Podcast
Questions and Answers
Delineate the biomechanical rationale underlying the Coleman block test in the context of tailor's bunion assessment.
Delineate the biomechanical rationale underlying the Coleman block test in the context of tailor's bunion assessment.
- It isolates forefoot varus influence by negating the impact of the peroneus longus tendon.
- It differentiates between flexible and rigid forefoot deformities by eliminating ground reaction forces on the lateral column. (correct)
- It assesses the degree of rearfoot varus by manipulating the subtalar joint axis.
- It identifies a rigid plantarflexed first ray by eliminating ground reaction forces on the lateral column.
Which statement best describes Coughlin's Type II tailor's bunion deformity in relation to radiographic findings?
Which statement best describes Coughlin's Type II tailor's bunion deformity in relation to radiographic findings?
- It involves abnormal lateral bowing of the distal fifth metatarsal with a normal 4-5 intermetatarsal angle. (correct)
- It exhibits a combination of increased intermetatarsal angle and lateral bowing, indicative of a complex deformity.
- It is characterized by an enlarged lateral surface of the fifth metatarsal head with an elevated DMAA.
- It is defined by an increased 4-5 intermetatarsal angle, typically exceeding 15 degrees.
A patient presents with a tailor's bunion and an intermetatarsal angle, measured using the Fallat and Buckholz method, of 9.2 degrees. What is the most accurate interpretation of this finding?
A patient presents with a tailor's bunion and an intermetatarsal angle, measured using the Fallat and Buckholz method, of 9.2 degrees. What is the most accurate interpretation of this finding?
- The intermetatarsal angle is borderline abnormal, suggesting a need for advanced imaging.
- The intermetatarsal angle is within normal limits, indicating that the bunion is primarily due to lateral bowing.
- The intermetatarsal angle is elevated above Fallat and Buckholz's indicated threshold, suggesting a need for surgical intervention. (correct)
- The intermetatarsal angle is significantly decreased and a tailor's bunion is unlikely.
When interpreting a lateral radiograph of a patient presenting with tailor's bunion, which declination angle of the fifth metatarsal would be most indicative of a plantarflexed fifth ray contributing to the pathology?
When interpreting a lateral radiograph of a patient presenting with tailor's bunion, which declination angle of the fifth metatarsal would be most indicative of a plantarflexed fifth ray contributing to the pathology?
In the surgical management of a tailor's bunion, what crucial anatomical structure must a surgeon consider to minimize the risk of avascular necrosis following a proximal osteotomy of the fifth metatarsal?
In the surgical management of a tailor's bunion, what crucial anatomical structure must a surgeon consider to minimize the risk of avascular necrosis following a proximal osteotomy of the fifth metatarsal?
A surgeon is planning a distal chevron osteotomy for a tailor's bunion correction. For optimal biomechanical stability and to minimize the risk of rotation, which modification to the osteotomy design should be considered?
A surgeon is planning a distal chevron osteotomy for a tailor's bunion correction. For optimal biomechanical stability and to minimize the risk of rotation, which modification to the osteotomy design should be considered?
What biomechanical consequence is most likely to arise from over-resectioning the lateral condyle during an exostectomy for a tailor's bunion?
What biomechanical consequence is most likely to arise from over-resectioning the lateral condyle during an exostectomy for a tailor's bunion?
A patient who underwent a scarf osteotomy for the correction of a tailor's bunion now presents with persistent pain, swelling, and radiographic evidence of nonunion. Which complication is most likely contributing to this outcome?
A patient who underwent a scarf osteotomy for the correction of a tailor's bunion now presents with persistent pain, swelling, and radiographic evidence of nonunion. Which complication is most likely contributing to this outcome?
An adductovarus deformity of the fifth toe associated with a tailor's bunion is often referred to as a 'curly toe.' What specific biomechanical change contributes MOST significantly to the development of this deformity?
An adductovarus deformity of the fifth toe associated with a tailor's bunion is often referred to as a 'curly toe.' What specific biomechanical change contributes MOST significantly to the development of this deformity?
For a patient presenting with a tailor's bunion and a concomitant flexible adductovarus deformity of the fifth toe, which surgical intervention would MOST effectively address both deformities simultaneously?
For a patient presenting with a tailor's bunion and a concomitant flexible adductovarus deformity of the fifth toe, which surgical intervention would MOST effectively address both deformities simultaneously?
Consider the anatomical implications of performing a skin plasty for correction of an adductovarus fifth toe deformity. What are you avoiding by using a Z or VY plasty?
Consider the anatomical implications of performing a skin plasty for correction of an adductovarus fifth toe deformity. What are you avoiding by using a Z or VY plasty?
A patient presents with a tailor's bunion in the context of a skew foot deformity. Identify the MOST critical radiographic parameter to evaluate when planning surgical intervention.
A patient presents with a tailor's bunion in the context of a skew foot deformity. Identify the MOST critical radiographic parameter to evaluate when planning surgical intervention.
During the surgical correction of a tailor's bunion, a surgeon inadvertently disrupts the periosteal blood supply. What potential sequela should the surgeon be MOST concerned about?
During the surgical correction of a tailor's bunion, a surgeon inadvertently disrupts the periosteal blood supply. What potential sequela should the surgeon be MOST concerned about?
A patient presents with radiographic evidence of metatarsus adductus alongside a tailor's bunion. How does the presence of metatarsus adductus complicate the management of the tailor's bunion?
A patient presents with radiographic evidence of metatarsus adductus alongside a tailor's bunion. How does the presence of metatarsus adductus complicate the management of the tailor's bunion?
What best describes the primary goal of a de-rotational arthroplasty performed in the surgical correction of an adductovarus fifth toe associated with a tailor's bunion?
What best describes the primary goal of a de-rotational arthroplasty performed in the surgical correction of an adductovarus fifth toe associated with a tailor's bunion?
In the context of tailor's bunion surgery, which factor increases the risk of iatrogenic flail toe deformity?
In the context of tailor's bunion surgery, which factor increases the risk of iatrogenic flail toe deformity?
A patient presents with a tailor's bunion and reports significant pain exacerbated by shoe gear. Which non-surgical intervention should be trialed first to alleviate their symptoms?
A patient presents with a tailor's bunion and reports significant pain exacerbated by shoe gear. Which non-surgical intervention should be trialed first to alleviate their symptoms?
What is the MOST LIKELY underlying biomechanical pathomechanics for a Tailor's bunion in the setting of a rigid plantarflexed 1st ray?
What is the MOST LIKELY underlying biomechanical pathomechanics for a Tailor's bunion in the setting of a rigid plantarflexed 1st ray?
Which statement critically differentiates a Voutney procedure used by a podiatric surgeon from a more traditional closing wedge osteotomy?
Which statement critically differentiates a Voutney procedure used by a podiatric surgeon from a more traditional closing wedge osteotomy?
Post-surgical correction of a tailor's bunion requires an understanding of possible complications. What is the most likely scenario to cause a transfer lesion?
Post-surgical correction of a tailor's bunion requires an understanding of possible complications. What is the most likely scenario to cause a transfer lesion?
You are evaluating a patient with a tailor's bunion. Radiographs reveal a large exostosis but a normal 4-5 intermetatarsal angle and DMAA. What structural etiology is most likely?
You are evaluating a patient with a tailor's bunion. Radiographs reveal a large exostosis but a normal 4-5 intermetatarsal angle and DMAA. What structural etiology is most likely?
You are treating a patient with a painful tailor's bunion and associated adductovarus of the 5th digit, with a painful interdigital corn. What is the definitive surgical treatment?
You are treating a patient with a painful tailor's bunion and associated adductovarus of the 5th digit, with a painful interdigital corn. What is the definitive surgical treatment?
What would be the INITIAL treatment for an adduction and varus fifth toe?
What would be the INITIAL treatment for an adduction and varus fifth toe?
What is the PRIMARY purpose of the abductor digiti minimi muscle?
What is the PRIMARY purpose of the abductor digiti minimi muscle?
A patient presents with a large heloma molle. What underlying musculoskeletal imbalance would MOST drive this pathology?
A patient presents with a large heloma molle. What underlying musculoskeletal imbalance would MOST drive this pathology?
What is a clinical finding of plantarflexed 5th ray?
What is a clinical finding of plantarflexed 5th ray?
In which plane does malunion occur with greater than 16 degrees post-operatively and commonly cause a transfer lesion after tailor's bunion surgery?
In which plane does malunion occur with greater than 16 degrees post-operatively and commonly cause a transfer lesion after tailor's bunion surgery?
A rigid forefoot varus is most often best compensated with which of the following?
A rigid forefoot varus is most often best compensated with which of the following?
What is the most accurate way in which to describe a Skew Foot?
What is the most accurate way in which to describe a Skew Foot?
What does the Fallat and Buckholz method measure?
What does the Fallat and Buckholz method measure?
What is a typical normal 5th metatarsal declination angle?
What is a typical normal 5th metatarsal declination angle?
What is THE most common tailor's bunion type that you will encounter?
What is THE most common tailor's bunion type that you will encounter?
What can one observe radiographically to assess for tailor's bunion lateral bowing?
What can one observe radiographically to assess for tailor's bunion lateral bowing?
What vascular structure should the surgeon focus on to avoid mal- or non-union?
What vascular structure should the surgeon focus on to avoid mal- or non-union?
Which type of surgical procedure is LEAST likely to benefit a tailor's bunion that is causing the patient pain?
Which type of surgical procedure is LEAST likely to benefit a tailor's bunion that is causing the patient pain?
Which of the following is NOT a complication directly associated with a Tailor's Bunion correction?
Which of the following is NOT a complication directly associated with a Tailor's Bunion correction?
What is the most effective way to describe an adduction and varus 5th digit?
What is the most effective way to describe an adduction and varus 5th digit?
You resect a 5th metatarsal head to permanently solve an adduction and varus and pain that is not responsive to conservative treatment. What is the MOST LIKELY outcome?
You resect a 5th metatarsal head to permanently solve an adduction and varus and pain that is not responsive to conservative treatment. What is the MOST LIKELY outcome?
To fix an adductovarus 5th digit, a surgeon cuts an ellipse. How and where is the cut made?
To fix an adductovarus 5th digit, a surgeon cuts an ellipse. How and where is the cut made?
Of the following list, select the primary goal of the abductor digit quinti (ADQ)
Of the following list, select the primary goal of the abductor digit quinti (ADQ)
In the biomechanical cascade leading to a tailor's bunion, what intrinsic muscle imbalance MOST directly contributes to the progressive adduction and supination of the fifth digit, exacerbating the bunionette deformity?
In the biomechanical cascade leading to a tailor's bunion, what intrinsic muscle imbalance MOST directly contributes to the progressive adduction and supination of the fifth digit, exacerbating the bunionette deformity?
What is the MOST critical biomechanical consideration when differentiating between an adduction and varus fifth toe deformity associated with a tailor's bunion and one arising from a congenital brachymetatarsia?
What is the MOST critical biomechanical consideration when differentiating between an adduction and varus fifth toe deformity associated with a tailor's bunion and one arising from a congenital brachymetatarsia?
In assessing a patient with a tailor's bunion and suspected hypermobility of the fifth ray, which clinical test would MOST accurately quantify the degree of sagittal plane instability at the fifth metatarsal-cuneiform joint in relation to adjacent metatarsals?
In assessing a patient with a tailor's bunion and suspected hypermobility of the fifth ray, which clinical test would MOST accurately quantify the degree of sagittal plane instability at the fifth metatarsal-cuneiform joint in relation to adjacent metatarsals?
What surgical alteration during a distal chevron osteotomy for tailor's bunion correction would MOST effectively mitigate the risk of iatrogenic elevation of the fifth metatarsal head, a common cause of post-operative transfer metatarsalgia?
What surgical alteration during a distal chevron osteotomy for tailor's bunion correction would MOST effectively mitigate the risk of iatrogenic elevation of the fifth metatarsal head, a common cause of post-operative transfer metatarsalgia?
In the context of a tailor's bunion correction complicated by avascular necrosis (AVN) following a proximal osteotomy, which factor is MOST likely implicated in the disruption of the fifth metatarsal's primary vascular supply?
In the context of a tailor's bunion correction complicated by avascular necrosis (AVN) following a proximal osteotomy, which factor is MOST likely implicated in the disruption of the fifth metatarsal's primary vascular supply?
A patient undergoing a scarf osteotomy for tailor's bunion correction develops a nonunion with radiographic evidence of hypertrophic callus formation. Which of the following factors is MOST likely responsible for this specific presentation of nonunion?
A patient undergoing a scarf osteotomy for tailor's bunion correction develops a nonunion with radiographic evidence of hypertrophic callus formation. Which of the following factors is MOST likely responsible for this specific presentation of nonunion?
What surgical strategy would be MOST effective in addressing a tailor's bunion associated with a skew foot deformity, characterized by both metatarsus adductus and hindfoot valgus, while simultaneously minimizing the risk of destabilizing the medial column?
What surgical strategy would be MOST effective in addressing a tailor's bunion associated with a skew foot deformity, characterized by both metatarsus adductus and hindfoot valgus, while simultaneously minimizing the risk of destabilizing the medial column?
In the context of surgical correction for a tailor's bunion with an associated flexible adductovarus deformity of the fifth toe, which adjunctive procedure is MOST likely to address the deforming force caused by the flexor tendons, preventing recurrence of the toe deformity?
In the context of surgical correction for a tailor's bunion with an associated flexible adductovarus deformity of the fifth toe, which adjunctive procedure is MOST likely to address the deforming force caused by the flexor tendons, preventing recurrence of the toe deformity?
During a surgical correction of tailor's bunion, inadvertent disruption of the periosteal blood supply occurs. Immediate intervention should prioritize which of the following to primarily prevent nonunion?
During a surgical correction of tailor's bunion, inadvertent disruption of the periosteal blood supply occurs. Immediate intervention should prioritize which of the following to primarily prevent nonunion?
What is the MOST significant ramification of failing to differentiate between a structural tailor's bunion and a functional tailor's bunion when formulating a surgical plan?
What is the MOST significant ramification of failing to differentiate between a structural tailor's bunion and a functional tailor's bunion when formulating a surgical plan?
Which statement provides the MOST accurate clinical interpretation of an increased Fallat and Buckholz angle in the context of a tailor's bunion evaluation?
Which statement provides the MOST accurate clinical interpretation of an increased Fallat and Buckholz angle in the context of a tailor's bunion evaluation?
A patient presents with a symptomatic tailor's bunion and radiographic findings demonstrating a lateral bowing of the fifth metatarsal. Which adjunctive radiographic measurement would BEST guide surgical planning to quantify the degree of bowing?
A patient presents with a symptomatic tailor's bunion and radiographic findings demonstrating a lateral bowing of the fifth metatarsal. Which adjunctive radiographic measurement would BEST guide surgical planning to quantify the degree of bowing?
What is the MOST critical aspect during the clinical assessment of a patient presenting with tailor’s bunion and an associated interdigital corn in the fourth interspace?
What is the MOST critical aspect during the clinical assessment of a patient presenting with tailor’s bunion and an associated interdigital corn in the fourth interspace?
What is the MOST appropriate initial non-surgical treatment strategy for addressing a painful, early-stage adductovarus deformity of the fifth toe associated with a tailor's bunion?
What is the MOST appropriate initial non-surgical treatment strategy for addressing a painful, early-stage adductovarus deformity of the fifth toe associated with a tailor's bunion?
In the context of surgical planning for a tailor's bunion correction, which anatomical consideration is MOST crucial for preserving vascular integrity during a proximal metatarsal osteotomy?
In the context of surgical planning for a tailor's bunion correction, which anatomical consideration is MOST crucial for preserving vascular integrity during a proximal metatarsal osteotomy?
Which statement MOST accurately elucidates the radiographic criteria for classifying Coughlin Type III tailor's bunion deformity?
Which statement MOST accurately elucidates the radiographic criteria for classifying Coughlin Type III tailor's bunion deformity?
A patient presents with a tailor's bunion and radiographic evidence of metatarsus adductus. Which surgical intervention would BEST address both deformities while minimizing the risk of overcorrection and lateral column overload?
A patient presents with a tailor's bunion and radiographic evidence of metatarsus adductus. Which surgical intervention would BEST address both deformities while minimizing the risk of overcorrection and lateral column overload?
What is the PRIMARY biomechanical objective of a de-rotational arthroplasty performed in the surgical correction of an adductovarus fifth toe in conjunction with tailor's bunion repair?
What is the PRIMARY biomechanical objective of a de-rotational arthroplasty performed in the surgical correction of an adductovarus fifth toe in conjunction with tailor's bunion repair?
In the surgical management of a tailor's bunion with concomitant adductovarus of the fifth toe, which technical error during soft tissue release carries the HIGHEST risk of inducing an iatrogenic flail toe deformity?
In the surgical management of a tailor's bunion with concomitant adductovarus of the fifth toe, which technical error during soft tissue release carries the HIGHEST risk of inducing an iatrogenic flail toe deformity?
Which of the following statements BEST explains the biomechanical rationale for utilizing a Coleman block test in the context of evaluating a tailor's bunion?
Which of the following statements BEST explains the biomechanical rationale for utilizing a Coleman block test in the context of evaluating a tailor's bunion?
When surgically managing an intractable, painful adduction and varus fifth toe associated with a tailor's bunion, what factor is MOST critical in preventing a post-operative 'floppy toe'?
When surgically managing an intractable, painful adduction and varus fifth toe associated with a tailor's bunion, what factor is MOST critical in preventing a post-operative 'floppy toe'?
Why are proximal osteotomies like the Gerbert Closing Abductory Wedge Osteotomy considered to have higher overall risk compared to distal osteotomies?
Why are proximal osteotomies like the Gerbert Closing Abductory Wedge Osteotomy considered to have higher overall risk compared to distal osteotomies?
When evaluating a rigid forefoot varus in a patient with a tailor's bunion, what is MOST likely to be present?
When evaluating a rigid forefoot varus in a patient with a tailor's bunion, what is MOST likely to be present?
What clinical signs would the astute clinician observe to indicate a plantarflexed 5th ray?
What clinical signs would the astute clinician observe to indicate a plantarflexed 5th ray?
Post-operatively following a tailor's bunion correction a patient begins to demonstrate signs of a transfer lesion under the 4th metatarsal. Angular malunion should be assessed in what plane on X-Ray?
Post-operatively following a tailor's bunion correction a patient begins to demonstrate signs of a transfer lesion under the 4th metatarsal. Angular malunion should be assessed in what plane on X-Ray?
A patient demonstrates a rigid forefoot varus, MOST likely demonstrating what kind of compensation?
A patient demonstrates a rigid forefoot varus, MOST likely demonstrating what kind of compensation?
What radiographic parameters define a skew foot?
What radiographic parameters define a skew foot?
What is the primary clinical significance of the abductor digiti quinti (ADQ) muscle in maintaining proper foot biomechanics, particularly in the context of tailor's bunion development?
What is the primary clinical significance of the abductor digiti quinti (ADQ) muscle in maintaining proper foot biomechanics, particularly in the context of tailor's bunion development?
What anatomical location primarily experiences increased pressure in individuals with tailor's bunions?
What anatomical location primarily experiences increased pressure in individuals with tailor's bunions?
Which structural component is NOT typically associated with the structural etiology of a tailor's bunion?
Which structural component is NOT typically associated with the structural etiology of a tailor's bunion?
When the fifth metatarsal is unstable with pronation, which of the following deformities is indicated?
When the fifth metatarsal is unstable with pronation, which of the following deformities is indicated?
What is the MOST likely outcome of resecting a 5th metatarsal head to permanently solve an adduction and varus that is pain unresponsive to conservative treatment?
What is the MOST likely outcome of resecting a 5th metatarsal head to permanently solve an adduction and varus that is pain unresponsive to conservative treatment?
What is the normal declination angle of the fifth metatarsal?
What is the normal declination angle of the fifth metatarsal?
When measuring the intermetatarsal angle using the Fallat and Buckholz method, which anatomical aspect of the metatarsals is utilized?
When measuring the intermetatarsal angle using the Fallat and Buckholz method, which anatomical aspect of the metatarsals is utilized?
What is the average measurement for lateral bowing of the fifth metatarsal considered to be normal?
What is the average measurement for lateral bowing of the fifth metatarsal considered to be normal?
What radiographic measurement of lateral bowing using the Fallat and Buckholz method is usually associated with a symptomatic tailor's bunion?
What radiographic measurement of lateral bowing using the Fallat and Buckholz method is usually associated with a symptomatic tailor's bunion?
What is the MOST common etiology of tailor's bunion?
What is the MOST common etiology of tailor's bunion?
Which of the following statements is MOST accurate with regards to functional/biomechanical causes of tailor's bunion?
Which of the following statements is MOST accurate with regards to functional/biomechanical causes of tailor's bunion?
You are evaluating a patient with a tailor's bunion. Radiographs reveal a 4/5 IM angle of 10.5 degrees and lateral bowing 0f 0 degrees, without an enlarged 5th metatarsal head. How is this best classified, using Coughlin's classification?
You are evaluating a patient with a tailor's bunion. Radiographs reveal a 4/5 IM angle of 10.5 degrees and lateral bowing 0f 0 degrees, without an enlarged 5th metatarsal head. How is this best classified, using Coughlin's classification?
Which of the following is considered a conservative treatment option for tailor's bunion?
Which of the following is considered a conservative treatment option for tailor's bunion?
Which of the following is a surgical treatment option for tailor's bunion?
Which of the following is a surgical treatment option for tailor's bunion?
According to the surgical treatment algorithm proposed by Coughlin, which procedure is most appropriate to treat a tailor's bunion classified as Type I?
According to the surgical treatment algorithm proposed by Coughlin, which procedure is most appropriate to treat a tailor's bunion classified as Type I?
When performing a surgical correction for tailor's bunion, from which artery does the nutrient artery typically arise?
When performing a surgical correction for tailor's bunion, from which artery does the nutrient artery typically arise?
What surgical option is typically required when there is a larger deformity associated with tailor's bunion?
What surgical option is typically required when there is a larger deformity associated with tailor's bunion?
What is the MAIN benefit when performing a distal metatarsal osteotomy, compared to performing a proximal osteotomy?
What is the MAIN benefit when performing a distal metatarsal osteotomy, compared to performing a proximal osteotomy?
Which of the following is considered a disadvantage of distal metatarsal osteotomies for tailor's bunion correction?
Which of the following is considered a disadvantage of distal metatarsal osteotomies for tailor's bunion correction?
Which of the following is a surgical option for tailor's bunion correction, that involves multiple bone cuts may be technically more difficult, but more stable with less likelihood to elevate?
Which of the following is a surgical option for tailor's bunion correction, that involves multiple bone cuts may be technically more difficult, but more stable with less likelihood to elevate?
Which statement BEST describes the oblique osteotomy for a tailor's bunion correction?
Which statement BEST describes the oblique osteotomy for a tailor's bunion correction?
Which statement accurately describes a midshaft metatarsal osteotomy?
Which statement accurately describes a midshaft metatarsal osteotomy?
Which of the following best describes why care should be taken when performing a midshaft/proximal metatarsal osteotomy?
Which of the following best describes why care should be taken when performing a midshaft/proximal metatarsal osteotomy?
Which statement BEST describes a surgical option for tailor's bunion correction that has the greatest risk to the nutrient artery?
Which statement BEST describes a surgical option for tailor's bunion correction that has the greatest risk to the nutrient artery?
What is the MAIN disadvantage of performing a metatarsal head resection for tailor's bunion correction?
What is the MAIN disadvantage of performing a metatarsal head resection for tailor's bunion correction?
Which surgical complication might you see if there is troughing when performing a scarf osteotomy?
Which surgical complication might you see if there is troughing when performing a scarf osteotomy?
Which surgical error is most likely to cause a joint dislocation?
Which surgical error is most likely to cause a joint dislocation?
Which of the following is least likely to result in shortening and/or flail toe?
Which of the following is least likely to result in shortening and/or flail toe?
The image results in a post-operative lateral x-ray, demonstrating nonunion. Which of the following surgical complications should you suspect?
The image results in a post-operative lateral x-ray, demonstrating nonunion. Which of the following surgical complications should you suspect?
What is the term for adductovarus of the 5th toe?
What is the term for adductovarus of the 5th toe?
A patient with an adductovarus 5th toe may develop a Lister corn. Where does the Lister corn develop in this case?
A patient with an adductovarus 5th toe may develop a Lister corn. Where does the Lister corn develop in this case?
Heloma molle resulting in ulceration can develop in an adductovarus 5th toe. Where is this most likely to occur?
Heloma molle resulting in ulceration can develop in an adductovarus 5th toe. Where is this most likely to occur?
What happens as the 5th metatarsal shaft everts in an adductovarus 5th toe?
What happens as the 5th metatarsal shaft everts in an adductovarus 5th toe?
Which of the following is a conservative management of adductovarus 5th toe?
Which of the following is a conservative management of adductovarus 5th toe?
Which statement describes how an ellipse is cut during a de-rotational arthroplasty?
Which statement describes how an ellipse is cut during a de-rotational arthroplasty?
Which of the following should you consider in addition to tailor's bunion in the setting of metatarsus adductus?
Which of the following should you consider in addition to tailor's bunion in the setting of metatarsus adductus?
What parameters define a splay foot?
What parameters define a splay foot?
Clinically, what characterizes a skew foot deformity?
Clinically, what characterizes a skew foot deformity?
What statement BEST describes the deformity when there is an adduction deformity of the metatarsals at the tarsometatarsal joints?
What statement BEST describes the deformity when there is an adduction deformity of the metatarsals at the tarsometatarsal joints?
What would you expect to observe if the distance decreases between the 1st and 5th metatarsal heads?
What would you expect to observe if the distance decreases between the 1st and 5th metatarsal heads?
Which conservative treatment is MOST appropriate for long-term relief for an adductovarus deformity?
Which conservative treatment is MOST appropriate for long-term relief for an adductovarus deformity?
What is the MOST appropriate bone resection at the toe(s) for your patient who has an adductovarus hammertoe in addition to a tailor's bunion with an interdigital heloma molle?
What is the MOST appropriate bone resection at the toe(s) for your patient who has an adductovarus hammertoe in addition to a tailor's bunion with an interdigital heloma molle?
What is the MOST likely reason for a rigid hypermobile 5th ray?
What is the MOST likely reason for a rigid hypermobile 5th ray?
Why do tailor's experience bunionettes?
Why do tailor's experience bunionettes?
Which is LEAST likely to occur in an adductovarus fifth toe?
Which is LEAST likely to occur in an adductovarus fifth toe?
A patient presents with pain at the 5th metatarsal head. Which location is LEAST likely to be affected by this pain?
A patient presents with pain at the 5th metatarsal head. Which location is LEAST likely to be affected by this pain?
What is a synonym for tailor's bunion?
What is a synonym for tailor's bunion?
According to the McGlamry classification, which of the following is considered a structural cause of tailor's bunion?
According to the McGlamry classification, which of the following is considered a structural cause of tailor's bunion?
What is the average range for the normal measurement of lateral bowing using the traditional method?
What is the average range for the normal measurement of lateral bowing using the traditional method?
If a patient presents with a tailor's bunion and their radiograph shows an increased 4-5 intermetatarsal angle, which of Coughlin's classifications BEST describes this?
If a patient presents with a tailor's bunion and their radiograph shows an increased 4-5 intermetatarsal angle, which of Coughlin's classifications BEST describes this?
During a physical exam you note prominence of the 5th metatarsal head laterally and observe that the patient has an unstable 5th metatarsal. What could be a structural etiology?
During a physical exam you note prominence of the 5th metatarsal head laterally and observe that the patient has an unstable 5th metatarsal. What could be a structural etiology?
A patient's radiograph reveals a 4/5 IM angle of 9 degrees with no lateral bowing or enlargement of the metatarsal head. How is this best classified?
A patient's radiograph reveals a 4/5 IM angle of 9 degrees with no lateral bowing or enlargement of the metatarsal head. How is this best classified?
For a patient presenting with a tailor's bunion and an associated flexible adductovarus deformity of the fifth toe, what is the MOST effective surgical intervention to address BOTH deformities?
For a patient presenting with a tailor's bunion and an associated flexible adductovarus deformity of the fifth toe, what is the MOST effective surgical intervention to address BOTH deformities?
What is a potential complication of performing a metatarsal head resection to correct a tailor's bunion?
What is a potential complication of performing a metatarsal head resection to correct a tailor's bunion?
A patient has continued pain after a scarf osteotomy and post-operative CT scan reveals a nonunion. What surgical complication can lead to this?
A patient has continued pain after a scarf osteotomy and post-operative CT scan reveals a nonunion. What surgical complication can lead to this?
What is the MOST likely reason for an adductovarus 5th toe to develop a Lister corn?
What is the MOST likely reason for an adductovarus 5th toe to develop a Lister corn?
Which of the following factors is MOST important in surgical treatment planning for tailor's bunion correction in the setting of metatarsus adductus?
Which of the following factors is MOST important in surgical treatment planning for tailor's bunion correction in the setting of metatarsus adductus?
During a physical exam, you observe a rare type of flatfoot characterized by forefoot adduction and hindfoot valgus. How is this best classified?
During a physical exam, you observe a rare type of flatfoot characterized by forefoot adduction and hindfoot valgus. How is this best classified?
Which of the following is MOST likely to be included in the conservative treatment of an adductovarus deformity of the fifth toe?
Which of the following is MOST likely to be included in the conservative treatment of an adductovarus deformity of the fifth toe?
What is the rationale for performing a debridement of hyperkeratosis as a conservative treatment for tailor's bunion?
What is the rationale for performing a debridement of hyperkeratosis as a conservative treatment for tailor's bunion?
A patient is diagnosed with a tailor's bunion and is seeking conservative treatment. What INITIAL recommendation should you make?
A patient is diagnosed with a tailor's bunion and is seeking conservative treatment. What INITIAL recommendation should you make?
When performing a de-rotational arthroplasty for an adductovarus fifth toe, how is the ellipse cut?
When performing a de-rotational arthroplasty for an adductovarus fifth toe, how is the ellipse cut?
Which surgical procedure is LEAST appropriate for Coughlin type I tailor's bunion?
Which surgical procedure is LEAST appropriate for Coughlin type I tailor's bunion?
Which surgical treatment option for tailor's bunion correction is technically more difficult, involves multiple bone cuts, and is more stable with less likelihood of elevation?
Which surgical treatment option for tailor's bunion correction is technically more difficult, involves multiple bone cuts, and is more stable with less likelihood of elevation?
When is distraction MOST likely to occur when cutting bone?
When is distraction MOST likely to occur when cutting bone?
Which is LEAST likely to result in shortening and/or flail toe?
Which is LEAST likely to result in shortening and/or flail toe?
You are evaluating a patient with a painful tailor's bunion and associated adductovarus of the 5th digit, with a painful corn developing between the digits. What is the definitive surgical treatment?
You are evaluating a patient with a painful tailor's bunion and associated adductovarus of the 5th digit, with a painful corn developing between the digits. What is the definitive surgical treatment?
Though not described originally by Coughlin's classification, how would you classify a tailor's bunion combining 4/5 IM angle increase and distal 5th metatarsal bowing?
Though not described originally by Coughlin's classification, how would you classify a tailor's bunion combining 4/5 IM angle increase and distal 5th metatarsal bowing?
When correcting an adductovarus 5th digit, you need to perform a skin plasty. Where are the appropriate locations?
When correcting an adductovarus 5th digit, you need to perform a skin plasty. Where are the appropriate locations?
One operates on an adductovarus 5th digit, and makes the following observations: the 5th toe has greater adduction than abduction, and the abductor digiti quinti has migrated plantarly. What is happening to the 5th metatarsal shaft?
One operates on an adductovarus 5th digit, and makes the following observations: the 5th toe has greater adduction than abduction, and the abductor digiti quinti has migrated plantarly. What is happening to the 5th metatarsal shaft?
In the absence of angular or bowing deformity on x-ray, what type of bunion is indicated?
In the absence of angular or bowing deformity on x-ray, what type of bunion is indicated?
Which of the following is the MOST crucial step in a tailor's bunion correction to prevent flail toe?
Which of the following is the MOST crucial step in a tailor's bunion correction to prevent flail toe?
What is the MOST severe complication that you can observe in a tailor's bunion correction?
What is the MOST severe complication that you can observe in a tailor's bunion correction?
Flashcards
What is a tailor's bunion?
What is a tailor's bunion?
A tailor's bunion, also known as a bunionette, is a prominence on the lateral side of the fifth metatarsal head.
Clinical Presentation of Tailor's Bunion
Clinical Presentation of Tailor's Bunion
A bony prominence on the lateral aspect of the fifth metatarsal head, often associated with pain and redness.
Structural Causes of Tailor's Bunion
Structural Causes of Tailor's Bunion
Increased 4-5 intermetatarsal angle, fifth metatarsal head shape, fifth metatarsal shaft shape, plantarflexed fifth ray
Functional/Biomechanical Causes of Tailor's Bunion
Functional/Biomechanical Causes of Tailor's Bunion
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Coughlin Type I Bunionette
Coughlin Type I Bunionette
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Coughlin Type II Bunionette
Coughlin Type II Bunionette
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Coughlin Type III Bunionette
Coughlin Type III Bunionette
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Non-surgical Tailor's Bunion Treatment
Non-surgical Tailor's Bunion Treatment
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Surgical Options for Tailor's Bunion
Surgical Options for Tailor's Bunion
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Nutrient Artery Location
Nutrient Artery Location
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Tailor's Bunion Surgery Complications
Tailor's Bunion Surgery Complications
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Adductovarus 5th Toe
Adductovarus 5th Toe
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Adductovarus 5th Conservative Treatments
Adductovarus 5th Conservative Treatments
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Adductovarus 5th Toe Surgical Options
Adductovarus 5th Toe Surgical Options
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Metatarsus Adductus Deformity
Metatarsus Adductus Deformity
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Skew Foot Deformity
Skew Foot Deformity
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Splay Foot Deformity
Splay Foot Deformity
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Bunionette
Bunionette
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Tailor's Bunion Presentation
Tailor's Bunion Presentation
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Adventitial Bursa
Adventitial Bursa
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IM Angle Significance
IM Angle Significance
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Lateral Bowing Measurement
Lateral Bowing Measurement
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Lateral Deviation Significance
Lateral Deviation Significance
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Conservative Treatments
Conservative Treatments
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Nutrient Artery Origin
Nutrient Artery Origin
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Transfer Lesions
Transfer Lesions
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Transverse Plane Mal-alignment
Transverse Plane Mal-alignment
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Adductovarus presentation
Adductovarus presentation
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Surgical Approach for Adductovarus 5th toe
Surgical Approach for Adductovarus 5th toe
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Exostectomy: Adductovarus 5th Toe
Exostectomy: Adductovarus 5th Toe
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Skew Foot
Skew Foot
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Study Notes
Tailor's Bunion Overview
- Tailor's bunion is synonymous with bunionette.
- Week 4 focuses on tailor’s bunion and the associated adductovarus “curly” toe.
Learning Objectives
- Recognize radiographic findings of tailor’s bunions.
- Understand biomechanical causes of tailor’s bunions.
- Understand the etiology of adductovarus of the 5th toe.
- Identify conservative and surgical treatments for tailor’s bunions and associated adductovarus of the 5th toe.
- Recognize complications of surgical interventions for tailor’s bunions.
- Understand clinical and radiographic findings of splay foot, skew foot, and metatarsus adductus deformities associated with tailor’s bunions.
Tailor's Bunion Definition
- Tailors sitting cross-legged on the ground can cause tailor's bunion
- The lateral aspect of the foot becomes a pressure point, especially at the fifth metatarsal head.
- A bunionette is a smaller version of a bunion where the 5th MTP joint is smaller than the first MTP joint.
Clinical Presentation
- Prominence of the 5th metatarsal head can be dorsal, dorsolateral, lateral, or plantar lateral.
- Often associated with adductovarus of the fifth toe.
- Shoe gear pressure worsens pain and causes redness.
- An adventitial bursa, a fluid-filled sac, develops due to repeated trauma/shearing.
Etiology of Tailor's Bunion
- Structural causes include increased 4-5 IM angle, fifth metatarsal head shape, fifth metatarsal shaft shape, and plantarflexed 5th ray.
- Functional/biomechanical causes include uncompensated or rigid forefoot deformity, rigid rearfoot deformity with forefoot compensation, and hypermobile 5th ray.
Structural 5th Ray Deformities
- Enlarged 5th metatarsal head.
- Increased 4/5 intermetatarsal angle.
- Increased fifth metatarsal lateral deviation angle (lateral bowing).
- Plantarflexed 5th metatarsal.
Plantarflexed 5th Metatarsal
- Causes prominence of the 5th metatarsal head laterally or plantar-laterally.
- Causes the 5th metatarsal to be very unstable when pronating.
- A normal 5th metatarsal declination angle is 10°.
- A plantarflexed 5th metatarsal pathology has a declination angle greater than 10°.
Functional/Biomechanical 5th Ray Pathology
- Uncompensated or rigid forefoot deformity.
- Rigid rearfoot deformity with forefoot compensation.
- Hypermobile 5th ray.
- Second and third metatarsals are relatively stable compared to the 5th and 1st metatarsals.
- Total excursion can be compared to the 2nd and 3rd metatarsals.
- Hypermobile 5th ray allows the foot to remain pronated for a longer period.
- Stabilize the central metatarsals and grasp the 5th metatarsal head, not the 5th toe.
- Normal is less than 3 mm.
Tailor's Bunion Classifications
- Coughlin described 3 types- based on weight-bearing AP radiographs.
- Type I: enlargement of the lateral surface of the fifth metatarsal.
- Type II: abnormal lateral bowing of the distal fifth metatarsal with a normal 4th-5th IM angle.
- Type III: increased 4th-5th IM angle with divergence of the 4th and 5th metatarsals.
- Type IV: a combination of types I, II and III.
Fallat and Buckholz
- Developed a method to accurately measure the 4/5 intermetatarsal angle.
- Lateral deviation angle is measured by bisecting a line drawn along the distal fifth metatarsal (head and neck), and a line drawn along the proximal medial margin of the 5th metatarsal.
- A lateral deviation angle greater than 8° is associated with symptomatic tailor's bunion.
Measurements for Intermetatarsal(IM) Angle
- Traditional measurement bisects the shafts of the respective metatarsals.
- The Fallat et al. method uses the MEDIAL shaft of the 5th metatarsal.
Traditional IM Angle
- The IM angle by Fallat and Buckholz is greater than 8.71° and associated with tailor’s bunion.
Measurements for Lateral Bowing (Deviation) Angle
- Is the angle created by the intersection of bisection of the articular surface of the fifth metatarsal head and neck and the line drawn along the medial margin of the 5th metatarsal.
- The normal range is 0° to 7°, and the average in tailor’s bunion is 8.05°.
Tailor’s Bunion Treatment Options
- Conservative: padding, shoe modification, orthotics, activity modification, debridement of hyperkeratosis, NSAIDs, steroid injection, and physical therapy.
- Surgical: exostectomy/condylectomy, distal, midshaft, proximal metatarsal osteotomies, and metatarsal head resection.
Surgical Treatment Considerations
- The nutrient artery arises from the 4th plantar metatarsal artery.
- Enters from the medial aspect of the 5th metatarsal base.
- Open growth plates must be considered in skeletally immature patients.
Exostectomy/Condylectomy
- This procedure is quick and easy, requires no fixation.
- Rarely curative and does not address most deformities; removing too much can lead to subluxation or dislocation.
Distal Metatarsal Osteotomies
- Intraoperative image of planned bone cut can be performed at distal 5th metatarsal.
- Reverse Hohmann involves a transverse osteotomy at the metatarsal neck.
- Reverse Wilson osteotomy distal lateral to proximal medial.
- Distal procedures help avoid complications associated with proximal osteotomies, and fixation is not always required.
- Technically more difficult as you are creating two bone cuts, and unable to fully address larger deformities. One screw (one point of fixation) can lead to rotation.
Midshaft/Proximal Metatarsal Osteotomies
- Long oblique osteotomy at the midshaft to proximal 5th metatarsal.
- More dissection and close proximity to nutrient artery lead to a greater risk of delayed union and nonunion. The more proximal the osteotomy, the more angular correction and risk to the nutrient artery.
- Scarfette, reverse scarf, or Z osteotomy can be performed at the midshaft to proximal 5th metatarsal.
Tailor’s Bunion Surgical Treatment Options: Wedge Metatarsal Osteotomies
- A transverse osteotomy is performed at the metatarsal neck and a K-wire is used for fixation.
Proximal Metatarsal Osteotomies
- Gerbert closing wedge osteotomy provides the greatest angular correction.
- Mimics a Jones’ fracture with location near nutrient artery.
Metatarsal Head Resection
- Technically less challenging and curative for tailor’s bunion.
- Shortens the 5th ray, increasing the risk of transfer lesion and flail toe.
Complications
- Transfer lesions, transverse or sagittal plane malunion, nonunion, troughing, joint dislocation, flail toe, and overcorrection cause shortening.
- A sagittal plane deviation angle greater than 16° post-operatively is predictive of transfer lesion.
- Troughing is associated with the Z or scarf (scarfette) osteotomy.
Adductovarus 5th Toe
- Also known as curly toe.
- Often associated with tailor’s bunion.
- The lateral margin of the toenail may develop a Lister corn.
- Heloma mole in 4th interspace with ulceration can develop.
- As the 5th metatarsal shaft everts, the abductor digiti quinti moves more plantar.
- The 5th toe with greater adduction than abduction moves into a varus position.
Adductovarus 5th Toe Treatments
- Conservative: padding, shoe modification, orthotics, activity modification, debridement, NSAIDs, steroid injection, physical therapy.
- Surgical: exostectomy/condylectomy, tenotomy, arthroplasty, skin plasty, syndactyly, amputation.
Surgical Treatments for Adductovarus of the 5th Toe
- De-rotational arthroplasty, where the ellipse is distal medial to proximal lateral, also known as “two semi-elliptical”, or lenticular.
- Skin Plasty Z or V-Y.
- Lesion directly exostectomy with temporary k-wire fixation to prevent a floppy or flail toe.
- Fifth digit hammertoe surgery is most often Arthroplasty, not Arthrodesis to allow for proper shoe fitting.
Splay Foot Deformity
- Is a combination of hallux valgus and tailor’s bunion.
- The 1-2 IM angle is greater than 12°.
- The 4-5 IM angle is greater than 8°.
Metatarsus Adductus Deformity
- There is an adduction deformity of the metatarsals (medial deviation) at the forefoot associated with the tarsometatarsal joints.
Skew Foot Deformity
- A rare type of flatfoot described as a “Z” foot or serpentine foot.
- Characterized by forefoot adduction and hindfoot valgus.
Tailor’s Bunion in Setting of Metatarsus Adductus
- Although the 4/5 IM angle is not significantly increased, nor is there bowing of the 5th metatarsal, the distance between the medial first metatarsal head and the lateral 5th metatarsal head is increased. This increases pressure to the first and fifth met heads in shoe gear, with possible development of soft tissue swelling, bursitis, and/or bony hypertrophy of the 5th metatarsal head.
- Correcting both the bunion and adductus can reduce the distance between the 1st and 5th metatarsal heads which is a 10.5 mm (~1cm) difference that can be a ½ size difference in shoes.
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