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A 54-year-old male with Protein C deficiency sustained a stroke 3 months ago with subsequent left sided weakness. The patient's skin is intact with no sign of ulcerations or callosities. His left foot is developing a varus deformity secondary to a spastic tibialis anterior. His ankle has a 5 degree plantar flexion deformity due to a gastrocnemius contracture which improves with knee flexion (positive Silverskiold test). The patient has an intrinsic minus foot with supple claw toes present. Which of the following is the most appropriate next step in management?
Gastrocnemius fascia lengthening (Strayer) procedure
Split anterior tibial tendon transfer (SPLATT)
Flexor hallucis longus tendon transfer to the dorsum of the foot and release of the flexor digitorum longus and brevis tendons at the base of each toe
Fractional lengthening of the tibialis posterior
Ankle foot orthosis (AFO) with physical therapy
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Which of the following best describes the physical examination test demonstrated in Figure A?
Silfverskiöld test used to differentiate gastrocnemius tightness from achilles tendon contracture
Thompson test used to differentiate soleus tightness from achilles tendon contracture
Coleman test used to differentiate soleus tightness from achilles tendon contracture
Silfverskiöld test to differentiate soleus tightness from achilles tendon contracture
Thompson test to differentiate gastrocnemius tightness from achilles tendon contracture
HPI - Patient 29 years old from Honduras, male, sustained a Type C Weber ankle fracture in Nov last year. Soon after waking up from surgery medial aspect of the heel and sole of the foot was without sensation with concomitant pain on the dorsal aspect of the distal third of the leg, where fracture site was. Allodynia, pain and progressive contracture of the toes developed.
EMG: Sensitive-motor neuropathy with axonal lesion of right peroneal nerve and severe posterior tibial nerve.
Motor Nerve conduction study: right tibial nerve at ankle = Lat: 4.3ms; Dur:1.0ms; Amp:50.0uV; Area:0.0mVms; Segment: Ankle; Distance: 120mm; Interval: 4.3ms
What is the best treatment?