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An 18-year-old male presents with recurrent ankle sprains of the left ankle and painful callus underneath the 5th metatarsal. Standing examination is shown in Figures A and B. During Coleman block testing the hindfoot is positioned in 3 degrees of valgus. The peroneus brevis and anterior tibialis have 4/5 strength compared to 5/5 strength in peroneal longus, gastrocsoleus complex, and posterior tibialis. Using a semi-ridged orthotic with a recess for the head of the first ray and lateral hindfoot posting has failed to improve symptoms. Which of the following is most appropriate as one part of the surgical plan??
Peroneus brevis to longus transfer with medial calcaneal slide osteotomy
First ray dorsiflexion osteotomy with plantar fascia release
First tarsometatarsal joint arthrodesis and metatarsophalangeal capsular release
Select Answer to see Preferred Response
What is the preferred orthotic device for a symptomatic adult foot deformity that is shown in Figure A, has no arthritis on radiographs, and responds to Coleman block testing as shown in Figure B?
Short walker boot
Accommodative custom orthotics
Lace up soft ankle brace
Medial hindfoot posting with arch support
Lateral hindfoot posting with recessed first ray
Subtle Cavus Foot: Arthur Manoli, MD (CSFA #21, 2017)
In the first segment about assessing foot flexibility, Vince Mosca, MD quickly c...
In the second segment about assessing foot flexibility, Vince Mosca, MD demonstr...
HPI - 12 yo with low lumbar spina bifida (L4-S1), who ambulates without any supports. Parents report a progressive cavus deformtiy more on the right than the left. They feel it is progressing rapidly. She has sensation to most of her foot, somewhat decreased on the lateral part of the dorsum of the foot, but normal in all toes and plantar surface. Complains of frequent ankle sprains. She has had de-tethering procedure 9 months ago, but parents feel it is still progressing. MRI scans and neurosurgical consult completed recently suggest no evidence of residual tethering.
Normal motor function on EMG of peroneals and tib ant and gastrocsoleus. Normal peroneal nerve and sural nerve conduction.
How would you treat this patient?