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A 42-year-old male presents with chronic plantar foot pain. The pain is worst when he wakes up, and remains persistent throughout his workday. Which of the following findings is an indication for gastrocnemius recession?
A Silverskjold test demonstrates 10 degrees less than neutral with the knee in extension versus 10 degrees beyond neutral with the knee flexed
A Silverskjold test demonstrates 5 degrees of ankle dorsiflexion with the knee in extension, which does not change with the knee flexed.
Persistent pain despite three months of rigorous physical therapy
Flexible pes planovalgus
A positive "too many toes" sign
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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
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