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Review Question - QID 546

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QID 546 (Type "546" in App Search)
An 18-year-old male complains of a painful prominence over his medial midfoot for the past 2 years; NSAIDs and orthotics have failed to provide relief. Physical exam demonstrates a firm, nonmobile, tender bump on the medial midfoot with no skin changes. A radiograph is provided in figure A. Which of the following is the best treatment option?
  • A

Total contact cast

3%

74/2841

Steroid injection

1%

37/2841

MRI of the foot and chest CT scan

1%

36/2841

Open biopsy

1%

20/2841

Surgical excision

94%

2663/2841

  • A

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The radiograph demonstrates an accessory navicular. Conservative measures are the first line treatment for the symptomatic accessory navicular. Surgical excision is a reliable intervention for cases refractory to conservative management.

Grogan et al reviewed 39 patients with symptomatic accessory naviculars. Twenty-five went on to surgical resection following failure of conservative management with all 25 achieving complete relief.

Incorrect answers:
There are no periosteal changes, signs of bony destruction, or matrix present on the radiograph eliminating selections 3 and 4 for the work-up of malignancy.

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