PC Treatment Planning & Management 3

Question 1

A patient with Type 2 diabetes has an ABI of 0.55 and a non-healing plantar ulcer. What is the next most critical step in treatment planning?

Accepted Answer

Refer for vascular evaluation and possible revascularization

Answer

Start systemic antibiotics and observe for 4 weeks

Answer

Apply total contact cast immediately

Answer

Perform bedside surgical debridement and discharge

Question 2

In planning surgical correction of a flexible hammertoe at the proximal interphalangeal joint (PIPJ), which procedure is most appropriate?

Accepted Answer

PIPJ arthrodesis with K-wire fixation

Answer

DuVries arthroplasty (condylectomy)

Answer

Jones tenosuspension

Answer

Girdlestone-Taylor flexor-to-extensor tendon transfer only

Question 3

Which total contact cast (TCC) application principle is most important to prevent iatrogenic ulceration in a neuropathic patient?

Accepted Answer

Using stockinette and felt padding to protect bony prominences before casting

Answer

Applying the cast with maximum pressure to limit edema

Answer

Applying fiberglass directly over the foot without padding

Answer

Leaving the heel exposed for wound monitoring

Question 4

A patient with gout has a first MPJ with acute swelling, erythema, and crystals confirmed on aspiration. Initial treatment should be:

Accepted Answer

Corticosteroid injection into the joint, oral colchicine or NSAIDs, and activity rest

Answer

Urate-lowering therapy (allopurinol) started immediately during the acute attack

Answer

Surgical excision of the tophus within 48 hours

Answer

Ice only with no pharmacologic treatment

Question 5

When planning a calcaneal osteotomy for symptomatic adult-acquired flatfoot, a medializing calcaneal osteotomy (Koutsogiannis) achieves correction by:

Accepted Answer

Shifting the calcaneal tuberosity medially to realign the Achilles pull under the tibia

Answer

Lengthening the lateral column of the foot

Answer

Fusing the subtalar joint

Answer

Transferring the flexor digitorum longus to the navicular

Question 6

For a patient with plantar fasciitis failing 6 months of conservative treatment, what is the most appropriate next intervention?

Accepted Answer

Extracorporeal shockwave therapy (ESWT)

Answer

Immediate surgical plantar fascia release

Answer

Repeat corticosteroid injection series (5 injections)

Answer

Casting in plantar flexion

Question 7

In managing a Charcot neuroarthropathy foot (Eichenholtz Stage I), the primary treatment goal is:

Accepted Answer

Immobilization to prevent further fragmentation and deformity progression

Answer

Surgical reconstruction of the arch immediately

Answer

Weight bearing as tolerated with supportive shoes

Answer

Amputation to prevent septic arthritis