial column lengthening, and gastrocnemius lengthening 6% (122/1906) 5 Medializing calcaneal osteotomy, lateral column lengthening, and gastrocnemius lengthening 80% (1519/1906) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept (OBQ06.234) A 55-year-old woman presents with a planovalgus deformity of her foot. She is unable to perform a single-limb heel rise and has tenderness and swelling behind the medial malleolus. Her hindfoot valgus is passively correctable and she has failed a trial of orthotics. What is the most appropriate treatment? QID: 245 Type & Select Correct Answer 1 posterior tibial tendon debridement 6% (92/1460) 2 medial displacement calcaneal osteotomy and posterior tibial augmentation with flexor digitorum longus tendon transfer 89% (1294/1460) 3 triple arthrodesis 2% (28/1460) 4 ankle fusion 1% (11/1460) 5 Lapidus procedure 2% (28/1460) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept (OBQ05.33) A 40-year-old male with a progressive planovalgus foot deformity secondary to posterior tibial tendon insufficiency (PTTI) has failed nonoperative treatment. What feature must be evaluated for that is commonly seen in patients with advanced PTTI and should be addressed at time of surgery? QID: 70 Type & Select Correct Answer 1 Plantar fasciitis 5% (55/1018) 2 Equinus contracture 75% (762/1018) 3 Claw toes 4% (43/1018) 4 Hallux varus 2% (21/1018) 5 Hallux valgus 13% (133/1018) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept (OBQ04.18) When harvesting flexor digitorum longus (FDL) for a tendon transfer for stage II posterior tibialis tendon dysfunction, what anatomic structure crosses immediately deep (dorsal) to it in the midfoot region? QID: 129 Type & Select Correct Answer 1 Achilles tendon 0% (2/2361) 2 flexor hallucis brevis (FHB) 10% (231/2361) 3 adductor hallucis 6% (131/2361) 4 flexor hallucis longus (FHL) 81% (1903/2361) 5 abductor hallucis 4% (86/2361) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept
FREE PDF Foot & Ankle Orthopaedics 2019, Vol. 4(1) 1-17 Adult-Acquired Flatfoot Deformity Jensen K. Henry MD Rachel Shakked MD Scott J. Ellis MD Foot & Ankle - Posterior Tibial Tendon Insufficiency (PTTI) Jensen K. Henry MD, 9 views 0.0
All Videos (10) Podcasts (1) Login to View Community Videos Login to View Community Videos Adult Acquired Flatfoot Deformity . *Pes Planus- Pes Planovalgus* Kemal Gokkus Foot & Ankle - Posterior Tibial Tendon Insufficiency (PTTI) 2 days ago 37 views 5.0 (1) Login to View Community Videos Login to View Community Videos 2018 Orthopaedic Summit Evolving Techniques The Flexible Adult Flatfoot & Posterior Tibial Dysfunction: How The Z Cut Calcaneal Osteotomy Is The Answer - Keith L. Wapner, MD (OSET 2018) Keith L. Wapner Foot & Ankle - Posterior Tibial Tendon Insufficiency (PTTI) C 9/12/2019 384 views 4.0 (3) California Orthopaedic Association Annual Meeting - 2017 Posterior Tibial Tendonopathy – David Sitler, M.D.(COA 2017, 7.4) Foot & Ankle - Posterior Tibial Tendon Insufficiency (PTTI) A 4/12/2018 1905 views 4.7 (6) Foot & Ankle⎜Posterior Tibial Tendon Insufficiency (PTTI) Team Orthobullets (5) Foot & Ankle - Posterior Tibial Tendon Insufficiency (PTTI) Listen Now 15:43 min 10/16/2019 669 plays 4.7 (12) See More See Less
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