PC Podiatrist Surgical & Non-Surgical Procedures 3 — Questions and Answers
Question 1: Which tendon is most commonly transferred in a flexible hammertoe correction when there is a flexion contracture at the proximal interphalangeal joint?
- Extensor digitorum longus
- Flexor digitorum longus to extensor (Girdlestone-Taylor transfer) (Correct answer)
- Peroneus brevis
- Flexor hallucis brevis
Correct answer: Flexor digitorum longus to extensor (Girdlestone-Taylor transfer)
The Girdlestone-Taylor flexor-to-extensor tendon transfer redirects the flexor digitorum longus to act as an extensor, correcting the flexible flexion deformity at the PIP joint.
Question 2: During a subtalar joint arthroscopy, which portal is positioned adjacent to the sinus tarsi and provides access to the posterior facet?
- Anterolateral portal (Correct answer)
- Posteromedial portal
- Central posterior portal
- Anteromedial portal
Correct answer: Anterolateral portal
The anterolateral portal of the subtalar joint is placed at the sinus tarsi and allows visualization of the posterior facet, the most commonly accessed area in subtalar arthroscopy.
Question 3: A patient with a symptomatic tarsal coalition between the calcaneus and navicular is best treated non-surgically with:
- Arch taping and corticosteroid injection
- Short leg cast immobilization for 4–6 weeks combined with orthotics (Correct answer)
- Physical therapy focusing on subtalar mobilization
- Night splinting in dorsiflexion
Correct answer: Short leg cast immobilization for 4–6 weeks combined with orthotics
Initial conservative management of calcaneonavicular coalition includes immobilization in a short leg cast to reduce pain and inflammation, followed by custom orthotic support.
Question 4: Which structure is at highest risk of injury during endoscopic plantar fasciotomy?
- Posterior tibial artery
- Lateral plantar nerve and its branches (Correct answer)
- Achilles tendon insertion
- Sural nerve
Correct answer: Lateral plantar nerve and its branches
The lateral plantar nerve and its first branch (nerve to the abductor digiti minimi) run close to the medial calcaneal tuberosity and are vulnerable during endoscopic plantar fasciotomy.
Question 5: A Cotton osteotomy is performed on which bone, and for what primary deformity correction?
- First metatarsal; metatarsus primus elevatus
- Medial cuneiform; forefoot varus or plantarflexion of the medial column (Correct answer)
- Navicular; pes planus arch elevation
- Calcaneus; heel valgus correction
Correct answer: Medial cuneiform; forefoot varus or plantarflexion of the medial column
The Cotton osteotomy is an opening wedge osteotomy of the medial cuneiform used to plantarflex the medial column and correct forefoot varus in flatfoot reconstruction.
Question 6: In treating an ingrown toenail with a chemical matrixectomy, which chemical agent is most commonly used to ablate the nail matrix?
- Trichloroacetic acid (TCA)
- Phenol (88%) (Correct answer)
- Silver nitrate
- Hydrogen peroxide
Correct answer: Phenol (88%)
88% phenol is the standard chemical agent applied to the nail matrix following partial nail avulsion to permanently destroy the matrix cells and prevent regrowth.
Question 7: A patient develops complex regional pain syndrome (CRPS) after bunion surgery. Which early intervention is most appropriate?
- Repeat surgical exploration
- Multidisciplinary pain management including physical therapy and sympathetic nerve blocks (Correct answer)
- Prolonged immobilization in a cast
- Oral corticosteroid taper only
Correct answer: Multidisciplinary pain management including physical therapy and sympathetic nerve blocks
Early CRPS management requires a multidisciplinary approach including physical therapy for desensitization and sympathetic nerve blocks to interrupt the pain cycle.
PC Podiatrist Surgical & Non-Surgical Procedures 3
Which tendon is most commonly transferred in a flexible hammertoe correction when there is a flexion contracture at the proximal interphalangeal joint?