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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A patient undergoes serial casting for the foot abnormalities shown in Figure A and achieves excellent correction. Unfortunately, the patient returns at 22 months of age with a recurrence which will require repeat casting and posteromedial releases. What is/are the risk factor(s) for recurrence in this condition?
Noncompliance with brace wear
Parent's level of education
Answers 1 and 4
Select Answer to see Preferred Response
A 16-year-old female underwent a corrective foot procedure as a young child and presents with the progressive deformity shown in Figure A. What was the most likely cause of the original deformity?
Charcot-Marie-Tooth, Type 1
Congenital vertical talus
Duchenne muscular dystrophy
A 19-year-old female presents with metatarsalgia and difficulty with wearing closed-toe shoes on her left foot. She is found to have a muscular strength imbalance between the anterior tibialis and peroneus longus on the left side. A clinical image and lateral foot radiograph are shown in Figures A and B, respectively. Which congenital condition most likely contributed to the development of the current foot deformity?
Congenital calcaneonavicular coalition
Congenital oblique talus
Congenital talipes equinovarus
Which of the following photographs is most consistent with pediatric clubfoot deformity?
A 3-week-old infant presents with the unilateral foot deformity displayed in Figure A. All of the following are key concepts for treatment of this deformity with manipulation and serial casting EXCEPT:
Forefoot is supinated and not pronated during correction
Forefoot abduction with lateral pressure on the talus
Percutaneous achilles tenotomy done before final cast application for residual equinus
Weekly cast changes
The last cast is applied with the foot in 30 degrees of abduction
A 16-year-old female complains of foot pain with ambulation. She previously underwent clubfoot soft tissue releases at 5 months of age. Each of the following are complications or late deformities associated with clubfoot surgery EXCEPT:
Osteonecrosis of the talus
Rigid pes planus
Tarsal tunnel syndrome
A 3-year-old boy has been treated in the past with Ponseti casting now presents with dynamic supination during gait. You're planning to perform an anterior tibialis transfer to the lateral cuneiform. All of the following are true EXCEPT:
This transfer is required in 10-20% of children who undergo the Ponseti treatment
Weak peroneals are counteracted by overpull of the anterior tibialis
Grade 4 or 5 strength of the anterior tibialis is needed prior to transfer
Subtalar rigidity supplements the transfer
Dynamic supination includes foot supination during swing phase and landing on the lateral foot border during stance phase
In patients with clubfeet treated with soft-tissue release, which of the following variables shows the greatest correlation with long-term functional impairment.
Extent of soft-tissue release
Subtalar joint function
Ankle joint function
Peroneal muscle function
Duration of cast treatment
A 3-year-old boy had been treated with serial casting for a right congenital idiopathic clubfoot deformity. The parents are concerned because the child now walks on the lateral border of the right foot. Examination shows that the foot passively achieves a plantigrade position with neutral heel valgus and ankle dorsiflexion to 15 degrees. The forefoot inverts during active ankle dorsiflexion. Mild residual metatarsus adductus is present. Management should now consist of
additional serial casting.
a floor-reaction ankle-foot orthosis.
closing wedge cuboid osteotomy.
lateral transfer of the anterior tibialis tendon.
posterior tibial tendon transfer through the interosseous membrane to the third metatarsal.
Which of the following components of the clubfoot deformity should be addressed first when using the Ponseti method?
A 4-year-old boy demonstrates excessive supination occuring during the swing phase of gait following Ponseti casting for an isolated right clubfoot. Which of the following sites identified in Figure A shows the correct destination for the transferred tendon in order to balance the foot and eliminate the supination?
A 5-year-old boy has a history of being treated with the Ponseti technique for a unilateral clubfoot. What muscle most commonly causes a dynamic deformity in the swing phase of gait following Ponseti casting?
A tibialis anterior transfer is appropriate for which of the following patients with clubfoot?
Newborn with forefoot adduction
3-year-old with a foot that supinates when he dorsiflexes
6-month-old residual equinus after casting
5-year-old boy with a fixed hindfoot varus
2-year-old with a foot that pronates when he plantarflexes
Residual cavus after surgical correction of a clubfoot deformity with comprehensive clubfoot release and pinning is caused by what technical error?
Inadequate Achilles tendon lengthening
Failure to correct hindfoot valgus
Failure to perform a posteromedial imbrication
Placement of the navicular in a dorsally subluxated position
Failure to perform a lateral column lengthening
Figure A shows a lateral radiograph of an 9-month old's dorsiflexed foot. What is the first line treatment for this condition?
Manipulation under anesthesia followed by a single casting
Serial manipulation and casting followed by surgical release and talonavicular reduction with pinning
A 3-month-old patient with clubfoot who you've been treating with the Ponseti Method has returned to your office. On examination, the foot appears as it does in Figure A. What treatment error has been made?
Under correction of foot pronation
Over corrected metarsus adductus
Tried correcting equinus before heel varus
Used below knee casts instead of above knee casts
Transitioned to the wrong size braces after casting
A 7-year-old male with a history of clubfoot surgery presents with pain on the dorsum of his foot with shoewear. The clinical appearance of his foot is shown in Figure A. The weakened muscle which leads to this condition is innervated by which nerve?
Common peroneal nerve
Deep peroneal nerve
Superficial peroneal nerve
A 6-week-old boy presents with bilateral lower extremity deformities shown in Figure A. All of the following are true regarding the Ponseti technique for correction of this congenital deformity EXCEPT:
Weekly manipulation and application of long leg casts
Achilles tenotomy is indicated for residual equinus before final cast application
Pronation of the foot during initial cast correction
Abduction of the foot with counterpressure at the talus
Correction of adduction deformity prior to equinus