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8. Foot and Ankle MCQs

Practice Set 133 of 353

This practice set contains high-yield board review questions covering key concepts in 8. Foot and Ankle. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 2641

Topic: 8. Foot and Ankle

A 23-year-old woman with a history of bilateral recurrent ankle sprains, progressive cavovarus feet, and a family history of high arches and foot deformities is seen for evaluation. Management consisting of bracing and physical therapy has been poorly tolerated. Heel varus is partially corrected with a Coleman block. There are thick calluses under the first metatarsal heads. Sensation to touch and Weinstein monofilament is normal. Tibialis anterior and peroneus brevis are weak but present. What is the most appropriate management?

. Continued bracing, physical therapy, and Botox injections in the triceps surae
. Peroneus longus to brevis transfer, medializing calcaneal osteotomy, and transfer of the extensor digitorum longus to the peroneus tertius
. Peroneus longus to brevis transfer, and transfer of the posterior tibial tendon to the tibialis anterior tendon
. Peroneus longus to brevis transfer, first metatarsal cuneiform dorsal closing wedge osteotomy, and lateralizing calcaneal osteotomy with proximal translation
. Triple arthrodesis

Correct Answer & Explanation

. Peroneus longus to brevis transfer, first metatarsal cuneiform dorsal closing wedge osteotomy, and lateralizing calcaneal osteotomy with proximal translation

Explanation

The history and presentation are consistent with type I Charcot-Marie-Tooth (CMT), the most common form of hereditary peripheral motor sensory neuropathy. Type I CMT is the most common, occurring in 50% of patients with CMT, and is characterized by marked slowing of motor neuron velocities, and inconsistent slowing of sensory neuron velocities. Peroneus longus to brevis transfer is indicated to release the overpull of the peroneus longus, and restore the eversion and dorsiflexion function of the peroneus brevis. A lateralizing calcaneal osteotomy with proximal translation is indicated to correct heel varus given that the Coleman block only allows for partial correction of heel varus. Proximal translation of the posterior tuber corrects for the increased calcaneal dorsiflexion, improving the lever arm for the triceps surae. A medial column closing wedge osteotomy is often required to correct a rigid, or semirigid plantar flexed first ray to allow for a balanced, plantigrade foot. Triple arthrodesis is indicated for rigid, arthritic hindfoot deformities. Transfer of the posterior tibial tendon to the tibialis anterior is not indicated since it is an out-of-phase transfer. Transfer of the posterior tibial tendon, when performed, should be to the lateral aspect of the foot. A medializing calcaneal osteotomy would accentuate the heel varus. There is no indication for Botox in CMT; Botox injection of the calf would further weaken push-off during gait. Bracing of a progressive semirigid or rigid deformity is not recommended. Younger AS, Hansen ST Jr: Adult cavovarus foot. J Am Acad Orthop Surg 2005;13:302-315. Sammarco GJ, Taylor R: Cavovarus foot treated with combined calcaneus and metatarsal ostetotomies. Foot Ankle Int 2001;22:19-30.

Question 2642

Topic: 8. Foot and Ankle

Figures 20a and 20b show the radiographs of a 14-year-old boy who sustained a twisting injury to his ankle. If attempted closed reduction is unsuccessful, what is the primary reason to proceed with surgical treatment?

. Decreased risk of posttraumatic arthritis
. Avoid growth arrest
. Minimize risk of osteonecrosis
. Prevent clinical internal rotation deformity
. Prevent development of a late tarsal tunnel syndrome

Correct Answer & Explanation

. Decreased risk of posttraumatic arthritis

Explanation

Triplane fractures generally occur in children who are near skeletal maturity. The injury is generally caused by a supination external rotation mechanism. The number of fracture fragments present (two or three) depends on what part of the physes is closed at the time of injury. Articular congruity is the major concern in the management of these injuries since the patient has almost reached skeletal maturity. The goal is to restore articular congruity to minimize the development of posttraumatic arthritis. Vaccaro A (ed): Orthopaedic Knowledge Update 8. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2005, pp 757-765. Kling TF Jr, Bright RW, Hensinger RN: Distal tibial physeal fractures in children that may require open reduction. J Bone Joint Surg Am 1984;66:647-657.

Question 2643

Topic: 8. Foot and Ankle

Figures 8a through 8d show the radiographs and CT scans of a 14-year-old girl who has a painful, rigid planovalgus foot. Management consisting of arch supports and anti-inflammatory drugs failed to provide relief. A below-knee walking cast resulted in pain resolution, but she now reports that the pain has recurred. Management should now consist of

. custom orthotics.
. a below-knee non-weight-bearing cast.
. exploration and resection of the calcaneocuboid joint.
. exploration and resection of the talocalcaneal joint.
. triple arthrodesis.

Correct Answer & Explanation

. triple arthrodesis.

