What is a common complication of an Evans calcaneal neck lengthening?
C)
What is true about Triple-C osteotomy and Evans calcaneal neck lengthening?
A)
More complications with evans
Better talar head coverage with Triple C
Triple C involves Dorsal opening wedge osteotomy
What is the best option for symptomatic hallux rigidus in a 45 year-old active labourer?
A)
53- What tendon is seen after debriding the medial facet through a lateral subtalar joint approach for an arthrodesis?
A)
What is true about gait?
A)
stance is 60%
lowest point at time of double limb support
A 47yo male insulin-dependent diabetic presents with a callus and ulceration on the plantar aspect of the 5th metatarsal. This was managed with trimming of the ulcer edges and local skin care, but is worsening. On exam he has mild cavus alignment bilaterally. What is the best treatment?
a) Gastrocsoleus stretching exercises and referral for specialized diabetic footwear
b) Medial calcaneal slide osteotomy
c) Dorsiflexion osteotomy of the 5th metatarsal
d) Percutaneous lengthening of the Achilles tendon
A vs D
Patient with Achilles tendon rupture. Surgeon decides to treat him in cast and allows him to weight-bear. What is the expected outcome ?
A)
Regarding sesamoids, which of the following is true?
B)
Tibial sesamoid larger
FHB TENDON attaches to sesamoids
FLH glides between them
A patient has pain 8 years post total ankle arthroplasty, what is the most common cause?
C)
All are associated with Achilles tendon contractures, (IF EXCEPT) ?
C)
Morton's neuroma not associated to achilles contractures
What is commonly found with anterior tibiotalar impingement?
A)
Which is not an etiology of chronic ankle instability symptoms?
B)
Causes of chronic ankle instability
OCD
peroneal tendon injuries
Cavovarus
Deltoid ligament injury
60F with medial sided ankle pain and tenderness posterior to med mal 3 weeks after minor torsion. What is the cause? What do you see on exam?
A)
Tib post insufficiency physical exam: single toe rise
What is the function of the gastrocsoleus complex?
A)
Patient with chronic ankle pain and they show you a picture of a ball and socket ankle. What is the most likely cause? (repeat)
D)
What step is common for all procedures treating plantar fasciitis? REpeat
B)
Treatment plantar fasciitis
Partial plantar facsia release
Gastrocts resession
Tarsal tunnel decompression
All surgical treatment of plantar fasciitis involves (Repeat)
A)
what is part of every surgical procedure for plantar fasciitis?
C)
incision is medial
protect medial calcaneal nerve
Release abductor hallucis fascia
Release 1-2/3 of fascia
For a diabetic patient with a foot ulcer, what is the most important factor in the ability to heal? REPEAT
C)
When performing a calcaneal neck lengthening in a patient with posterior tibialis tendon insufficiency, what is true? (Sherbrooke: pediatric patient)
A)
Osteotmy 1-1.5cm from CC
No need to Pin CC or TN joints
What is true about muscle activity in mid-swing phase of gait? REPEAT
A)
Patient presents with decreased sensation in the foot. All are possible causes except?
C)
Polio preserves sensation with altered motor
What is true regarding hallux rigidus?
A)
Need 15 degrees dorsiflexion
Dorsal osteophyte prevents dorsiflexion
COR becomes more proximal
A 64yo female presents with a painful bunion. X-rays demonstrate hallus valgus with an intermetatarsal angle (IMA) of 20 degrees and a hallux valgus angle (HVA) of 45 degrees, with an incongruent 1st MTP joint. She has failed non-op treatment. What is the best treatment?
A)
Need proximal and distal if IMA >13 and HVA>40
Distal only if IMA <13 and HVA <40
A 47yo male insulin-dependent diabetic presents with a callus and ulceration on the plantar aspect of the 5th This was managed with trimming of the ulcer edges and local skin care, but is worsening. On exam he has mild cavus alignment bilaterally. What is the best treatment?
a) Gastrocsoleus stretching exercises and referral for specialized diabetic footwear
b) Medial calcaneal slide osteotomy
c) Dorsiflexion osteotomy of the 5th metatarsal
d) Percutaneous lengthening of the Achilles tendon
A vs D
Ideally needs total contact casting
A patient with flexible flat feet undergoes lateral column lengthening through the anterior calcaneus. Which of the following is a complication of lateral column lengthening?
