215 Questions
What is the primary mechanism leading to digital deformities?
Flexor stabilization
Which of the following is NOT a type of digital deformity?
Tarsal tunnel syndrome
What is the result of the FDL overpowering the interossei?
Mild hyperextension deformity at the MTP
What is the term for the condition where the short flexors fail to stabilize the middle phalanx?
Clawtoe
Which of the following is an underlying biomechanical etiology of digital deformity?
Flexor stabilization
What is the result of the quadratus plantae losing its mechanical advantage?
Adductovarus deformity
Which of the following is a characteristic of flexor substitution?
Supinated foot
What is the term for the condition where the deep posterior and peroneal muscles gain advantage as major plantarflexors?
Flexor substitution
What is the result of the FDB failing to stabilize the middle phalanx?
Clawtoe
What is the primary reason for fixed MTPJ subluxation in extensor substitution?
Chronic contraction of extensor tendons
Which of the following is NOT a type of digital deformity?
Flexor elongation
What is the term for the condition where the interossei lose the ability to stabilize the proximal phalanx?
Mild hyperextension deformity
What is the purpose of CFT in the evaluation and surgical work-up?
To evaluate blood flow to the digits
What is the primary presenting complaint in patients with digital deformity?
Callus or corn
What is the significance of flexible deformity in extensor substitution?
It becomes rigid over time
What is the significance of a pronated foot in digital deformity?
It indicates flexor substitution
What is the percentage of vascular compromise reported by Kramer et al (2015) in hammertoe corrections?
0.6%
What is the primary cause of chronic edema, also known as 'Sausage toe'?
Damage to lymphatic or venous structures
What is Blue Toe usually indicative of?
Venous congestion or active bleeding
What is the recommended management for White Toe?
Monitor and prevent infection
What is a risk factor for vascular compromise in hammertoe correction?
Increased severity of deformity
What is the recommended approach to a patient with chronic edema after hammertoe correction?
Educate the patient on compression
What is the primary purpose of retrograde placement of K-wire in arthroplasty or arthrodesis?
To stabilize the joint for arthroplasty or arthrodesis
In which digits is arthrodesis traditionally avoided?
Fourth and fifth digits
What is the main difference between the techniques of arthroplasty and arthrodesis?
Removal of articular cartilage versus removal of the head of proximal phalanx
What is the primary goal of derotational arthroplasty?
To correct adductovarus deformity in the fourth and fifth toes
What is the recommended post-operative course for arthroplasty with derotational surgical management?
Ambulating in surgical shoe for 3-4 weeks
What is the name of the procedure that involves removal of a section of skin dorsally at the level of the PIPJ?
Derotational arthroplasty
What is the primary goal of patient education in surgical management of digital deformities?
To manage patient expectations and goals
What is the contraindication for elective correction of digital deformity in a patient with a high HbA1c level?
Co-morbid medical conditions
What is the primary indication for Hibbs tenosuspension procedure?
Hammertoe or clawtoe deformity secondary to overactive EDL
What is the technique used in flexor tendon transfer to convert flexor tendons into plantarflexors of the MTPJ?
Transferring the FDL and FDB tendons dorsally to the proximal phalanx
What is the primary indication for extensor tendon transfer procedure?
Chronic insufficiency or attenuation of the extensor tendon
What is the primary goal of syndactylization procedure?
To treat interdigital ulceration or persistent heloma molle
What is the technique used in soft tissue contracture release procedure?
Extensor tenotomy and dorsomedial capsulotomy
What is the primary indication for plantar plate repair procedure?
Instability, pain, and deformity stemming from the level of the MPJ
What is the primary goal of arthroplasty procedure in surgical management of digital deformities?
To shorten the toe and relax soft tissue
What is the primary indication for metatarsal osteotomy procedure?
To realign the metatarsal bone
What is the radiographic appearance of a first metatarsal elevatus?