Explanation

Tarsal coalitions commonly present in the preadolescent age group as a rigid, planovalgus foot. Small coalitions of the calcaneonavicular joint or the middle facet of the talocalcaneal joint can be excised with interposition of fat or muscle tissue. Isolated calcaneocuboid joint coalitions are very rare. This patient has an associated large talocalcaneal coalition; therefore, resection is contraindicated. Surgery is warranted after failure of nonsurgical management, and because of the involvement of two joints, the only viable option for the severely symptomatic foot is triple arthrodesis. Vincent KA: Tarsal coalition and painful flatfoot. J Am Acad Orthop Surg 1998;6:274-281.

Question 2644

Topic: Midfoot & Hindfoot

A 40-year-old man with amyloidosis injured his left knee while walking. Figure 17a shows an AP radiograph that was obtained 2 weeks after the injury. The radiograph shown in Figure 17b was obtained after the patient wore a hinged knee brace for 3 months. A clinical photograph is shown in Figure 17c. What is the most likely diagnosis?

. Pyarthrosis
. Pigmented villonodular synovitis
. Synovial osteochondromatosis
. Charcot arthropathy
. Spontaneous osteonecrosis

Correct Answer & Explanation

. Charcot arthropathy

Explanation

The patient has a Charcot arthropathy of the knee, which is associated with amyloidosis. The rapid joint destruction shown in the radiographs is most consistent with that diagnosis. Drennan D, Fahey J, Maylahn D: Important factors in achieving arthrodesis of the Charcot knee. J Bone Joint Surg Am 1971;53:1180-1193. Soudry M, Binazzi R, Johanson N, et al: Total knee arthroplasty in Charcot and Charcot like joints. Clin Orthop 1986;208:199-204.

Question 2645

Topic: 8. Foot and Ankle

Figure 7 shows the CT scan of a 25-year-old soccer player who has had posterior ankle pain with plantar flexion for the past 2 years. Immobilization has failed to provide relief. He is ambulatory. Management should consist of

Foot & Ankle 2006 Practice Questions: Set 1 (Solved) - Figure 24

. a local steroid injection into the flexor hallucis longus tendon sheath.
. range-of-motion exercises.
. open reduction and internal fixation.
. nonsteroidal anti-inflammatory drugs.
. excision of the fragment.

Correct Answer & Explanation

. excision of the fragment.

Explanation

An os trigonum is usually asymptomatic, but this accessory bone has been associated with persistent posterior ankle pain, which has been described as os trigonum syndrome. This usually affects athletes and ballerinas. Forced plantar flexion leads to impingement of the os trigonum against the posterior tibial plafond, and flexor hallucis tendinitis may develop. It may be difficult to differentiate a fractured trigonal process from the os trigonum. MRI may reveal bone marrow edema that may aid in the diagnosis of os trigonum syndrome. Steroid injections may lead to tendon rupture. The results of excision of a symptomatic os trigonum through a posteromedial or lateral approach are favorable, with a rapid return to full function. The main complication of this procedure is sural nerve injury with a lateral approach. Hedrick MR, McBryde AM: Posterior ankle impingement. Foot Ankle Int 1994;15:2-8.

Question 2646

Topic: 8. Foot and Ankle

Figures 3a and 3b show the current radiographs of a 59-year-old woman who has pain and deformity after undergoing bunion surgery 1 year ago. Nonsurgical management has failed to provide relief. Treatment should now consist of

. revision first metatarsal osteotomy.
. medial soft-tissue release and lateral plication.
. metatarsophalangeal arthrodesis.
. transfer of the extensor hallucis longus tendon.
. reverse Akin osteotomy of the proximal phalanx.

Correct Answer & Explanation

. metatarsophalangeal arthrodesis.

Explanation

The hallux varus seen in this patient is most likely the result of a combination of causes. Based on the degenerative changes and the significant shortening of the first metatarsal relative to the second metatarsal, a metatarsophalangeal arthrodesis is the treatment of choice. The other surgical approaches are not expected to provide a satisfactory result. Coughlin MJ, Mann RA: Adult hallux valgus, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Mosby-Year Book, 2000, pp 150-269.

Question 2647

Topic: 8. Foot and Ankle

A 48-year-old man reports localized plantar forefoot pain. Examination reveals a discrete callus (intractable plantar keratosis) with well-localized tenderness beneath the second metatarsal head. The callus most likely lies beneath what structure?

. Lateral (fibular) condyle of the second metatarsal head
. Second metatarsophalangeal sesamoid
. Plantar condyle of the base of the proximal phalanx
. Exostosis of the plantar second metatarsal head
. Osteochondroma of the second metatarsal distal metaphysis

Correct Answer & Explanation

. Lateral (fibular) condyle of the second metatarsal head

Explanation

A discrete or focal callus is a response to excessive weight-bearing stress beneath the lateral (fibular) condyle of a lesser metatarsal head (most commonly second). The other structures generally have not been associated with a discrete callus. Coughlin MJ, Mann RA: Keratotic disorders of the plantar skin, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby-Year Book, 1993, pp 413-465.

Question 2648

Topic: 8. Foot and Ankle
A 6-year-old girl has the bilateral foot deformity shown in Figure 1. There is no family history of disease. Examination reveals fixed hindfoot equinus, and muscle function testing shows strong posterior tibial function, fair plus anterior tibial function, poor peroneal function, and strong gastrocnemius function. A Coleman block test shows a correctable hindfoot. Nerve conduction velocity studies show diminished function in the peroneal and ulnar nerves on both sides. Pathologic changes found in a sural nerve biopsy include "onion bulb" formation, and DNA testing confirms the presence of a mutation in the MPZ gene, consistent with hereditary motor sensory neuropathy type III (HMSN-III). What is the best course of action?
. Triple arthrodesis
. Midfoot closing wedge resection osteotomy
. Calcaneal and metatarsal osteotomies
. Plantar release, posterior tibial tendon transfer to the dorsum, and Achilles tendon lengthening
. Serial casting

Correct Answer & Explanation

. Calcaneal and metatarsal osteotomies

Explanation

The patient has HMSN-III or Dejerine-Sottas syndrome. This form of HMSN progresses very rapidly and frequently results in severe foot deformity in early childhood. The changes are progressive and are the result of muscle imbalance during growth. Balancing of the foot musculature is essential, particularly during the phases of rapid growth of the foot. However, this cannot be accomplished using the anterior tibial muscle because it is already weak and the transfer will further weaken it. Bony procedures also may be required, and tendon transfers cannot be depended on to correct bony deformity. However, these procedures can be deferred until the foot is closer to adult size. Surgeries that lead to joint arthrodesis, such as triple arthrodesis and some midfoot osteotomies, are contraindicated because the feet may lose protective sensation as the disease progresses. Fusions in insensate feet are less successful than realignment procedures that maintain mobility.

Question 2649

Topic: 8. Foot and Ankle

A 10-year-old boy reports a gradual onset of weakness; however, he is fully ambulatory. History reveals that he has a 17-year-old brother who has just stopped walking because of a similar condition. Laboratory studies show a creatine kinase level of 5,480 IU/L (normal 25 to 232 IU/L), and examination shows a slightly positive Gower sign. What is the most likely diagnosis?

. Spinal muscular atrophy, type II
. Myotonic dystrophy
. Duchenne muscular dystrophy
. Becker muscular dystrophy
. Hereditary motor sensory neuropathy, type II (HMSN)

Correct Answer & Explanation

. Becker muscular dystrophy

Explanation

The patient has Becker muscular dystrophy. Patients with this condition have a slower rate of progression of disease compared with patients who have Duchenne muscular dystrophy, and walking may continue into the late teens. The creatine kinase level is not as high as in Duchenne muscular dystrophy, which can range from 20,000 to 30,000 IU/L. Becker muscular dystrophy is allelic to Duchenne muscular dystrophy, resulting in a mutation in the dystrophin gene. Myotonic dystrophy is characterized by a progressive inability to relax the muscles after contracture. The Gower sign is not helpful in this disease. Patients with Charcot-Marie-Tooth disease, one type of which is also known as HMSN type II, do not have elevated creatine kinase levels and usually present with a foot deformity. Spinal muscular atrophy, type II, usually presents with severe weakness in the second year of life. Matsuo M: From molecular diagnosis to gene therapy. Brain Dev 1996;18:167-172. Darras BT: Molecular genetics of Duchenne and Becker muscular dystrophy. J Pediatr 1990;117:1-15.

Question 2650

Topic: 8. Foot and Ankle

An 11-year-old girl has had pain in the medial arch of her foot for the past 3 months. She reports that pain is present even with daily activities such as walking to class at school, and ibuprofen provides some relief. She denies any history of trauma. Examination reveals a flexible pes planus with focal tenderness over a prominent tarsal navicular tuberosity. Radiographs show a prominent accessory navicular. Management should consist of

Foot & Ankle 2006 Practice Questions: Set 1 (Solved) - Figure 30

. cast immobilization for 4 to 6 weeks.
. posterior tibial tendon advancement and repair (Kidner procedure).
. corticosteroid injection of the posterior tibial tendon insertion.
. triple arthrodesis.
. needle biopsy of the trochar.

Correct Answer & Explanation

. cast immobilization for 4 to 6 weeks.

Explanation

The patient has the classic symptoms, examination findings, and radiographs for a painful accessory navicular. Initial treatment should always be nonsurgical, specifically cast immobilization. Surgery should be reserved for those patients who fail nonsurgical management. Corticosteroids should not be injected into a posterior tibial tendon or insertion point because they can weaken the tendon and possibly cause tendon rupture. Triple arthrodesis and biopsy have no role in the management of a painful accessory navicular.

