EBM: Hammertoes & Second Ray Pathology

In a patient presenting with a digital deformity characterized by flexion at the PIP joint and hyperextension at both the MTP and DIP joints, which of the following biomechanical etiologies is MOST likely to be the primary driver of this presentation, assuming no neurological involvement?

A 68-year-old male presents with a chief complaint of pain localized to the plantar aspect of the second metatarsal head. Clinical examination reveals a positive Lachman's test and visible dorsal subluxation of the second MTP joint. Radiographs demonstrate subtle joint space narrowing. Which of the following interventions represents the MOST judicious initial surgical approach, considering the progressive nature of the pathology?

In a patient diagnosed with Stage 3 Freiberg's Infarction according to Smillie's classification, presenting with persistent pain despite conservative management, what surgical intervention demonstrates the HIGHEST likelihood of restoring joint congruity and long-term function, while mitigating the risk of progressive arthrosis?

A 45-year-old female presents with atraumatic onset of pain in the second metatarsal head, exacerbated by activity. Examination reveals a positive tuning fork test, but initial radiographs are unremarkable. Which of the following imaging modalities is MOST sensitive for detecting early signs of a metatarsal stress fracture in this scenario?

A patient presents with a 15-degree proximal phalanx dorsiflexion at the PIP joint and a 20-degree MTP joint extension angle, secondary to extensor substitution stemming from anterior compartment weakness due to Charcot-Marie-Tooth disease. What surgical strategy appropriately addresses the PATHOMEDICAL etiology of this deformity?

What diagnostic tests are MOST RELIABLE when assessing a suspected plantar plate tear of the 2nd MTP joint while also differentiating it from similar MTP pathologies like capsulitis?

What technical adjustment during a Weil osteotomy BEST FACILITATES correction of a medially deviated digit, specifically ensuring optimal alignment and mitigating the risk of recurrent deformity?

What is the rationale for performing a flexor digitorum longus (FDL) tendon transfer in conjunction with PIP joint arthroplasty for hammertoe correction, particularly in cases demonstrating recalcitrant digital deformity?

What specific advantage does a single-component intramedullary hammertoe implant offer over traditional K-wire fixation in achieving and maintaining optimal digital alignment following PIP joint arthrodesis?

Which surgical intervention for a hammertoe deformity is MOST EFFECTIVE at directly addressing the underlying biomechanical etiology related to excessive pronation and flexor stabilization?

A patient presents to you with curling of the 4th and 5th toes. Assuming the patient has normal muscle strength testing with ankle dorsiflexion (5/5), but plantarflexion is decreased to 3/5. You ascertain the digital deformity originates from the MTP joints. This patient most likely has what kind of hammertoe PATHOMECHANICS?

A 35-year-old male presents with pain and progressive deformity of the second toe characterized by MTPJ dorsiflexion, PIP flexion, and DIP extension. You release the extensor hood, the dorsal capsule and the plantar plate. Despite the above releases, the MTPJ will not reduce. What is the next best step in surgical management?

Which intervention is MOST appropriate for treating Smillie Classification Stage 1 Freiberg's disease, given the pathology involved at that stage?

You are treating a patient with a non-displaced distal to midshaft metatarsal fracture. Which of the following findings is an absolute indication for surgical referral and intervention?

You are treating a patient with malalignment after a previously healed 2nd metatarsal fracture and are trying to decide on treatment options. Why should you reverse osteotomy technique in this patient?

What are the most reliable diagnostic findings for pathology of the second MTPJ? (Select all that apply)

What key surgical consideration is paramount in achieving optimal outcomes when performing an ORIF for a distal to midshaft metatarsal fracture?

What properties do you need the fixation device to possess in hammertoe surgery?

What objective intraoperative assessment can be used to assess the adequate release of soft tissue contractures surrounding the MTPJ when managing hammertoe deformities?

The FIRST STEP in a hammertoe approach is:

What finding can be caused by disuse, age, or an injection?

In the context of hammertoe pathomechanics, how does flexor stabilization as a primary etiological factor, MOST directly contribute to the digital deformity?

Delineate the MOST SIGNIFICANT limitation of utilizing plain film radiography in the early diagnosis of Freiberg's Infarction, particularly during Smillie's Stage 1, considering its underlying pathophysiology?

In a patient presenting with acute onset pain and swelling localized to the second metatarsophalangeal joint (MTPJ) without any precipitating trauma, which rheumatological condition would be MOST critical to exclude DIRECTLY based on its propensity to mimic plantar plate pathology?

Upon encountering a patient with a triplanar deformity of the lesser metatarsals, what specific biomechanical principle should be prioritized when employing a Weil osteotomy to prevent iatrogenic sagittal plane malalignment?

When using the Kelikian push-up test intraoperatively during hammertoe surgery, what specific structural anatomical alteration would indicate an adequate release of the MTP joint?

In cases of severe, recalcitrant hammertoe deformity where extensor hood release, dorsal capsulotomy, and plantar plate release fail to achieve adequate MTP joint reduction, what adjunctive procedure provides the MOST biomechanically sound means of addressing persistent digital contracture?

For a patient presenting with flexible mallet toe deformity secondary to tendon imbalance, what selective tenotomy demonstrates the HIGHEST degree of specificity in directly addressing the deforming force while minimizing unintended biomechanical consequences?

In the surgical correction of hammertoe deformities, WHAT is the MOST critical biomechanical determinant when deciding between complete proximal phalanx head resection versus partial resection, in order to prevent destabilization while maximizing joint preservation?

When evaluating a patient for plantar plate rupture, which clinical sign has the highest specificity for CONFIRMING the diagnosis?

A patient status post-Weil osteotomy presents with dorsal malreduction of the second metatarsal head and subsequent cock-up deformity of the digit. What is MOST EFFECTIVE means of surgically addressing this complication?

During a Lapidus procedure of the 1st TMT joint, what specific biomechanical correction at the lesser metatarsals will MOST directly mitigate the recurrence of a painful hammertoe deformity in the 2nd digit?

In a patient undergoing surgical correction of a hammertoe with an FDL tendon transfer, what intraoperative maneuver is MOST critical to assess the appropriate tensioning of the transferred tendon?

What radiological parameter yields the MOST RELIABLE insight into the overall coronal plane alignment of a malunited metatarsal fracture?

Upon intraoperative assessment following PIP arthroplasty for hammertoe correction, the surgeon notes residual sagittal plane instability at the MTPJ. What specific soft tissue structure should be meticulously evaluated and addressed to restore MTPJ stability?

In the context of surgical technique, what parameter MOST SIGNIFICANTLY differentiates a Weil osteotomy performed for metatarsalgia versus one performed for correction of MTPJ dislocation?

When managing a patient with Smillie Stage 3 Freiberg’s Infarction, what surgical intervention offers the MOST biomechanically sound approach to restore joint congruity, mitigate impingement, and promote long-term joint preservation?

In the presence of an irreducible plantar-dislocated MTP joint secondary to plantar plate rupture, what is the MOST critical technical consideration during surgical repair to ensure long-term joint stability?

What specific element of fixation is MOST critical to the successful arthrodesis of the PIP joint when using an intramedullary implant for hammertoe correction?

What distinguishes extensor substitution from the other two types of hammertoe pathomechanics?

In the surgical management of flexible hammertoe deformities, what BEST describes why it is VITAL to release the flexor digitorum brevis (FDB) tendon?

Considering isolated plantar plate injury of the 2nd MTP joint, delineate the OPTIMAL surgical technique if conservative managment fails?

In a patient presenting with a flexible hammertoe deformity and radiographic evidence of Smillie Stage 2 Freiberg's infraction affecting the second metatarsal head, which surgical intervention simultaneously addresses both the digital deformity and the underlying osseous pathology with the HIGHEST biomechanical rationale?

A surgeon encounters an irreducible second MTP joint dislocation secondary to a chronic plantar plate rupture in a patient with significant forefoot splay. Post meticulous debridement of the joint and mobilization of the plantar plate, which of the following suture anchor configurations offers the MOST biomechanically sound and durable repair, accounting for multiplanar instability?

In the reconstruction of a severely cavovarus foot with a recalcitrant hammertoe deformity of the second digit, which of the following surgical strategies offers the MOST comprehensive biomechanical correction by addressing both the osseous malalignment and the tendinous imbalances contributing to the deformity?

During a surgical intervention for a symptomatic Smillie Stage 4 Freiberg's infraction, post debridement, subchondral drilling, and osteochondral allograft implantation, intraoperative fluoroscopy reveals persistent incongruity of the MTP joint. Which adjunctive procedure demonstrates the HIGHEST probability of restoring optimal joint mechanics and preventing accelerated degenerative changes?

A patient presents with a 15-degree dorsiflexion contracture at the MTP joint of the second digit and concomitant hammertoe deformity, secondary to spasticity from cerebral palsy. Despite having normal posterior muscle strength with ankle plantarflexion testing at 5/5, the patient exhibits noticeable toe clawing during gait. Which surgical intervention is MOST appropriate to address both the MTP joint contracture and the digital deformity, while ensuring sustained correction and functional improvement?

A patient presents with a digital deformity characterized by MTP joint hyperextension, PIP joint flexion, and DIP joint flexion. Histopathological analysis reveals hypertrophic changes within the flexor digitorum longus tendon, and selective nerve blocks of the tibial nerve significantly reduce the degree of PIP and DIP joint contracture. Which pathomechanical etiology is MOST likely responsible for this presentation?

During surgical correction of an adducted and plantarflexed fourth digit with a painful corn, a surgeon finds that after sequential release of the extensor hood, collateral ligaments, and plantar plate, the MTP joint remains resistant to reduction. Radiographic evaluation reveals a severely distorted metatarsal head. Which adjunctive procedure offers the MOST biomechanically sound approach to achieving complete joint reduction and preventing recurrence?

In the treatment of Freiberg's infraction, a 28-year-old competitive marathon runner presents with Smillie Stage 2 disease involving the second metatarsal head. Conservative treatment has failed. Considering the patient's activity level, what surgical intervention offers MOST optimal long-term outcome and the HIGHEST probability of returning the patient to pre-injury athletic performance?

A 62-year-old female presents with chronic second metatarsalgia and a painful, plantarflexed second digit. Radiographs reveal a malunited, shortened second metatarsal with significant plantar bone callus formation. Conservative care has failed. Which corrective osteotomy technique will BEST address the combined sagittal and transverse plane deformities, while optimizing load sharing across the metatarsal parabola and minimizing risk of transfer metatarsalgia?

A patient with Charcot-Marie-Tooth disease presents with a severe cavovarus foot and claw toe deformities. Examination reveals significant weakness of the anterior compartment musculature (0/5 strength). Considering the underlying neuromuscular etiology, which surgical procedure is MOST appropriate to comprehensively address the claw toe deformities and prevent recurrence, while simultaneously correcting the cavovarus deformity?

In a patient undergoing surgical correction of a hammer toe deformity with a plantar plate tear, which suture anchor placement technique provides the MOST biomechanically stable repair, optimizing resistance to both tensile and shear forces, and thereby mitigating the risk of recurrent instability?

During a revision hammertoe surgery, significant scarring around the MTP joint is encountered. Following meticulous dissection and release of all identifiable contractures, the MTP joint remains dislocated dorsally. Intraoperative fluoroscopy reveals a severely attenuated plantar plate with near complete loss of substance. What reconstruction technique is MOST appropriate to restore MTP joint stability?

What advantage does a cannulated headless compression screw offer over Kirschner wire fixation and intramedullary implants for PIP joint arthrodesis in a hammertoe correction, especially in patients with compromised bone quality (e.g., osteoporosis) or a history of prior K-wire related complications?

In a patient presenting with flexible hammertoe deformities secondary to a cavus foot, which surgical approach simultaneously addresses the digital realignment, plantar fascia contracture, and Achilles tendon equinus, to achieve a lasting correction and minimize recurrence?

While performing a Weil osteotomy for metatarsalgia, the surgeon inadvertently destabilizes the plantar plate, leading to intraoperative MTP joint subluxation. What is the MOST appropriate immediate course of action to restore joint stability during the procedure?

A patient presents with a 2nd MTP joint dislocation that has failed conservative measures. There is adduction of the 2nd digit and plantar plate rupture on MRI. Of the following, what is the MOST appropriate surgical intervention?

Which fixation method is BEST for hammertoe surgery when considering properties of compression, derotation, bone quality, ease of use, and low infection rate?

When confronted with a Stage 4 Smillie Classification Freiberg’s infraction in an active 30-year-old patient, which surgical option yields the BEST biomechanical outcome and return to activity?

During a primary plantar plate repair, the surgeon is unable to bring the tissue edges together without excessive tension, despite extensive mobilization. What is the next BEST step?

What is the MOST appropriate next step in a hammertoe surgery after incising the skin?

During a Weil osteotomy, after making the bone cut, you notice that the MTPJ is still plantarflexed. What do you do?

What is the MOST common etiology of a hammer toe deformity stem from?

When performing a plantar plate repair, one must know that the plantar plate is a continuation of what other structure?

What is the BEST description of how to perform the Kalikian push-up test?

What is meant by performing a reverse oblique osteotomy for malalignment of the 2nd metatarsal?

A patient with a flexible hammertoe at the PIPJ has tried conservative measures and they have failed. What is the next BEST surgical step?

Which of the following contributes to fat pad atrophy? (Select all that apply)

In a patient presenting with a flexible hammertoe deformity characterized by MTP joint hyperextension and PIP joint flexion, which biomechanical pathomechanism is MOST likely the primary driver, assuming no neurological involvement?

Following a plantar plate repair, a patient returns several months later with increased pain and swelling at he MTPJ. Of the following, what is the BEST answer?

You diagnose a patient with Freiberg's infraction. On the x-ray, there is slight deformity. Using the Smillie classification, what stage fits this the BEST?

You are performing a plantar plate repair and decide to utilize anchors for the repair. Where is the BEST placement of these anchors?

When is it BEST to utilize a cartilage replacement during a Freiberg's procedure?

You are about to perform a 2nd MTPJ release. Of the following, what is the order of those releases?

What kind of suture is BEST to place to repair a plantar plate?

What is the MOST appropriate angle to make an osteotomy when performing an oblique osteotomy to correct the metatarsal length?

When is the BEST time to perform a bone scan to indicate the presence of a stress fracture?

Which of the following can be used to classify Freiberg's infraction?

When performing a Weil osteotomy, one is taught to ensure that there is space for the sagittal band and a tenotomy performed. Why is it VITAL to do this?

What is the MOST COMMON finding with a metatarsal stress fracture?

How long does one have to wait to take serial x-rays after beginning conservative tx of a stress fx?

During a surgical plantar plate exposure, you are determining if a direct plantar approach vs dorsal approach. Why would you choose direct plantar?

Where should surgical padding be localized when treating lesser MTP joint pain?

What is a hammertoe?

During a Weil osteotomy, what do you shift the metatarsal?

You perform a triple arthrodesis, EHL tendon transfer, and flexor-to-extensor transfer. What kind of pathology is this MOST appropriate for?

You can't bring the plate together in a plantar plate reconstruction. What do you do?

In the context of hammertoe pathomechanics, should the flexor digitorum longus (FDL) tendon be released when performing a flexor tenotomy?

In a patient presenting with a flexible hammertoe deformity and a high degree of MTPJ subluxation, which surgical procedure would be MOST appropriate?

In the surgical management of a hammertoe deformity with an associated plantar plate tear via a plantar approach, what represents the MOST critical step in optimizing MTP joint stability and minimizing recurrence?

When addressing a malunited metatarsal fracture with associated shortening, dorsiflexion, and plantar bone callus, what represents the MOST biomechanically sound surgical approach?

In a revision surgery for a failed plantar plate repair complicated by significant scarring and MTPJ instability, which of the following techniques offers the MOST robust and durable solution?

When performing a Weil osteotomy for the purpose of correcting a medially deviated digit, what adjunctive measure is MOST crucial to prevent iatrogenic sagittal plane malalignment?

A patient with a claw toe deformity secondary to anterior compartment weakness from Charcot-Marie-Tooth disease presents with a fixed plantarflexion contracture of the distal interphalangeal (DIP) joint. In addition to addressing the MTP and PIP joint contractures, which of the following is the MOST appropriate surgical intervention to address the DIP joint?

A patient presents with a flexible hammertoe deformity, hallux valgus, and an elevated first metatarsal. Which surgical approach offers the MOST comprehensive biomechanical correction?

In a patient with a Smillie Stage 4 Freiberg's infraction, post debridement, subchondral drilling, and osteochondral allograft implantation, the surgeon notes persistent incongruity of the MTP joint on intraoperative fluoroscopy. What adjunctive procedure demonstrates the HIGHEST probability of restoring optimal joint mechanics and preventing accelerated degenerative changes?

Following surgical correction of a hammertoe with a flexor digitorum longus (FDL) tendon transfer, what intraoperative assessment yields the MOST reliable information about the appropriate tensioning of the transferred tendon?

When confronted with an irreducible second MTP joint dislocation secondary to a chronic plantar plate rupture in a patient with significant forefoot splay, what suture anchor configuration offers the MOST biomechanically sound and durable repair?

You are treating a patient with a non-displaced distal to midshaft metatarsal fracture. The patient has severe peripheral arterial disease and cannot tolerate any amount of immobilization. Which of the following findings is an absolute indication for surgical referral and intervention?

During the surgical correction of a flexible hammertoe deformity, post plantar FDB release and a dorsal capsulotomy at the PIP joint, the surgeon finds the MTP joint remains significantly dorsiflexed. What is the NEXT MOST appropriate surgical step:

A patient presents with a flexible hammertoe deformity at the PIPJ. What is the BEST surgical step?

When performing a 2nd MTPJ release, what is the typical order of soft tissue releases?

A 62-year-old female presents with chronic second metatarsalgia and a painful, plantarflexed second digit. Radiographs reveal a malunited, shortened second metatarsal with significant plantar bone callus formation. Which corrective osteotomy technique will BEST address the combined sagittal and transverse plane deformities?

A patient with a flexible hammertoe deformity is found to have undergone multiple injections for pain at the second MTPJ. Which of the following causes is the MOST likely contributor to fat pad atrophy?

When confronted with a painful Stage 4 Smillie Classification Freiberg’s infraction in an active 30-year-old patient, which surgical option yields the BEST biomechanical outcome and return to activity?

During reduction of a distal to midshaft metatarsal fracture, the surgeon is trying to reduce it and is having trouble manipulating the bone fragments. What key surgical consideration is paramount?

Why should you reverse osteotomy technique in this patient with a malalignment after a previously healed 2nd metatarsal fracture?

When is it BEST to perform a bone scan to indicate the presence of a stress fracture?

When performing a Weil osteotomy, after the bone cut is made, is it important to also perform a tenotomy? WHY?

What is the MOST appropriate angle to make an osteotomy when performing an oblique osteotomy to correct malalignment of the metatarsal length?

After failing end-to-end repair, what is the next BEST step when repairing a painful plantar plate tear?

What is the MOST reliable diagnostic test to confirm plantar plate pathology?

In the surgical management of flexible hammertoe deformities, releasing the flexor digitorum brevis (FDB) tendon is VITAL for what reason?

If one cannot bring the plantar plate after meticulous dissection in a plantar plate reconstruction. What is the next best step?

What are you trying to correct when using a condylectomy? (Select all that apply)

Why would you choose a direct plantar approach in surgical plantar plate exposure vs dorsal approach?

What is the first step in a hammertoe approach?

In the context of surgical intervention for a severely plantarflexed second digit with associated metatarsalgia secondary to a malunited metatarsal fracture, which osteotomy technique is MOST appropriate for restoring the metatarsal parabola and normalising weight distribution across the metatarsal heads?

A patient with a long history of rheumatoid arthritis presents with multiple hammertoe deformities characterized by MTP joint subluxation and PIP joint contractures. After extensor hood release and dorsal capsulotomy, significant resistance to MTP joint reduction persists. Which of the following soft tissue balancing procedures would BEST address this recalcitrant deformity, considering the underlying inflammatory arthropathy?

In a patient presenting with a flexible hammertoe deformity exhibiting extensor substitution due to tibialis anterior tendon dysfunction, and an associated cavus foot, what surgical intervention would BEST address the combined biomechanical abnormalities to prevent recurrence?

During a surgical exploration for a plantar plate repair utilizing a direct plantar approach, the surgeon encounters extensive scarring and attenuation of the plantar plate, rendering direct end-to-end repair unfeasible. Which of the following adjunctive techniques offers this MOST biomechanically sound strategy for reconstruction?

When managing a Smillie Stage 3 Freiberg's Infraction in a high-performing athlete with persistent pain despite conservative management, arthroscopic assessment reveals significant synovitis and articular cartilage damage, but the plantar hinge remains intact. Which surgical procedure would be MOST appropriate.

What is the MOST specific characteristic of a claw toe deformity?

A patient presents with pain in the 4th and 5th digits and adductovarus deformity. Which pathomechanical etiology is MOST likely the cause?

In hammertoe pathomechanics, what gait phase is flexor substitution MOST likely to occur?

In a patient with anterior compartment weakness leading to hammertoe development, what is the PRIMARY compensatory mechanism contributing to the digital deformity?

A patient with a flexible mallet toe has pain relief after a flexor tenotomy. Which tendon is released during this procedure?

What is the PRIMARY goal of performing a flexor tendon transfer in hammertoe surgery?

After performing a PIP joint arthrodesis for hammertoe correction, what type of tissue primarily contributes to the long-term stability of the joint?

Which of the following fixation methods is LEAST likely to provide compression at the fusion site following PIP joint arthrodesis for hammertoe correction?

What is a PRIMARY advantage of using a single component intramedullary hammertoe implant compared to K-wire fixation?

A surgeon performs a hammertoe correction and releases the extensor hood, dorsal capsule, and plantar plate, but the MTP joint remains contracted. Which of the following is the MOST appropriate next step?

Which of the following conservative treatment options is MOST appropriate for managing early stages of pre-dislocation syndrome?

Which of the following is the MOST reliable clinical test for assessing plantar plate integrity?

Which imaging modality is MOST sensitive for detecting early plantar plate tears?

What is the PRIMARY purpose of a Weil osteotomy in the context of lesser metatarsal pathology?

You are performing a Weil osteotomy to correct a medially deviated digit. To MOST accurately correct the malalignment, in which direction should you shift the capital fragment?

What is a key consideration when performing a Weil osteotomy?

In which Smillie classification stage of Freiberg's infraction is the restoration of normal anatomy no longer possible?

What is the PRIMARY goal of surgical intervention for Smillie Stage 1-3 Freiberg's infraction?

What is the MAINstay of conservative treatment for metatarsal stress fractures?

Which imaging modality is BEST for visualizing early stress fractures?

What is the typical timeframe for obtaining serial radiographs after initiating conservative treatment for a metatarsal stress fracture?

What radiographic parameter is MOST important when assessing malalignment after a healed metatarsal fracture?

What is the PRIMARY goal in performing an oblique osteotomy to correct malalignment of a metatarsal after a previous fracture?

Following a plantar plate repair, what post-operative finding would warrant IMMEDIATE further investigation for potential complications?

Which of the following is the BEST indication to perform a direct plantar approach during plantar plate repair surgery?

In a patient presenting with a medially deviated second digit, which surgical intervention is MOST appropriate to address the transverse plane deformity?

After performing a Weil osteotomy, the surgeon finds that the MTP joint is still plantarflexed. What is the MOST appropriate next step?

When performing a FDL transfer, how should one assess the correction and approprite tensioning of the tendon?

After failing end-to-end repair of a torn plantar plate, surgical pearls suggest to BEST use what other fixation method?

The Smillie Classification is a descriptive radiographic staging of osteonecrosis of the metatarsal head called Freiberg's Infraction. What does each stage describe?

After incising the skin, what is the BEST next step when perform surgical correction for a hammertoe deformity?

During the process of evaluating a patient's foot ailment, which is the MOST reliable test to help confirm that the patient has a plantar plate tear?

What can fat pad atrophy MOST commonly be caused by?

While performing surgery, you've tried to bring two torn ends of tissue together again, but are finding this impossible due to excessive tension. What is MOST appropriate solution?

During plantar plate reconstruction you release plantar structures and you utilize anchors to fix the plate back down to the bone. Where is it BEST to place these anchors?

During a 2nd MTPJ release for a hammertoe correction, what is the typical order in which structures are released?

What degree is MOST appropriate when performing an oblique osteotomy to correct malalignment of the metatarsal length?

What is the MOST common etiology of a hammer toe deformity?

When determining if one should perform a cartilage replacement procedure during a Freiberg's procedure, what stage should it be?

When performing a plantar plate repair, what other structure is vital to know that the plantar plate is a continuation of?

If one can't bring the plantar plate together after meticulous dissection in a plantar plate reconstruction, what is the next best step?

Which of the following is the MOST common pathomechanical cause of an adductovarus deformity of digits 4 and/or 5?

What is the MOST appropriate initial treatment for pre-dislocation syndrome?

Which of the following is MOST likely to be visualized using MRI?

What is the BEST description of a claw toe?

In hammertoe pathomechanics, what is the effect of the flexor tendons gaining a mechanical advantage and overpowering the intrinsic muscles?

What is the MOST likely cause of pain on the plantar aspect of the foot that increases with weight bearing?

What type of foot is flexor stabilization MOST commonly observed in?

Which of the following is the LEAST likely cause of fat pad atrophy?

According to the Smillie classification, what is the definition of Stage 4 Freiberg's?

If one cannot bring the plantar plate edges together after meticulous dissection in a plantar plate reconstruction, which technique is MOST appropriate?

Which of the following is the MOST common etiology of hammertoe deformity?

What is the BEST next step in a hammertoe surgery after incising the skin, based on the presented surgical approach?

The MOST common cause of digital deformities is?

What is the BEST classification to use for Freiberg's infraction?

What does an oblique osteotomy correct when performing it for malalignment of the 2nd metatarsal?

After failing end-to-end repair of a plantar plate tear, what is the BEST course of action?

In the context of hammertoe pathomechanics, during which phase of gait is flexor substitution MOST likely to occur?

Which of the following surgical procedures is BEST employed to address a severely plantarflexed second digit with associated metatarsalgia?

What is the MOST reliable imaging modality for visualizing early stress fractures in the metatarsals.

What is the MOST critical surgical step when repairing a plantar plate?

What is the MOST appropriate surgical intervention when addressing a malunited metatarsal fracture with associated shortening, dorsiflexion, and plantar bone callus?

Which of the following statements is MOST accurate regarding the Smillie Classification for Freiberg's disease?

What is the MOST correct statement regarding Weil osteotomies?

What is MOST required to be performed during hammertoe correction to be able to assess proper tensioning of a flexor tendon transfer?

What conservative treatment method is BEST for pre-dislocation syndrome?

In a patient with anterior compartment weakness leading to hammertoe development, what represents the PRIMARY compensatory mechanism contributing to the digital deformity?

What should one do if during a Weil osteotomy, after making the bone cut, you notice that the MTPJ is still plantarflexed?

Which fixation method is LEAST likely to provide compression at the fusion site when performing PIP joint arthrodesis for hammertoe correction?

When carrying out the stepwise approach in a hammertoe correction surgery, you have just incised the skin. What is your next step in this series?

What step BEST describes the Kelikian push-up test?

What is the MOST accurate definition of hammer toe?

Which of the following should be assessed with a serial radiograph after beginning conservative treatment of a stress fracture?

When should you consider performing a cartilage replacement procedure during a Freiberg's procedure?

You are performing a 2nd MTPJ release for a hammertoe correction. What is the MOST appropriate order for those releases?

A 55-year-old male presents to your office with "curled up toes that rub on shoes". He reports he ruptured his right Achilles tendon 5 years ago during soccer. Plantarflexion strength is 3/5, while ankle dorsiflexion is normal at 5/5. His lesser digits are extended at the MTP joints and flexed at the PIP joints. Which biomechanical pathology BEST describes this condition?

In a patient presenting with a flexible hammertoe deformity and MTP joint hyperextension. Assuming no ankle equinus and no neurologic involvment, which pathomechanical etiology is MOST likely?

The decision to use a direct plantar approach for plantar plate repair is BEST determined by what?

Following a surgically repaired plantar plate, a patient returns several months later with increased pain and swelling. Which of the following is the BEST next step?

After performing a PIP joint arthrodesis with retrograde K-wire fixation for hammertoe correction, you appreciate that the toe is deviated in the transverse plane. What is the BEST course of action?

What is an appropriate angle when performing an oblique osteotomy to correct malalignment of a metatarsal length.?

What is the MOST common biomechanical pathomechanism leading to adductovarus deformity of the 4th and/or 5th digits?

A patient presents with forefoot pain. Radiographs are normal, but you still suspect a plantar plate tear. What is the MOST appropriate next step in diagnosis?

What is the PRIMARY goal of performing a Weil osteotomy?

Match the Smillie stages of Freiberg's infraction with its description. Which stage indicates the articular surface has sunk so far that restoration of normal anatomy has passed?

Which of the following intrinsic muscles is split during the Flexor Digitorum Longus (FDL) tendon transfer when addressing hammertoe pathology?

Which of the following statements best describes the pathomechanics of flexor stabilization as a cause of hammertoe deformity?

In the context of hammertoe deformities, extensor substitution primarily manifests during the stance phase of gait, marked by an increased reliance on the extensor digitorum longus to maintain ground contact due to weakness in the plantarflexors.

Following a skin incision in a stepwise surgical approach to hammertoe correction, which of the following is the MOST critical subsequent step in order to minimize post-operative complications and optimize deformity reduction?

Which statement accurately contrasts single versus double K-wire fixation in hammertoe surgery?

What is the MOST significant biomechanical consequence of failing to adequately address equinus contracture when surgically correcting hammertoe deformities, and how does this impact long-term outcomes?

In the context of surgical intervention for hammertoe deformity with concurrent MTP joint instability, which of the following represents the MOST biomechanically sound approach for addressing both the digital deformity and the underlying joint instability?

A patient presents with a flexible mallet toe deformity. Which statement accurately guides the MOST appropriate initial surgical intervention?

In the surgical management of hammertoe deformities, a flexor tendon transfer from plantar to dorsal is primarly indicated when MTP joint purchase is achievable without complete release of the plantar plate.

When contemplating PIP joint arthroplasty versus arthrodesis for hammertoe correction, what critical biomechanical consideration would favor arthrodesis?

While performing a plantar plate repair using a direct plantar approach, it is found that an end-to-end repair cannot be achieved due to tissue retraction. What strategy would BEST secure the proximal plantar plate?

Weil osteotomy is particularly indicated when attempting to lengthen a metatarsal to restore the metatarsal parabola.

In the context of plantar plate injuries, a positive ______'s test suggests dorsal subluxation of the proximal phalanx on the metatarsal head.

Which imaging modality offers the HIGHEST sensitivity and specificity for detecting early plantar plate tears, while also differentiating between partial and complete ruptures?

When interpreting MRI findings for plantar plate injuries, which of the following is the MOST reliable indicator of a complete plantar plate tear?

In the context of Freiberg's disease, Smillie's classification remains exclusively an intraoperative tool, with radiographic findings playing a limited role in staging and treatment planning.

Based on the Smillie Classification for Freiberg's disease, at what stage does the articular surface sink so far that restoration of normal anatomy is deemed impossible?

Following a Weil osteotomy for Freiberg's disease, what is the MOST critical post-operative management strategy to prevent proximal migration of the metatarsal head and subsequent transfer metatarsalgia?

Which surgical intervention is MOST LIKELY indicated for a Smillie Stage 1 Freiberg's infraction?

Stress features of the metatarsal are easily seen on initial radiographs and do not require further advanced imaging.

In evaluating a patient with suspected metatarsal stress fracture, what clinical finding offers the HIGHEST positive predictive value for confirming the diagnosis, particularly in the absence of immediate radiographic evidence?

What is the MOST APPROPRIATE initial intervention for a non-displaced distal shaft metatarsal fracture?

Match each hammertoe pathomechanic to its associated clinical presentation and compensatory mechanism:

Compared to anatomical plating, what represents a KEY biomechanical advantage of using intramedullary screw fixation for diaphyseal metatarsal fractures?

In cases of metatarsal fracture malunion with symptomatic plantarflexion of the metatarsal head, osteotomy should focus on reversing the initial malalignment, thus elevating and shortening segment.

Given the complex interplay of intrinsic and extrinsic factors contributing to hammertoe development, which non-surgical intervention offers the MOST biomechanically comprehensive approach to managing flexible hammertoe deformities while addressing underlying pathomechanics?

In second MTP joint plantar plate repair, which surgical approach is associated with problems of scar formation and potential iatrogenic nerve injury?

What is the MOST significant risk associated with aggressive distraction during MTP joint arthrodesis?

In a Weil osteotomy, medial deviation can be achieved by cutting the metatarsal obliquely in a transverse plane and shifting it medially under the toe.

Which of the following is the MOST common cause for second digit adduction?

Which intervention is MOST appropriate in the surgical management of a symptomatic Freiberg's infraction at Smillie stage 4, characterized by significant flattening and deformity of the metatarsal head?

For proximal phalanx fractures, ORIF should be selected over percutaneous approaches to provide stability single screw fixation.

When selecting a single component intramedullary implant for PIP joint arthrodesis in hammertoe surgery, what crucial factor distinguishes its performance from traditional K-wire fixation?

When performing a Weil osteotomy, which modification is MOST appropriate to address elevation of a metatarsal head?

In the direct approach for plantar plate repairs, a K-wire should be passed from plantar to dorsal plate to help identity plantar location in the joint.

What is the BEST test to determine second metatarsal MTP joint dislocation?

A digital deformity with a flexed DIP joint would be classified as a ______.

A 55-year-old male presents to your office complaining of pain to his right foot caused by “curled up toes that rub on shoes”. He is healthy and active. He does report an injury 5 years ago in which he ruptured his right Achilles' tendon while playing soccer. He was treated with a walking boot for 3 weeks and stretching exercises. He reports: “Since then, my right leg is weak”. Clinically you find muscle strength testing with Ankle dorsiflexion to be normal, 5/5, however plantarflexion is decreased to 3/5. His lesser digits are extended at the MTP joints and flexed at the PIP joints. What best describes the category of his biomechanical pathology?

In the context of hammertoe pathomechanics related to flexor stabilization, which of the following kinematic adaptations is LEAST likely to be observed?

In extensor substitution, the extensor digitorum longus (EDL) gains a mechanical advantage over the lumbricals, leading to flexion of the toes at the MTP joints during the swing phase of gait.

A 62-year-old female presents with a chief complaint of pain and progressive deformity of the 2nd digit of her right foot. Clinical examination reveals a flexible contracture at the PIP joint with associated dorsal bunion at the MTP joint. Radiographs demonstrate degenerative changes and joint space narrowing at the PIP joint, What is the MOST appropriate initial conservative treatment regimen?