A true widening angle distally of the dorsal first metatarsal cortex
What is the result of structural plantarflexion of the central metatarsals?
Increased pressure on the adjacent metatarsal heads
What is the role of the sesamoid axial view in the evaluation of preoperative position?
To evaluate the preoperative position and postoperative outcome
What is the effect of hallux abductovalgus on the normal distribution of weight to the forefoot?
It changes the normal distribution of weight to the forefoot
What is the result of structurally dorsiflexed central metatarsals?
Increased pressure on the adjacent metatarsal heads
What is the relationship between transverse and frontal plane deformities of the metatarsals?
They are less predictable and less obvious than the sagittal plane deformities
What is the meaning of the term 'Metatarsalgia'?
Pain in the foot originating from the Latin 'Meta' meaning next after, 'Tarsus' meaning of or pertaining to the ankle or instep, and 'Algia' meaning pain
What is the primary cause of callusing in metatarsalgia?
High levels of pressure and shear force on the skin
What is the result of the positive feedback mechanism in metatarsalgia?
Increased pain and breakdown of the skin
What is the significance of the 'Metatarsal parabola' in metatarsalgia?
It is a type of biomechanical abnormality
What is the relationship between abnormal levels of pressure and shear force, and callusing in metatarsalgia?
Abnormal levels of pressure and shear force lead to callusing
What is the significance of 'Equinus' in metatarsalgia?
It is a type of biomechanical abnormality
What is typically observed in T1 MRI findings for a sesamoid fracture?
Hypointensity
What is the usual screw size used for single screw fixation in a linear sesamoid fracture?
2.5mm
What is the potential consequence of sesamoidectomy?
Hallux varus
What is the purpose of the dorsal drawer test in evaluating a patient with suspected turf toe?
To evaluate the stability of the first metatarsophalangeal joint
What is the clinical presentation of a patient with turf toe?
Painful great toe with localized edema and ecchymosis
What is the indication for sesamoidectomy?
All of the above
What is the primary goal of treatment for stress fractures?
To allow for healing by ceasing harmful motion
What is the indication for surgical intervention in metatarsal base fractures?
Displacement >4mm or angulation >10 degrees
What is the approach for metatarsal fracture repair?
Dorsal approach for complex fractures of the shaft or base
What is the consideration when designing the incisional approach for metatarsal ORIF?
Avoiding neurovascular anatomy
What is the significance of height-differential information to the patient?
It informs the patient about the post-operative shoe wear
What is the primary goal of immobilization in stress fracture treatment?
To allow for healing by ceasing harmful motion
Why is it necessary to incise the periosteum during metatarsal ORIF?
To visualize the fracture line and evacuate any hematoma
What is the primary purpose of temporary stabilization with a clamp or wire during metatarsal ORIF?
To align the fracture fragments and hold them in place
Why is it important to ensure that the plate and heads of the screws are not prominent against the skin during metatarsal ORIF?
To allow for easier wound closure
What type of plating is required for complex comminuted fractures such as the third metatarsal fracture?
Bridge plating
What is the purpose of retracting tendons during metatarsal ORIF?
To identify and protect tendons during the procedure
Why is it necessary to check the position of the plate with intraoperative fluoroscopy during metatarsal ORIF?
To verify that the fracture fragments are properly aligned
What is the primary goal of immobilization in the treatment of sesamoiditis?
To reduce pain and inflammation
What is the significance of a naturally bipartite sesamoid in the diagnosis of sesamoid fracture?
It is a normal variant that can be found on the contralateral foot
What is the purpose of turf toe taping/strapping in the treatment of sesamoiditis?
To support the great toe
What is the primary goal of treatment for stress fractures?
To promote bone healing
What is the significance of callusing in metatarsalgia?
It is a sign of abnormal levels of pressure and shear force
What is the primary goal of surgical intervention in turf toe repair?
To restore the position of the sesamoids and repair the plantar plate tear
What is the characteristic of a stress fracture on an MRI?
