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A 55-year-old man is referred to you for management of a recalcitrant diabetic foot ulcer. He had previously undergone 2 cycles of total contact casting and several bedside debridements. A current clinical photograph is seen in Figure A. Recent midfoot and hindfoot weightbearing radiographs are seen in Figure B. After formal debridement, which of the following is the next best treatment step?
Charcot restraint orthotic walker
Achilles tendon lengthening
In-situ tibiotalocalcaneal fusion using an intramedullary device
Midfoot osteotomy and Lisfranc joint fusion using plates and screws
Reduction and arthrodesis of the Chopart joint using a ring fixator
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A 56-year-old male with uncontrolled diabetes presents for follow up of a recurrent midfoot ulceration. He has been placed into a total contact cast for extended periods without resolution of the ulcer. On physical examination the patient is unable to feel a 5.07 gm monofilament on the plantar aspect of his foot. He has an equinus contracture. A clinical photo of the patient and lateral radiograph of the foot are provided in Figures A & B. Radiographs are unchanged from prior evaluation. What is the next best option at this point?
Below the knee amputation
Exostectomy with placement into a protective brace
Exostectomy & achilles tendon lengthening with placement into a protective brace
A 65-year-old male with insulin-dependent diabetes and chronic kidney disease presents for follow-up care for issues in his right lower extremity. He has been treated for the past four months with the modality seen in Figure A (Panel A) for the condition seen in Figure A (Panel B). He has currently has no ulcerations on his foot. Which shoe modification, shown in Figure B-F, is most appropriate to prevent potential future skin breakdown by offloading the affected area in this patient?
A 50-year-old male with long-standing type 1 diabetes presents with redness, swelling and crepitus in his foot two weeks after a twisting injury. Elevation of the extremity reduces the hyperemia. A radiograph is shown in Figure A. What is the most likely diagnosis?
You are seeing a 62-year-old male for ankle and foot swelling (Figures A-C). There is no history of trauma and he has never seen a physician before. In addition to his lower extremity care, what other medical condition should he be evaluated for?
A 65-year-old diabetic female presents with a two-month history of mild ankle pain. She denies any specific injury and she does not have any foot ulcerations or wounds; her foot and ankle are edematous with erythema that resolves upon elevation. Her ESR, CRP, and WBC levels are within normal limits and her radiographs are shown in Figures A and B. What is the most appropriate initial treatment at this time?
Modification of shoe wear
Use of a total contact cast
Spanning external fixation of the ankle and hindfoot
A 62-year-old gentleman with a 10-year history of Type II diabetes complains of warmth, swelling, and pain in his right foot that has progressively worsened over the past 6 weeks. He denies fevers or chills, and states that the swelling and warmth dissipates each night after he sleeps with his foot elevated on pillows. A clinical photograph of the foot is provided in Figure A. The midfoot is hot to touch and mildly tender with palpation. A radiograph is provided in Figure B. Which of the following is the most appropriate management?
Custom orthotics with first ray recession and lateral heel posting
Total contact cast and non-weight bearing
Talonavicular and tarsometarsal arthrodeses
A 57-year-old woman with type 2 diabetes presents with right foot pain resulting in gait disturbance for the past 6 months. Medical comorbidities include renal insufficiency and hypertension. A radiograph is provided in Figure A. What initial management is most appropriate?
Carbon fiber shank insole
Custom orthotic with Jones bar and medial posting
AFO (ankle foot orthosis) with posterior leaf spring
Total contact casting
Accomodative plastizote insole with depression cut into the midfoot and extra-depth shoes
A 54-year-old diabetic man complains of swelling and erythema throughout the midfoot for 2 weeks. He denies any known trauma. The midfoot is warm, red, and swollen with no skin disruptions on physical exam. The erythema diminishes with elevation of the foot for 15 minutes. He has a temperature of 100.3 degrees Fahrenheit. The patient's CRP is 2.6 (normal range of <6.0). Which of the following is the most likely diagnosis?
Navicular stress fracture
A 43-year-old male presents with painless swelling and erythema of his ankle which resolves with elevation. He has begun to have trouble ambulating because he reports his ankle feels "floppy" since a fall several weeks ago. His x-ray is shown in Figure A. What physical exam test is most appropriate?
Syndesmosis squeeze test
Semmes-Weinstein monofilament testing
A 29-year-old male presents with left knee instability and progressive gait disturbance. He is only able to ambulate with the assistance of crutches or a walker. He has no pain with ambulation and has decreased vibratory sensation in the bilateral lower extremities. Radiographs are shown in Figures A-B. All of the following are possible etiologies for this condition EXCEPT: