PC Podiatrist Surgical & Non-Surgical Procedures 2 — Questions and Answers
Question 1: Which anesthetic technique is most appropriate for a digital nerve block of the hallux?
- Bier block
- Ankle block of the deep peroneal nerve only
- Web space injection with 1% lidocaine at the base of the toe (Correct answer)
- Spinal anesthesia
Correct answer: Web space injection with 1% lidocaine at the base of the toe
A digital nerve block of the hallux is performed by injecting local anesthetic at the medial and lateral bases of the toe to block the digital nerves.
Question 2: When performing a Lapidus procedure (first tarsometatarsal arthrodesis), the primary goal is to:
- Shorten the first metatarsal
- Correct hypermobility of the first ray contributing to hallux valgus (Correct answer)
- Fuse the first metatarsophalangeal joint
- Decompress the medial dorsal cutaneous nerve
Correct answer: Correct hypermobility of the first ray contributing to hallux valgus
The Lapidus procedure addresses first-ray hypermobility by fusing the first tarsometatarsal joint, correcting a key contributor to hallux valgus deformity.
Question 3: A patient presents with a Haglund's deformity. Which surgical approach best addresses both the retrocalcaneal bursitis and the bony prominence?
- Plantar fasciotomy
- Posterior calcaneal exostectomy with bursectomy (Correct answer)
- Achilles tendon lengthening
- Subtalar arthrodesis
Correct answer: Posterior calcaneal exostectomy with bursectomy
Posterior calcaneal exostectomy combined with bursectomy removes the prominent posterosuperior calcaneal ridge and the inflamed retrocalcaneal bursa.
Question 4: Which non-surgical treatment is the first-line recommendation for a mild plantar fasciitis case?
- Extracorporeal shock wave therapy
- Platelet-rich plasma injection
- Stretching exercises, orthotic support, and NSAIDs (Correct answer)
- Corticosteroid injection series
Correct answer: Stretching exercises, orthotic support, and NSAIDs
Conservative first-line management of plantar fasciitis includes stretching, arch support orthotics, and anti-inflammatory medications before advancing to invasive options.
Question 5: In a Weil osteotomy, the metatarsal head is repositioned by cutting the bone at approximately what angle relative to the weight-bearing surface?
- Perpendicular (90°)
- Parallel (0°)
- 20–25° angle from horizontal, parallel to the plantar surface (Correct answer)
- 45° angle
Correct answer: 20–25° angle from horizontal, parallel to the plantar surface
The Weil osteotomy uses a shallow oblique cut at roughly 20–25° from horizontal, allowing the metatarsal head to slide proximally and plantarly to decompress the metatarsophalangeal joint.
Question 6: Which complication is most specifically associated with the Austin/Chevron bunionectomy procedure?
- Avascular necrosis of the first metatarsal head (Correct answer)
- Tibial nerve entrapment
- Peroneus longus rupture
- Tarsal tunnel syndrome
Correct answer: Avascular necrosis of the first metatarsal head
Avascular necrosis of the first metatarsal head is a recognized complication of the Austin/Chevron osteotomy due to disruption of the dorsal blood supply.
Question 7: A patient with rheumatoid arthritis requires forefoot reconstruction. Which procedure most appropriately addresses panmetatarsalgia with multiple dislocated MTP joints?
- Selective cortisone injections at each MTP joint
- First MTP arthrodesis combined with lesser metatarsal head resection arthroplasty (Correct answer)
- Bilateral plantar fasciotomy
- Total ankle replacement
Correct answer: First MTP arthrodesis combined with lesser metatarsal head resection arthroplasty
Rheumatoid forefoot reconstruction typically combines first MTP arthrodesis for stability with resection arthroplasty of the lesser metatarsal heads to relieve plantar pressure.
PC Podiatrist Surgical & Non-Surgical Procedures 2
Which anesthetic technique is most appropriate for a digital nerve block of the hallux?