A cortical breach with marrow edema
What is the purpose of taping/strapping in conservative care of turf toe?
To prevent dorsiflexion and stabilize the hallux
What is the recommended approach to a patient with turf toe and a medial-only tear?
An isolated medial approach
What is the significance of the sesamoid axial view in the evaluation of preoperative position?
It helps in assessing the position of the sesamoids
What is the primary goal of immobilization in stress fracture treatment?
To allow the fracture to heal
What is the significance of a positive dorsal drawer test in a patient with suspected turf toe?
It indicates instability of the MTPJ
What is the primary indication for sesamoidectomy in the treatment of sesamoid fractures?
Infected sesamoid bones
What is the typical MRI finding in a patient with a sesamoid fracture?
T1: hypointensity, T2: hyperintensity
What is the purpose of single screw fixation in the treatment of linear sesamoid fractures?
To promote bone healing
What is the typical clinical presentation of a patient with turf toe?
Hyperextension trauma with localized edema and ecchymosis
What is the recommended management for stress fractures in the foot?
Immobilization and weight-bearing modification
What is the primary reason for performing an intermetatarsal neurectomy in Morton's neuroma?
To remove the intermetatarsal nerve and the associated fibrotic tissue
What is the characteristic of a Morton's neuroma on ultrasound?
Hypoechoic and non-compressible
What is the purpose of injecting 4% sclerosing alcohol in the treatment of Morton's neuroma?
To atrophy the fibrotic tissue around the nerve
What is the radiographic feature of Morton's neuroma on X-ray?
A divergence of the toes (Sullivan's sign)
What is the typical MRI appearance of a Morton's neuroma?
Barbel-shaped and hypointense on T2-weighted images
What is the goal of conservative treatment in Morton's neuroma?
To relieve pain and alleviate pressure
What is the indication for surgical intervention in Morton's neuroma?
No response to conservative treatment
What is the benefit of using ultrasound-guided injections in Morton's neuroma treatment?
Improved accuracy and reduced complications
What is the significance of the 'Vulcansalute sign' in Morton's neuroma?
A variation of Sullivan's sign
What is the primary benefit of cryogenic denervation in Morton's neuroma treatment?
Minimally invasive procedure
What is the primary indication for surgical intervention in metatarsal base fractures?
Displacement >4mm
Which approach is used for more complex fractures of the metatarsal shaft or base?
Dorsal
What is the purpose of informing the patient about height-differential?
To ensure proper fitting of postop shoe
What is the mainstay of treatment for stress fractures?
Immobilization
What is the significance of radiographic evaluation in metatarsal fracture repair?
All of the above
What is the primary goal of treatment for metatarsal fractures?
To allow for proper healing
What is a characteristic of intermetatarsal bursitis that distinguishes it from intermetatarsal neuroma?
It is compressible on ultrasound
What is a common complication of neurectomy?
All of the above
What is the purpose of an MRI in the evaluation of forefoot pain?
To identify soft tissue abnormalities
What is the role of ultrasound in the diagnosis of intermetatarsal neuroma?
To distinguish neuroma from bursitis
What is the purpose of X-ray in the evaluation of forefoot pain?
To diagnose stress fractures
What is a common feature of intermetatarsal neuroma on MRI?
It appears as a mass
What is the primary goal of ordering an MRI for a patient with a suspected plantar plate injury?
To visualize the plantar plate and surrounding soft tissue
Which imaging modality is most useful for diagnosing intermetatarsal neuroma?
Ultrasound
What is the primary indication for ordering an arthrogram for a patient with a suspected plantar plate injury?
To visualize the joint space and surrounding soft tissue
What is the primary benefit of using ultrasound-guided injections in the treatment of Morton's neuroma?
Increased accuracy of injection
What is the primary characteristic of a stress fracture on an MRI?
A high signal on T2-weighted images
What is the primary role of the sesamoid axial view in the evaluation of preoperative position?