In the stepwise approach to hammertoe surgery, after skin incision and extensor tenotomy, the next logical step is typically ______.

Match the fixation methods with their specific characteristics:

During a flexor tendon transfer for hammertoe correction, the Flexor Digitorum Longus (FDL) tendon is commonly accessed through which surgical plane?

In the context of joint preparation for PIP joint arthrodesis, cup and cone reamers are ideal because they preserve maximal bone stock while achieving multi-directional correction.

Which property is MOST advantageous with single component intramedullary hammertoe implants when compared to alternative hammertoe implants?

Describe the biomechanical rationale for performing an extensor hood release during a hammertoe correction.

During a plantar plate repair, why is it recommended tie the plantar plate suture LAST when combining other procedures with a plantar approach?

Conservative care for pre-dislocation syndrome involves strengthening of the plantar structures.

What is the primary biomechanical objective when performing a Weil osteotomy in the context of a dislocated lesser metatarsophalangeal (MTP) joint?

Describe the rationale for performing an oblique osteotomy in the context of metatarsal realignment following malunion and plantarflexion or shortening.

In direct plantar approach for plantar plate repair, what is the initial critical step to aid in identifying its location?

In Freiberg's disease, Smillie's classification relies exclusively on radiographic findings to stage the progression of the disease nonoperatively.

A patient presents with a suspected metatarsal stress fracture. Initial plain radiographs are normal. Which imaging modality would provide the HIGHEST sensitivity and specificity for confirming an occult metatarsal stress fracture in its EARLY stages?

Explain why midshaft metatarsal fractures are not suited to fixation with a single screw.

Which surgical approach is typically employed to elongate a shortened metatarsal resulting from a malunion, while also addressing sagittal plane malalignment?

What is the MOST appropriate initial treatment following diagnosis?

What clinical feature is mostly seen in flexor substitution hammertoe pathomechanics?

What clinical finding indicates Stage 2 of pre-dislocation syndrome?

The bouch paper test examines what?

According to Smillie's Classification of Freiberg's disease, which stage showcases a significant structural collapse of the articular joint with a hinged plantar?

Plantar Flexing is more effective than bone stimulator post ORIF.

What is the main diagnosis when having pain specifically at the plantar second metatarsal head?

What is the purpose of Fluoroscopy in podiatric surgery?

Which fixation is typically used post surgical with hammertoe surgeries and fixation hardware?

Which of the following best defines Extensor Substitution?

Arthroscopic examination is usually done on the second MTP Joint.

What is the most common cause of adductovarus of 4 or 5 digits in gait?

Mallet toe is when the lesser toe has an extensor MTP joint + Flexor PIP + extensor DIP joint.

In Flexor substitution, what is NOT the reason as to why it occurs?

You must correct the severe hallux abductovalgus prior to surgical correction.

You do a Weil osteotomy. What does this correct?

An ORIF with plates and screws is only used on what portion of the bones when wanting to stabilize?

Bone biopsy should always be considered when having a transverse plane.

What is the angle, in most cases, to be fixated at?

Tying the plantar plate suture is done when?

Conservative care is always the first choice.

In your opinion, what is the primary goal of fixation post-surgery?

Who is more suspectible to get forefoot pain?

A 62-year-old male presents with a progressive, flexible hammertoe deformity of the second digit, exacerbated by ambulation. Radiographs reveal no joint space narrowing, but advanced cavus foot architecture is evident. Electromyography (EMG) demonstrates diminished motor unit potentials in the tibialis anterior. Which pathomechanical etiology most accurately explains this condition?

In the stepwise surgical approach to hammertoe correction, after skin incision and extensor tenotomy, the next step typically involves resection of the _______ phalanx head, facilitating subsequent joint mobilization and deformity correction.

During surgical management of a severely contracted hammertoe deformity with fixed hyperextension at the MTP joint, a surgeon performs a complete capsular release, extensor tenotomy, and plantar plate release through a dorsal approach but fails to achieve adequate deformity reduction. Which of the following tendon transfers is most appropriate to address the residual deformity?

In the Smillie classification of Freiberg's disease, Stage 3 necessarily indicates the presence of loose bodies and requires surgical intervention independent of symptomatic presentation.

A 48-year-old female presents with acute, localized pain and swelling at the second metatarsophalangeal joint (MTPJ) following a recent increase in her high-intensity interval training (HIIT) regimen. A comprehensive exam reveals a subtly positive Digital Lachman's test and moderate plantar plate tenderness, but plain film radiographs are unremarkable. Which imaging modality would yield the most definitive diagnostic information?

Metatarsalgia is defined as painful forefoot.

Which of the following is a common symptom associated with hammertoes?

A digital deformity with a flexed PIP joint and hyperextended MTP and DIP joints is classified as a ______.

Which of the following best describes 'flexor stabilization' as a subtype of hammertoe pathomechanics?

Extensor substitution in hammertoe pathomechanics is typically seen in pronated feet during the late stance phase of gait.

Name three conservative treatments for hammertoes.

Match the following surgical steps to their corresponding description in a hammertoe correction:

In the stepwise surgical approach to hammertoe correction, if, after MTP joint capsulotomy, the MTP joint position is satisfactory upon Kelikian push-up test, which of the following steps may be avoided?

What is Flexor Digitorum Longus typically released?

Arthroplasty is defined as the fusion of a joint.

What is an advantage of a single component intramedullary hammertoe implant?

In hammertoe surgery, what tendon is often transferred?

What is a diagnostic technique for Plantar Plate Injury?

In the context of plantar plate injuries and MTP joint dislocations, what term describes the stage where deviation of the digit is clinically noticeable, but the joint is not yet fully dislocated?

In plantar plate repair, direct plantar approach is commonly performed as an isolated procedure.

What is a unique advantage of performing an oblique Weil osteotomy as opposed to a traditional Weil Osteotomy?

