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Floating-toe deformity is the most common complication of which of the following surgical procedures used to treat central metatarsalgia?
Dorsal soft-tissue release with pin fixation
Silicone implant arthroplasty
MTP joint excisional arthroplasty
Metatarsal shaft osteotomy (Helal procedure)
Metatarsal neck osteotomy (Weil procedure)
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A 40-year-old man has metatarsalgia secondary to a chronically dislocated 2nd metatarsalphalangeal(MTP) joint. Nonoperative modalities including shoe modifications have failed to improve his symptoms. When comparing osteotomy B (Weil osteotomy) to osteotomy A (Helal osteotomy) as shown in Figure A, all of the following are true EXCEPT:
Higher patient satisfaction rates
Lower incidence of recurrent metatarsalgia
Fewer transfer lesions
Higher percentage of radiographic reduction and maintenance of the MTP joint reduction
Increased rate of malunion or pseudoarthrosis
A 57-year-old man plays 45 holes of golf per week and has foot pain during the toe-off phase of gait. He notes the foot pain started 3 months ago after walking up a hill and falling forward on some wet grass. Your exam shows skin callosities dorsally at the 2nd PIP joint and plantarly at the 2nd MT head. Radiographs show a hyperextension deformity of the 2nd proximal phalanx in relation to the metatarsal. All of the following are true about this patient's condition EXCEPT:
Symptomatic treatment initially includes extra depth shoes, metatarsal pads, and well-padded liners
The MTP drawer test will likely show laxity at the MTP joint in the dorsal-plantar plane
Repeated MTP dorsiflexion weakens the plantar aponeurosis, plantar plate, and capsular stabilizers
Plantar callosities result from dorsal displacement of the fatty cushion underneath the metatarsal head
Condition is a result of repetitive stresses causing microfractures with subsequent compromised blood supply to the metatarsal subchondral bone
A 70-year-old man complains of inability to wear normal shoes on his left foot due to a second and third toe deformities. Radiographs are shown in Figures A and B. He decides to undergo surgical treatment. After intra-operative extensor tendon lengthening and capsular release, the joints continue to subluxate. What is the next step to correct the deformities?
Flexor tendon resection
Proximal phalangeal crescentic osteotomy
Metatarsophalangeal joint arthrodesis
Distraction osteogenesis of the metatarsal
Metatarsal shortening osteotomy