To assess the alignment of the sesamoid bones
What is the most likely diagnosis in a patient with a swollen and tender third metatarsal-phalangeal joint with redness and difficulty moving the joint?
Septic arthritis
What is the primary purpose of ordering an MRI in a patient with suspected plantar plate rupture?
To assess the soft tissue structures of the foot
What is the significance of a positive digital Lachman's test in a patient with suspected plantar plate rupture?
It suggests a rupture of the plantar plate
What is the primary advantage of using musculoskeletal ultrasound in the diagnosis of Morton's neuroma?
It allows for dynamic imaging of the foot
What is the primary indication for ordering a TC-99 scan in a patient with suspected plantar plate rupture?
To diagnose a plantar plate rupture when MRI is negative
What is the primary purpose of ordering an X-ray in a patient with suspected metatarsal fracture?
To visualize the bony anatomy of the foot
What is the primary benefit of using an Arthrogram in the diagnosis of plantar plate tears?
Allows for tracking of contrast into the tendon sheath indicating a PP tear/rupture
What is the significance of 'slices' in an MRI?
They measure thicker than the width of the injury, which can lead to missed diagnosis
What is the primary indication for ordering further tests in a patient with a suspected plantar plate tear?
Clinical suspicion, despite a negative MRI
What is the purpose of injecting contrast into the joint during an Arthrogram?
To track the contrast into the tendon sheath, indicating a PP tear/rupture
What is the significance of edema on an MRI?
It is a sign of plantar plate disruption
What is the primary benefit of using a plantar approach in plantar plate repair?
It allows for easier access to the plantar plate
What is a characteristic of late-stage Predislocation syndrome?
Subluxation of the MTPJ
What is the anatomical structure that inserts into the plantar plate?
Deep transverse intermetatarsal ligaments
What is the imaging modality that may be useful in determining plantar plate tears dynamically?
Ultrasound
What is the result of a blood pool phase Tc-99 scan in a patient with a plantar plate tear?
Positive radiotracer uptake
What is the characteristic of the plantar plate in anatomy?
A shallow cavity fibrocartilaginous structure
What is the surgical treatment for plantar plate tears in late-stage Predislocation syndrome?
Plantar plate repair
What is a common underlying factor that contributes to capsulitis/synovitis?
All of the above
What is the primary function of reducing the sesamoid complex with traction during an open first MTPJ reduction?
To gain leverage and properly reduce the joint
What is a characteristic symptom of capsulitis/synovitis?
Pain and swelling about the forefoot
Why is it essential to check the reduction of the sesamoid complex during an open first MTPJ reduction?
To confirm reduction of the sesamoid complex
What is often seen on plain film radiographs in patients with inflammatory arthropathies, such as psoriatic arthritis?
Peri-articular erosions of the bones
What is a common presentation of patients with capsulitis/synovitis?
Pain and swelling about the forefoot
What is the primary characteristic of Predislocation Syndrome stage II?
Moderate Edema and noticeable deviation of the digit
What is the purpose of Digital Lachman's test in Predislocation Syndrome?
To test for dorsal translocation of the digit
What is the radiographic finding often seen in Predislocation Syndrome?
Splayfoot deformity
What is the primary difference between Predislocation Syndrome stage II and stage III?
Degree of deviation of the digit
What is the clinical significance of noticing loss of toe purchase in Predislocation Syndrome?
It indicates a moderate condition
What is the primary reason for performing Digital Lachman's test on the contralateral side?
To compare with the affected side
What is the typical appearance of joint degeneration in the early stages of Psoriatic Arthritis?
Nonspecific
What is the radiographic feature associated with Psoriatic Arthritis?
Gull wing pattern at the DIPJ
What is Freiberg's infarction?
Avascular necrosis of the second metatarsal head
What is the percentage of PA patients with nail psoriasis?
Up to 70%
What is the characteristic clinical finding of Psoriatic Arthritis?