A)
What is the cause of osteopenia in a neuropathic (Charcot) joint?
B)
Increased blood flow > autonomic dysfunction and increased blood flow
A 20yo female presents to your clinic with a history of multiple ankle inversion injuries. She now has tenderness over the peroneal tendons and lateral ankle joint, and has a positive anterior drawer test. X-rays are normal. What investigation should be ordered to help with pre-op planning?
C)
52 y.o. lady with injury sometime ago, now with pes planus and hindfoot valgus. Can’t do single toe raise. Hind foot is passively correctable. Has 10 degree equinus contracture in knee extension. Able to passively dorsiflex ankle to 5 deg when knee flexed. What is problem?
Patient unable to do heel raise bc of tib post insufficiency
Guy with Achilles rupture- poor tissue as you debrided more than 50% of the tendon what do you use to supplement repair?
B)
find it at the knot of henry >>it is deep to FDS
Regarding Sesamoids, which of the following is true?
A)
Tibial sesamoid is larger
Imbedded in tendons of FHB
1 artery goes to each sesamoid
When doing a Syme’s amputation, what do you do with heel pad?
B)
Achilles tenodesis to tibia also helps prevent migration
65 yo.Diabetic with 4 week history of swollen, erythematous foot- you are given XR. She had complete dislocation of forefoot superior and lateral. She is well controlled and has no systemic issues. What you do? Think there was a pic for this one xray.
C)
Treatment of charcot is TCC
55 y.o. fat lady with gradual onset of pes planus and hindfoot valgus. Flexible hindfoot. Cannot do single leg toe raise. What is best surgical option?
A)
Patient has stage 2A PTTI: no rigid deformities
Triple fusion if arthritis and significant deformity
Debridement of tendon only for stage 1: can do heel rise and no deformity
Pt with RA, forefoot procedures- excision of DP 2-5 and fusion of 1st All true except we felt there were multiple correct answers may not appear again.
C)
Rheumatoid foot
Need to maintain cascade: prevent transfer metatarsalgia
There was a question about an acute tib post rupture what do you do?
a) Repair it
b) Enhance it with FDL
c) Transfer tib ant
d) Do something with peroneals
A or B
If acute rupture in fracture and no flatfoot or tendon degeneration: acute repair
If rupture and tib post insufficiency: FDL transfer to reinforce
20 year-old girl is known for JIA and comes in with severe foot pain and progressive deformity. You are shown an xray with severe subtalar joint involvement, forefoot abduction and talonavicular subluxation (talar head uncovered medially). You are told that the ankle joint is not significantly affected, good plantar/dorsiflexion. What is the best management at this point?
a) Triple arthrodesis
b) Isolated subtalar arthrodesis
a)
triple bc of forefoot abduction and TN dislocation
Tendon seen in subtalar fusion after debridement of posterior facet
C)
FHL runs medial edge of calc under sustentaculum tali
Syme amputation in trauma, all except?
B)
NEED SOCKET ON SAME SIDE BC CALC IS GONE >LLD
Posterior heel migration is complication: can avoid by suturing to anterior tibia
Lady comes in with acquired flatfoot deformity, what is cause?
Tib post rupture or incompetence
Best position for ankle arthrodesis
C)
Anterolateral OCD in 28 year-old female, cartilage not intact but lesion in position. Lesion measures 8 mm. What is the best treatment for her?
D)
If more than 1.5cm2 then consider mosaicplasty
Retrograde drilling if cartilage intact
Medial mall osteotomy for medial OCD
Which of the following is different in juvenile hallux valgus when compared to adult hallux valgus?
D)
Factors that differentiate juvenile from adult
Often bilateral and familial
Usually not painful
DMAA increased
Usually flexible flatfoot present
Patient presents with chronic Achilles tendon tear on MRI. Has a 7 cm gap. What is the best option?
