DPM Surgical Interventions & Procedures 2 — Questions and Answers
Question 1: Which osteotomy is most commonly used to correct a hallux valgus deformity at the first metatarsal shaft level?
- Lapidus procedure
- Scarf osteotomy (Correct answer)
- Keller arthroplasty
- Akin osteotomy
Correct answer: Scarf osteotomy
The scarf osteotomy is a long Z-shaped cut through the first metatarsal shaft that allows multiplanar correction of hallux valgus deformity.
Question 2: What is the primary indication for a Lapidus procedure in hallux valgus correction?
- Elevated intermetatarsal angle with hypermobility of the first ray (Correct answer)
- Isolated proximal phalanx deformity
- Hallux rigidus with arthrosis
- Tailor's bunion correction
Correct answer: Elevated intermetatarsal angle with hypermobility of the first ray
The Lapidus arthrodesis addresses hypermobility at the first tarsometatarsal joint, which is often the underlying cause of an elevated intermetatarsal angle.
Question 3: During an Achilles tendon repair, which suture technique is considered the gold standard for end-to-end tendon repair?
- Simple interrupted suture
- Kessler or modified Kessler technique (Correct answer)
- Figure-of-eight suture
- Running locked suture
Correct answer: Kessler or modified Kessler technique
The Kessler and modified Kessler suture techniques provide superior tensile strength for end-to-end Achilles tendon repairs compared to other methods.
Question 4: Which nerve is most at risk during a medial approach to the ankle for deltoid ligament repair?
- Sural nerve
- Superficial peroneal nerve
- Saphenous nerve and great saphenous vein (Correct answer)
- Deep peroneal nerve
Correct answer: Saphenous nerve and great saphenous vein
The saphenous nerve and great saphenous vein travel along the medial ankle and are at risk during medial approach incisions for deltoid ligament repair.
Question 5: A Dwyer calcaneal osteotomy corrects which deformity?
- Calcaneal valgus (planovalgus foot)
- Calcaneal varus (cavovarus foot) (Correct answer)
- Equinus deformity
- Calcaneal apophysitis
Correct answer: Calcaneal varus (cavovarus foot)
The Dwyer lateral closing wedge osteotomy removes a lateral wedge from the calcaneus to correct calcaneal varus in cavovarus foot deformities.
Question 6: What is the purpose of a gastrocnemius recession (Strayer procedure) in podiatric surgery?
- To lengthen the Achilles tendon at its insertion
- To selectively lengthen the gastrocnemius at the musculotendinous junction (Correct answer)
- To release the plantar fascia
- To correct hallux equinus
Correct answer: To selectively lengthen the gastrocnemius at the musculotendinous junction
The Strayer gastrocnemius recession selectively lengthens the gastrocnemius at its musculotendinous junction, preserving soleus function and reducing equinus contracture.
Question 7: Which approach provides the best exposure for subtalar joint arthrodesis?
- Anteromedial approach
- Sinus tarsi (lateral oblique) approach (Correct answer)
- Posterior approach
- Dorsomedial approach
Correct answer: Sinus tarsi (lateral oblique) approach
The sinus tarsi lateral oblique approach provides excellent visualization of the posterior and middle facets of the subtalar joint for arthrodesis preparation.
DPM Surgical Interventions & Procedures 2
Which osteotomy is most commonly used to correct a hallux valgus deformity at the first metatarsal shaft level?