Swelling of the digits
What is the response of stiffness to increased activity in Psoriatic Arthritis?
Stiffness decreases
What is the typical age range of female patients most commonly affected by Freiberg's infarction?
13-18
What is the ratio of female to male patients affected by Freiberg's infarction?
4:1
In which metatarsal bone is Freiberg's infarction most commonly seen?
Second metatarsal
What is the basis of Smille's staging system for Freiberg's infarction?
Intraoperative findings
What is the characteristic of Stage 2 in Freiberg's staging system?
Sinking of the articular surface
At which stage can joint-sparing surgery no longer be performed in Freiberg's infarction?
Stage 4
What is the radiographic appearance of a joint with capsulitis/synovitis?
Normal appearance
What is the primary association with capsulitis/synovitis?
All of the above
What is the purpose of taking radiographs during an open first MTPJ reduction?
To ensure the sesamoid complex is appropriately reduced
What is the typical presentation of a patient with capsulitis/synovitis?
Pain and swelling about the forefoot
What is the significance of tenderness with passive toe ROM in capsulitis/synovitis?
Is a common finding in capsulitis/synovitis
What is the difference between capsulitis and synovitis?
Capsulitis is inflammation of the joint capsule, while synovitis is inflammation of the synovial membrane
What is the significance of a high ANA titer in a patient's blood?
It is a nonspecific marker of autoimmune disorders
What is the purpose of measuring Rheumatoid Factor in a patient's blood?
To diagnose Rheumatoid Arthritis
What is the normal range for ESR in adults?
0-10mg/L
What is the significance of a low CRP titer in a patient's blood?
It indicates a low level of inflammation in the body
What is the purpose of performing an Anti-CCP antibody analysis?
To detect autoimmune disorders directed at human tissue
What is the significance of a high Anti-CCP antibody level in a patient's blood?
It is a definitive diagnosis for Rheumatoid Arthritis
In rheumatoid arthritis, which laboratory test must be normal prior to surgical intervention?
CRP
What is the primary purpose of ordering a C-spine X-ray in patients with rheumatoid arthritis?
To evaluate for atlanto-axial subluxation
Which laboratory test is used to diagnose and monitor rheumatoid arthritis?
Rheumatoid Factor (RF) testing
What is the significance of a high ESR in rheumatoid arthritis?
Indicates active inflammation
What is the role of Anti-CCP antibody analysis in rheumatoid arthritis?
To diagnose rheumatoid arthritis
What is the primary benefit of CRP testing in rheumatoid arthritis?
To monitor disease activity
What is the primary purpose of Anti-CCP antibody analysis in inflammatory arthritis?
To diagnose rheumatoid arthritis
What is the normal range for ESR in women?
0-29 mm/hour
What is the purpose of CRP testing in inflammatory arthritis?
To monitor disease activity and response to treatment
What is the significance of a positive ANA test in inflammatory arthritis?
It indicates the presence of an autoimmune disease
What is the significance of an elevated ESR in a patient with inflammatory arthritis?
It indicates the presence of inflammation or tissue damage
What is the purpose of Rheumatoid Factor diagnosis in inflammatory arthritis?
To diagnose rheumatoid arthritis
What is the approximate percentage of patients with rheumatoid arthritis who present with rheumatoid nodules at diagnosis?
Up to 7%
What is the most common non-skin location of rheumatoid nodules?
Lung
What is the characteristic histopathology of rheumatoid nodules?
Central area of necrosis surrounded by palisading epithelioid macrophages
What is the preferred treatment for symptomatic rheumatoid nodules?
Intra-lesional steroid injections with triamcinolone acetonide
What is the appearance of rheumatoid nodules on ultrasound?
Ill-defined, heterogeneous mass
What is the significance of multiple rheumatoid nodules in patients with known rheumatoid arthritis?
It is diagnostic of rheumatoid arthritis
What adjunct procedure could have been utilized to provide more stability while walking in a 69-year-old male patient with a history of rheumatoid arthritis who underwent a Hoffman pan-metatarsal head resection?