A)
VY turndown if gap < 5cm
A patient presents with an acute tear of his Achilles tendon. What should you tell the patient?
a) Nonop will involve early mobilization
b) Operative results in lower re-rupture rates
a)
Early functional recovery is better
What is the minimum Oxygen tension to allow healing of a diabetic foot ulcer?
A)
Also want ABI > 0.45
toe pressure of 40
All of the following are good to assess ankle stability except?
a) MRI
b) Anterior drawer test in plantarflexion
c) CT of the syndesmosis
d) Arthrogram showing dye extending to peroneal tendon sheath
C or D
Which of the following is an advantage of performing a lateral column lengthening vs. medial subtraction osteotomy?
C)
All of the following are true with Tarsal Coalition EXCEPT:
C)
CT is best for assessing coalition size
All of the following are true with talus microfracture long term EXCEPT:
B)
Good results on MRI 60%
Bad prognostic factor is size>1.5cm
A 30 y.o. female alcoholic falls and injures her foot. She comes to see you a 6 weeks later and you notice the deformity seen in the radiographs (you’re shown radiographs of ant. Talonavicular dislocation). Closed treatment failed. What is the best treatment?
D)
50 y old alcoholic presents to your office with a 4 month history of severe ankle pain being treated for an “ankle sprain”. Initial radiographs and CT provided – shows a talonavicular dislocation and no evidence of any arthritis at the tibiotalar or subtalar joint (ie. missed lateral subtalar dislocation). It is not possible to reduce this closed. What is the best option at this time:
B)
since 90% motion at TN, most surgeons will do triple if they think about fusing TN
What needs to be done with a Symes amputation?
D)
Position of ankle for arthrodesis
Something else
B)
Hallux valgus IMA 15 degrees, HVA 40 degrees, incongruent (XR shown, values given). Normal ROM.
B)
IMA <13 and HVA <40: Distal osteotomy
IMA >13 and HVA >40: proximal or double osteotomy
Instability TMT: lapidus
Arthritis or spasticity: MTP fusion
A patient undergoes an ankle fusion. Which prosthesis would be recommended for best gait?
B)
double rocker bottom for charcot rocker bottom foot
Shown an X-ray of a lateral ankle after ORIF. There is a long plate with screws in the proximal and distal segments, and no screws in the area of comminution in the middle. What type of fixation is this?
D)
Which of the following is NOT an indication to perform an ankle arthroscopy?
C)
Treatment of isolated medial ankle OA can be supramalleolar osteotomy
What is the most common location for an atraumatic OCD of the talus?
B)
anterolateral is traumatic
Correct position for ankle fusion?
B)
Chronic (6 months) pain post inversion ankle sprain. MRI Scar tissue in sinus tarsi
A)
ruling out sinus tarsi syndrome: inflammation and synovitis in sinus tarsi
best treatment is scope
Drunk man passed out and woke up with a peroneal nerve palsy. In what order is the nerve function expected to return?
E)
Chronic Achilles tendinopathy
A)
PT concentrates in eccentric strengthening
Regarding plantar fasciitis—non-op treatment failed. All are true except— (Question probably referring to chronic heel pain)
C)
Do not release more than 40% plantar fascia
If release all plantar fascia
Destabilize longitudinal arch
Overload lateral column
dorsolateral foot pain
with Achilles tendon rupture 3 months ago and 6 cm gap (Dalhousie has 3 cm). What to do?
C)
more than 5 cm need reconstruction with FHL
<5cm can try VY turndown
Acute tibialis posterior rupture with normal arch (no hindfoot valgus). What to do?
B)
can do primary repair if no signs of tendon pathology
All the following are etiological factors of planter fasciitis, Except?
B)
heel spurs appear as a result of plantar fasciitis but do not cause it
All the following are true regarding plantar fasciitis except:
B)
After an ankle fusion, what is your next anticipated problem?
D)
Up to 50% at 10 years
Poor wound healing in a diabetic is most indicated by which? UBC: What is the most predictive of ulcer healing in a diabetic foot?