According to Smillie's classification, what is the primary characteristic of Stage 1 Freiberg's disease?

What is the most common initial treatment option for a metatarsal stress fracture?

Multiple views are not necessary to visualize the displacement.

Unlike fractures of the fifth metatarsal, fractures of the more medial metatarsals are not suited to which type of fixation?

A Flexor Digitorum Longus (FDL) is released at the ______ joint.

Define 'arthrodesis'.

Which of the following are viable options as surgical treatment options for hammertoe?

When joints exhibiting a plantar plate injury are dislocated only conservative treatment will be necessary to realign the joint.

The Smillie's classification was originally based on intraoperative findings, but as time has gone on has since been adapted to be found through what?

What is the first stage called of "Pre” dislocation syndrome ?

Which of the following are potential contributing factors to the development of fat pad atrophy in the foot?

The Bouche paper pull out test is a range of motion test that helps define the amount of dorsilexion possible at the metatarsal joints.

What imaging modality is considered the most specific for evaluating a metatarsal stress fracture in the early stages?

You are carrying out the stepwise approach in a hammertoe correction surgery. You have just incised the skin. Your next step in this series would be:

You are carrying out a hammertoe correction surgery with a severely contracted digit with hyperextension of the MTP joint. You have released the hood, the dorsal capsule and the plantar plate without complete reduction of the deformity. Therefore, you elect to proceed with a tendon transfer procedure. What tendon are you going to transfer and to what position:

Choose the TRUE statement regarding the Smillie Classification for Freiberg's disease

Pathology of the second MTPJ is a broad term that can include pre-dislocation syndrome, capsulitis, Freiberg's, or synovitis. The importance of a thorough clinical examination cannot be overstated as many of these conditions present with similar findings. Your clinical exam reveals- Pain and swelling at the forefoot with exquisite pain at plantar second metatarsal head, pain with ROM of second MTP joint, and a positive digital Lachman's test. Your first differential diagnosis would be:

Besides pain, give 3 other symptoms of hammertoes.

All of the following are potential causes or biomechanical contributors to Hammertoes EXCEPT:

The hammer toe subgroup descriptions apply to paralytic contractures.

With excessive pronation, the long flexors fire _____ and _____ in the stance phase of gait

What is the goal of Extensor Digitorum Longus (EDL) firing early in the swing phase of gait for someone with extensor substitution?

What does PIP stand for when describing hammer toe procedures.

K-Wires are often made from the metal Nickel and Aluminum.

The Weil Osteotomy is designed to:

Metatarsalgia is defined as painful metatarsals, which equates to a painful midfoot.

Week 3's session focuses on hammertoes and associated pain sources in the lesser metatarsals, explicitly including which of the following?

Which of the following is a potential cause of hammertoes?

The terms 'hammertoe,' 'claw toe,' and 'mallet toe' are always interchangeable in clinical settings.

In a hammertoe deformity, what is the typical position of the PIP joint and the MTP joint?

Which of the following is the MOST common biomechanical mechanism leading to hammertoe deformities?

Which foot type is MOST likely to be associated with flexor substitution as a cause of hammertoe?

Extensor substitution, as a pathomechanical cause of hammertoe, results from weakness in which muscle group?

What is the primary goal of conservative treatment options for hammertoes?

During a stepwise surgical approach to hammertoe correction, which of the following typically follows skin incision?

What is the purpose of the Kelikian push-up test during hammertoe surgery?

In mallet toe repair, the Flexor Digitorum Longus (FDL) is released at the PIP joint.

When performing a flexor tendon transfer for hammertoe correction, which tendon is typically transferred and to what location?

What is the main difference between arthroplasty and arthrodesis in hammertoe surgery?

Which of the following is a potential advantage of using a single component intramedullary hammertoe implant compared to other types of fixation?

Avascular necrosis of the second metatarsal head is also known as:

Match the following hammertoe pathomechanics with their descriptions:

Which of the following is TRUE regarding metatarsal stress fractures?

Regarding distal to midshaft metatarsal fractures, which of the following is a surgical indication?

In extensor substitution, the extensor tendons are ______ for a weak anterior muscle group.

Conservative treatment for hammertoes aims to correct the underlying biomechanical causes.

Which of the following conservative treatments involves placing a pad to redistribute pressure on the foot?

What is the primary function of fixation devices in hammertoe deformity correction?

Which of these steps can be avoided during a stepwise approach to hammertoe surgery if the MTPJ position is satisfactory after initial soft tissue releases?

Hammer toe repair with flexor tenotomy can only be approached through a plantar incision.

In plantar plate pathology, which diagnostic test involves assessing dorsal translocation of the proximal phalanx at the MTP joint?

A Weil osteotomy is specifically indicated to translate the ______ fragment in the direction of the digital deformity.

Weil osteotomy is recommended when second digit is deviated laterally.

What are the 3 stages of "pre" dislocation syndrome?

A digital deformity with a flexed PIP joint and Hyperextended MTP and DIP joints would be classified as:

Stress fractures as they move through phases of healing, becomes less easier detectable on plain film radiographs.

Flexor ______ is released that is located between the PIP and DIP joint region when performing a hammertoe repair.

A digital deformity characterized by a flexed PIP joint and hyperextended MTP and DIP joints is classified as which of the following?

Following skin incision in a stepwise hammertoe correction surgery, what is the MOST appropriate next step?

In the Smillie Classification for Freiberg's disease, stages 2-5 are best treated with surgical intervention, while stage 1 should be treated with conservative interventions.

During hammertoe correction with notable plantar joint contracture, which tendon should be transferred and to which position?

A 55-year-old male presents complaining of pain to his right foot, he reports “curled up toes that rub on shoes”. He is healthy and active, and reports a previous ruptured Achilles tendon while playing soccer 5 years ago. Clinically you find muscle strength testing with ankle plantarflexion decreased to 3/5. His lesser digits are extended at the MTP joints and flexed at the PIP joints. What best describes the MOST likely category of his biomechanical pathology?