PC Treatment Planning & Management 2 — Questions and Answers
Question 1: A diabetic patient with a Wagner Grade 2 foot ulcer has adequate perfusion. What is the most appropriate initial treatment approach?
- Immediate amputation
- Debridement, offloading, and antibiotics for clinical infection (Correct answer)
- Hyperbaric oxygen therapy only
- Topical antifungal application
Correct answer: Debridement, offloading, and antibiotics for clinical infection
Wagner Grade 2 ulcers (deep to tendon/capsule/bone without abscess) are managed with debridement, total contact casting for offloading, and antibiotics only if clinical infection is present.
Question 2: Which orthotic design is most appropriate for a patient with a flexible flatfoot and symptomatic posterior tibial tendon dysfunction (PTTD) Stage I?
- Accommodative orthosis with metatarsal pad
- Rigid functional orthosis with medial heel skive and deep heel cup (Correct answer)
- Toe spacer and padding only
- Carbon fiber full-length orthosis with lateral flange
Correct answer: Rigid functional orthosis with medial heel skive and deep heel cup
Stage I PTTD with flexible deformity is best managed with a functional orthosis incorporating a medial heel skive to supinate the subtalar joint and a deep heel cup for rearfoot control.
Question 3: A patient presents with recurrent ingrown toenails despite conservative care. The most definitive surgical option is:
- Winograd procedure (partial nail avulsion with matricectomy) (Correct answer)
- Nail debridement and packing
- Zadik procedure (total nail avulsion with complete matricectomy)
- Splinting with gutter splint only
Correct answer: Winograd procedure (partial nail avulsion with matricectomy)
The Winograd procedure, a partial nail avulsion with permanent chemical or surgical matricectomy of the offending border, is the standard definitive treatment for recurrent ingrown toenails.
Question 4: When treating Achilles tendinopathy with eccentric exercise, what protocol is most evidence-based?
- Alfredson protocol: 3 sets of 15 repetitions twice daily, 12 weeks (Correct answer)
- Concentric heel raises once daily for 2 weeks
- Static stretching only three times per week
- Isokinetic training at high velocity daily
Correct answer: Alfredson protocol: 3 sets of 15 repetitions twice daily, 12 weeks
The Alfredson eccentric loading protocol (3×15 reps with knee straight and bent, twice daily, 12 weeks) has the strongest evidence base for mid-portion Achilles tendinopathy.
Question 5: A patient with rheumatoid arthritis develops hallux valgus with lesser toe deformities causing painful metatarsal head pressure. The preferred surgical reconstruction is:
- Isolated first MPJ fusion only
- Keller bunionectomy with simple hammer toe correction
- Pan-metatarsal head resection with first MPJ arthrodesis (Correct answer)
- Chevron osteotomy alone
Correct answer: Pan-metatarsal head resection with first MPJ arthrodesis
In RA with pan-metatarsal involvement, pan-metatarsal head resection combined with first MPJ arthrodesis restores a balanced forefoot and relieves plantar pressure across all metatarsals.
Question 6: Which dressing type is most appropriate for a heavily exudating, non-infected chronic venous ulcer?
- Dry gauze changed every 24 hours
- Hydrocolloid occlusive dressing
- Alginate or foam dressing with compression therapy (Correct answer)
- Petroleum-impregnated gauze only
Correct answer: Alginate or foam dressing with compression therapy
Alginate or foam dressings absorb heavy exudate while maintaining a moist wound environment; compression therapy addresses the underlying venous hypertension driving the ulcer.
Question 7: A 14-year-old presents with heel pain worsening with activity. X-ray shows fragmentation of the calcaneal apophysis. The most appropriate treatment is:
- Surgical excision of the apophysis
- Immobilization in a cast for 6–8 weeks only
- Activity modification, heel lifts, stretching, and NSAIDs as needed (Correct answer)
- Corticosteroid injection into the growth plate
Correct answer: Activity modification, heel lifts, stretching, and NSAIDs as needed
Sever's disease (calcaneal apophysitis) is a self-limiting condition managed conservatively with activity modification, heel lifts to reduce Achilles tension, stretching, and anti-inflammatory measures.
PC Treatment Planning & Management 2
A diabetic patient with a Wagner Grade 2 foot ulcer has adequate perfusion.
What is the most appropriate initial treatment approach?