DPM Pediatric Podiatry 2 — Questions and Answers
Question 1: The standard Ponseti protocol for clubfoot typically requires how many weekly casting sessions before tenotomy?
- 1–2 casts
- 5–7 casts (Correct answer)
- 10–12 casts
- 15–20 casts
Correct answer: 5–7 casts
The Ponseti method typically involves 5–7 weekly plaster casts to gradually correct the cavus, adductus, varus, and equinus components before a percutaneous Achilles tenotomy.
Question 2: Following successful Ponseti casting for clubfoot, what is the recommended bracing protocol?
- No bracing is required after casting
- Foot abduction brace (FAB) worn 23 hours/day for 3 months, then nights/naps until age 4–5 (Correct answer)
- Custom orthotics worn full-time for 1 year
- Below-knee cast worn for 6 additional months
Correct answer: Foot abduction brace (FAB) worn 23 hours/day for 3 months, then nights/naps until age 4–5
After casting, the foot abduction brace (Mitchell brace) is worn 23 hours/day for the first 3 months, then only during sleep until age 4–5 to prevent relapse, which is the most common complication.
Question 3: Tarsal coalition most commonly occurs between which bones?
- Navicular and cuboid
- Talus and cuboid
- Calcaneonavicular or talocalcaneal joints (Correct answer)
- First cuneiform and navicular
Correct answer: Calcaneonavicular or talocalcaneal joints
Calcaneonavicular coalition and talocalcaneal (middle facet) coalition together account for over 90% of all tarsal coalitions.
Question 4: At what age does tarsal coalition typically become symptomatic?
- Birth to 2 years
- 2–5 years
- 8–16 years (adolescence) (Correct answer)
- After age 25
Correct answer: 8–16 years (adolescence)
Tarsal coalition becomes symptomatic during adolescence (8–16 years) as the fibrocartilaginous or bony bridge ossifies and limits subtalar motion, causing pain and peroneal spasm.
Question 5: Kohler's disease is osteochondrosis (avascular necrosis) affecting which tarsal bone?
- Calcaneus
- Navicular (Correct answer)
- Talus
- Cuboid
Correct answer: Navicular
Kohler's disease is idiopathic avascular necrosis of the navicular, typically presenting in children ages 4–7 with medial midfoot pain and tenderness over the navicular.
Question 6: Sever's disease (calcaneal apophysitis) most commonly presents in which age group?
- 2–5 years
- 8–14 years (Correct answer)
- 15–18 years
- Adults over 20
Correct answer: 8–14 years
Sever's disease occurs most often in physically active children aged 8–14 during growth spurts when the Achilles tendon pulls on the unfused calcaneal apophysis.
Question 7: The 'anteater sign' on a lateral foot radiograph is associated with which condition?
- Talocalcaneal coalition
- Calcaneonavicular coalition (Correct answer)
- Tarsal tunnel syndrome
- Kohler's disease
Correct answer: Calcaneonavicular coalition
The 'anteater sign' refers to the elongated anterior process of the calcaneus that bridges toward the navicular, visible on lateral X-ray in calcaneonavicular coalition.
DPM Pediatric Podiatry 2
The standard Ponseti protocol for clubfoot typically requires how many weekly casting sessions before tenotomy?