PC Podiatrist Diagnosis & Treatment Methods 3 — Questions and Answers
Question 1: A patient with rheumatoid arthritis develops forefoot pain and metatarsalgia. Radiographs show metatarsophalangeal joint erosions and dorsal dislocation of the lesser toes. Which procedure addresses both the plantar fat pad displacement and the joint destruction?
- Pan-metatarsal head resection (Correct answer)
- Weil osteotomy alone
- Condylectomy only
- Moberg osteotomy
Correct answer: Pan-metatarsal head resection
Pan-metatarsal head resection removes all lesser metatarsal heads, relocating the plantar fat pad and eliminating painful erosive joints in rheumatoid forefoot.
Question 2: Which test is used to differentiate a tarsal coalition from other causes of peroneal spastic flatfoot in a pediatric patient?
- Harris-Beath axial radiograph (Correct answer)
- Silfverskiöld test
- Coleman block test
- Thompson squeeze test
Correct answer: Harris-Beath axial radiograph
The Harris-Beath (ski jump) axial radiograph provides the best plain film view of the subtalar joint to identify calcaneonavicular or talocalcaneal coalition.
Question 3: A patient on long-term fluoroquinolone therapy presents with acute Achilles tendon pain and swelling without trauma. Which physical examination finding best supports Achilles tendon rupture?
- Positive Mulder's click
- Positive Thompson (Simmonds) test (Correct answer)
- Positive Tinel's sign at the ankle
- Positive Homans' sign
Correct answer: Positive Thompson (Simmonds) test
The Thompson test (squeezing the calf with the patient prone) fails to plantarflex the foot when the Achilles tendon is ruptured.
Question 4: Which orthotic modification is indicated for a patient with a forefoot valgus deformity to prevent excessive supination during the propulsive phase of gait?
- Medial heel wedge
- Forefoot valgus post (Correct answer)
- Lateral heel flare
- Forefoot varus post
Correct answer: Forefoot valgus post
A forefoot valgus post (lateral wedge under the forefoot) corrects forefoot valgus by bringing the ground to the lateral forefoot, preventing supinatory compensation.
Question 5: A patient presents with numbness and burning in the third web space of the foot, worsened by tight footwear and relieved by removing shoes. Mulder's click is present. What is the diagnosis?
- Tarsal tunnel syndrome
- Morton's neuroma (interdigital neuroma) (Correct answer)
- Freiberg's infraction
- Intermetatarsal bursitis alone
Correct answer: Morton's neuroma (interdigital neuroma)
Morton's neuroma presents with web space pain/numbness, a palpable Mulder's click when compressing the forefoot, and is relieved by shoe removal.
Question 6: Which classification system is used to grade the severity of Charcot neuroarthropathy based on anatomic location in the foot?
- Wagner classification
- Brodsky classification (Correct answer)
- Texas University classification
- Sanders and Frykberg classification
Correct answer: Brodsky classification
The Brodsky classification categorizes Charcot neuroarthropathy by anatomic location (Types 1-3), with Type 1 (midfoot) being most common and prone to rocker-bottom deformity.
Question 7: What is the appropriate management for a Stage 0 (acute/active) Charcot neuroarthropathy with no deformity or ulceration?
- Immediate surgical reconstruction
- Total contact casting and non-weightbearing (Correct answer)
- Custom molded AFO and full weightbearing
- Corticosteroid injection
Correct answer: Total contact casting and non-weightbearing
Acute Charcot (Stage 0/I) requires total contact casting and offloading to prevent progressive bone destruction and deformity during the active inflammatory phase.
PC Podiatrist Diagnosis & Treatment Methods 3
A patient with rheumatoid arthritis develops forefoot pain and metatarsalgia.
Radiographs show metatarsophalangeal joint erosions and dorsal dislocation of the lesser toes.
Which procedure addresses both the plantar fat pad displacement and the joint destruction?