Foot and Ankle Quiz

A 50-year-old male presents with ongoing plantar medial heel pain for the past few months. It is associated with the first step in the morning and eases up after he takes a few additional steps. He attempted physical therapy, including Achilles Stretching, heel cups and ice massage with no relief. On physical examination, there is pain over the plantar medial heel with a Tinel's sign elicted just proximal to the abdutor hallucis musculature. The pain radiates to the base of the 5th metatarsal. A Tinel's signover the posterior tibial nerve is not found. Innervation of which anatomic structure is most likely affected in this patient?

• 1) Abductor hallucis

• 2) Abductor digiti minimi

• 3) FDL

• 4) FHL

• 5) Plantar fascia

Which of the following physical examination findings would suggest injury to the superior peroneal retinaculum?

• 1) Positive ankle anterior drawer test

• 2) Positive external rotation stress test

• 3) Crepitus over the anterolateral ankle joint

• 4) Palpable tendon snapping over the fibula during ankle dorsiflexion

• 5) Tenderness at the base of the 5th metatarsal with ankle eversion

A 35-year-old patient presents with right calf weakness of approximately six week duration. The patient noted a pop in the back of their heel when carrying a heavy box up a flight of stair. In the office, there is an approximately 3cm palpable defect in the posterior heel cord. When examined in the prone position the foot rests in greater dorsiflexion compared to the contralateral. Which procedure will most likely need to be performed at the time of surgical repair?

• 1) FDL transfer

• 2) Tibialis posterior transfer

• 3) VY advancement of the Achilles

• 4) Synthetic graft augmentation

• 5) Peroneal brevis tendon transfer

A 53 year old woman has had progressive hallux valgus deformity of the the right great toe for the last 12 years. She has failed nonoperative managment including she modification and padded inserts. Her surgeon recommends a Lapidus procedure (1st metatarsal cuneiform arthrodesis). Which of the following is an indication for this procedure?

• 1) IM angle 12

• 2) HVA 40

• 3) Age >50 years

• 4) Flexible cavovarus deformity

• 5) 1st TMT arthritis

In the treatment of intra-articular calcaneal fractures, surgical reduction and fixation has been shown to have improved outcomes over non-operative treatment in all the following patient groups EXCEPT:

• 1) Sedentary job

• 2) Sanders IIb fractures

• 3) Women

• 4) Younger (<29 years old)

• 5) Previous calcaneus fracture

Which of the followimng is not commonly seen following malunion of a conservatively managed calcaneus fracture.

• 1) Decreased hindfoot height and increased calcaneal width

• 2) Hindfoot valgus and subfibular impingement

• 3) Lateral wall exostosis with peroneal tendon irritation

• 4) Subtalar arthritis

• 5) Tibiotalar impingement