Clayton procedure
What additional diagnostic must be ordered prior to surgical intervention in patients with rheumatoid arthritis?
C-spine X-ray
What is the primary goal of the Hoffman procedure in patients with rheumatoid arthritis?
To alleviate pain
What is the significance of the Nijmegen criteria in patients with rheumatoid arthritis?
To diagnose early rheumatoid arthritis
What is the role of the Clayton procedure in the management of rheumatoid arthritis?
To alleviate pain in the forefoot
What is the purpose of the Hoffman pan-metatarsal head resection in patients with rheumatoid arthritis?
To alleviate pain in the forefoot
What is the primary purpose of the Nijmegen classification system?
To classify the severity of metatarsophalangeal joint deformity in patients with rheumatoid arthritis
What is the characteristic of Grade 1 in the Nijmegen classification system?
Decrease in MTPJ mobility with some erosive changes and/or joint space narrowing on X-rays
What is the significance of the Nijmegen classification system in surgical pre-planning?
It assists in deciding between joint-sparing surgery and more aggressive surgery
What is the typical finding on X-rays in patients with rheumatoid arthritis, according to the Nijmegen classification system?
Peri-articular erosions on the radial side of the MCP and plantar MTPJ
What is the correlation between staging and pain level in patients with rheumatoid arthritis, according to the initial study on the Nijmegen classification system?
There is a clear correlation between staging and pain level
What is the typical location of peri-articular erosions on X-rays in patients with rheumatoid arthritis, according to the Nijmegen classification system?
The 4th and 5th MTPJ
What is the primary advantage of the plantar approach in HoffmanClayton procedure?
Good visualization and relocation of plantar fat pad
Which of the following surgical approaches has a higher incidence of skin slough?
Dorsal linear 5 incision
What is the primary disadvantage of the dorsal linear 3 incision approach?
Limited surgical exposure
Which of the following surgical approaches is considered technically difficult and requires meticulous dissection?
Lazy S approach
What is the primary advantage of the dorsal linear 5 incision approach?
Good exposure to MPJ's and soft tissue
What is the primary consideration for the pan-metatarsal head resection procedure?
All of the above
What is the orientation of the bone cut during PAN met head resection?
30 degrees to the long axis of the metatarsal
What is the purpose of longitudinally dividing the EDL and EDB tendons during PAN met head resection?
To facilitate the resection of the metatarsal head
Why is it important to free the soft tissue attachments to the head of the metatarsal during PAN met head resection?
To facilitate the removal of the metatarsal head
What is the purpose of using a bone rasp to smooth down the remaining metatarsal during PAN met head resection?
To smooth down any prominent remaining metatarsal
What is the advantage of using a midline incision for met heads 2/3, and 4/5?
It allows for easier access to the metatarsal head
What is the purpose of reflecting the soft tissue attachments to the head of the metatarsal during PAN met head resection?
To facilitate the removal of the metatarsal head
What is the primary approach to resecting the metatarsal heads during a Pan Met Head Resection?
Resecting the lesser metatarsal heads working from medial to lateral
What is the purpose of bending the wire and capping it after pinning the toes during a Pan Met Head Resection?
To prevent the wire from sticking out of the toe
What is the recommended depth of resection of the head of the proximal phalanx during a Pan Met Head Resection?
About 5mm
What is the primary goal of developing the first MTPJ incision during a Pan Met Head Resection?
To fuse the first MTPJ
What is the significance of the 'sharp part' being placed medial and dorsal during a Pan Met Head Resection?
To reduce pressure on the toe pulp
What is the purpose of using a Rongeur or reciprocating saw during a Pan Met Head Resection?
To decompress the PIPJ
Test your knowledge of the different types of digital deformities, including hammertoe, clawtoe, and more. This quiz covers the classification and characteristics of various toe deformities. How well do you know the various types of digital deformities?
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