B)
Increased wound healing if albumin >3 or lymphocyte count >1500
Ankle instability, all of the following are good to assess except:
C)
Torn deltoid xray and widened syndesmosis, which is also torn?
C)
syndesmosis ligaments
23 year old female with pain at 1st MT and hallux valgus picture, told IM was 15 and HV angle was 40, looked incongruent and only partially corrected passively, tx?
A)
Lisfranc amputation and now problems with medial lateral stability and push off, best option to assist ambulation?
D)
Need forefoot filler and AFO for instability
Diabetic male with chronic infected plantar ulcers, best management? Ottawa: How do you best prevent recurrent forefoot ulcers in diabetes?
C)
In treating someone with an Achilles tendon rupture, most correct:
Open repair is associated with a higher re-rupture rate vs closed treatment
C)
Open repair has higher complications
open repair now has equal rate rerupture to closed
Scope the ankle, anteromedial portal is:
D)
Which is true in ankle xray tibial clear space? (tibiofibular clear space)
C)
shhould be less than 6mm on both AP and mortice
What are the characteristics associated with hallux rigidus?
C)
Dorsal exostosis limit dorsiflexion
COR moves proximal
Dorsiflexion required is 15 degrees
Charcot foot and osteopenia, most likely caused by which?
B)
Repeat; about woman with tibialis post dysfunction and loss of DF worse with knee extended than normal with knee flexion?
Long oblique metacarpal fracture fixed with interfragment screw, principles suggest:
A)
Definition of long oblique is thtat the lenght is twice as long as the diameter of the bone at the fracture site>>>long oblique means interfrag screw alone is sufficient
Tib post dysfunction why lateral column lengthen over medial calc osteotomy. This is reducible hindfoot valgus?
A)
Presented with an X-ray showing ankle bimalleolar ORIF. The fibula is comminuted and bridge plated. There is a Syndesmotic screw. The fibula is obviously fixed in a shortened position. You are told that the patient returns in 3 months with pain and are shown an X-ray of a widened syndesmosis (screw had been removed), non-union and hardware failure. Why did this happen?
B)
A fisherman sustained an open medial malleolus fracture and sharp laceration to tib post tendon. How should you manage the Tib-post tendon injury?
C)
reconstruct with FDL if signs of PTTI
DM with Charcot joint and ankle in valgus, stated CT showed ST arthrosis. Poor vascular supply. No ulcers, but impending breakdown on medial side. Failed orthosis/casting.
C)
In the foot and ankle, where do accessory ossicles NOT occur and are subsequently indicative of a fracture at that site?
A)
base 5th MT: Os vesalanium
Regarding lesser toe function during the stance phase of gait:
B)
during walking 2nd toe pressure is higher (keystone)
Given a history of a trauma with hindfoot pain with localized swelling and tenderness just anterior to the lateral malleolus. You are shown an X-ray with what looks like a lateral process fracture of the talus. What’s wrong with this patient?
B)
In a long spiral fracture of a metacarpal shaft deemed suitable for lag screw fixation:
B)
Trans-tibial amputation in vascular patient:
B)
better healing with fishmouth incision
What is not a risk factor for non-union of an ankle arthrodesis?
F)
all others are risk factors
The stance phase of gait is what percentage of the gait cycle
D)
With regards to gout? (except)
A)
x ray are punched out periarticular lesions: late finding
64 yo diabetic woman with 4 weeks of redness, increasing deformity, swelling in her foot, x-ray shows a dislocated TMT joint with some early fragmentation, what to do
C)
Young guy with x-ray of a Lisfranc
D)
fusion if ligamentous
Most common reason for ankle OA
C)
Rheumatoid forefoot reconstruction – it’s from the repeat question bank, but we all assumed it was a: which one of the following is TRUE. Surprise! Plan is to fuse 1st MTP and….which one of the following is FALSE
C)
Repeat question on Achilles tear risk factors. All are risk factors except one
B)
Males more common
Following ankle fusion – cause for hindfoot arthritis
D)
X-ray of adult foot showing rocker bottom foot with flat-top talus and 1st metatarsal varus. What is most likely cause of this presentation