Question 2651

Topic: 8. Foot and Ankle

A 14-year-old girl has a painful hallux valgus deformity that has not responded to shoe modifications. Figure 21 shows a standing AP radiograph. What is the most appropriate surgical procedure?

Pediatrics 2007 Practice Questions: Set 3 (Solved) - Figure 1

. Distal soft-tissue realignment
. Distal first metatarsal osteotomy with distal soft-tissue realignment
. Proximal first metatarsal osteotomy with distal soft-tissue realignment
. Proximal and distal first metatarsal osteotomy
. Osteotomy of the proximal phalanx

Correct Answer & Explanation

. Proximal and distal first metatarsal osteotomy

Explanation

The radiograph reveals an increased first-second intermetatarsal angle and a congruent metatarsophalangeal joint with an abnormal distal metatarsal articular angle. Correction of both of these abnormalities requires a proximal and distal first metatarsal osteotomy. Coughlin M: Juvenile bunions, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp 297-339.

Question 2652

Topic: 8. Foot and Ankle

An 18-year-old gymnast has had a 1-year history of foot pain. Examination reveals medial midfoot tenderness without swelling. Non-weight-bearing in a cast for 6 weeks has failed to provide relief. An axial CT scan of the midfoot is shown in Figure 20. What is the optimal treatment for this condition?

Sports Medicine 2007 Practice Questions: Set 3 (Solved) - Figure 11

. Partial weight bearing in a walking cast for an additional 6 weeks
. Open reduction and internal fixation
. Open reduction and internal fixation with autologous bone grafting
. No treatment
. Non-weight-bearing in a cast for an additional 6 weeks

Correct Answer & Explanation

. Open reduction and internal fixation with autologous bone grafting

Explanation

Stress fractures of the navicular are often seen in running and jumping sports. Whereas most individuals heal with nonsurgical management consisting of 6 weeks of casting, this gymnast has had pain for 1 year and nonsurgical management has failed. Open reduction with bone grafting is the preferred treatment. Quirk RM: Stress fractures of the navicular. Foot Ankle Int 1998;19:494-496.

Question 2653

Topic: 8. Foot and Ankle

A 47-year-old man has an acute swollen, red, painful first metatarsophalangeal joint. He denies any history of similar symptoms. What is the first step in evaluation?

Foot & Ankle 2006 Practice Questions: Set 1 (Solved) - Figure 3

. Serum uric acid level studies and administration of indomethacin
. Administration of colchicine
. Administration of allopurinol
. Aspiration with evaluation of crystals, cell count, and culture
. Aspiration with evaluation of crystals and steroid injection

Correct Answer & Explanation

. Aspiration with evaluation of crystals, cell count, and culture

Explanation

The patient's symptoms are typical for gouty arthropathy, and the diagnosis can only be confirmed with aspiration and visualization of the crystals. A concomitant infection also must be ruled out; therefore, it is important to obtain a cell count and culture. Colchicine may have a role in gouty management, but the diagnosis must be confirmed. Allopurinol is not effective in acute gouty arthropathy. Measurement of serum uric acid levels is often not helpful in making a definitive diagnosis. Steroid injections should be deferred until cell count and culture results indicate no accompanying infection. Richardson EG (ed): Orthopaedic Knowledge Update: Foot and Ankle 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, pp 172-173.

Question 2654

Topic: 8. Foot and Ankle

A 50-year-old man reports the onset of back pain and incapacitating pain radiating down his left leg posterolaterally and into the first dorsal web space of his foot 1 day after doing some yard work. He denies any history of trauma. Examination reveals ipsilateral extensor hallucis longus weakness. MRI scans are shown in Figures 19a through 19c. What nerve root is affected?

. Left L4
. Right L4
. Left L5
. Right L5
. Left S1

Correct Answer & Explanation

. Left L5

Explanation

The MRI scans clearly show an extruded L4-5 disk that is affecting the L5 root on the left side. In addition, the L5 root has a cutaneous distribution in the first dorsal web space. S1 affects the lateral foot, and L4 affects the medial calf. An HS: Principles and Techniques of Spine Surgery. Baltimore, MD, Williams and Wilkins, 1998, pp 98-100.

Question 2655

Topic: Midfoot & Hindfoot

A 47-year-old woman has had medial ankle pain and swelling for the past 3 months. She recalls no specific injury, and casting and nonsteroidal anti-inflammatory drugs have failed to provide relief. Examination reveals a pes planus with heel valgus that is passively correctable. Radiographs show no evidence of arthritis. An MRI scan is shown in Figure 16. What is the most appropriate surgical procedure to alleviate her pain?

Foot & Ankle Board Review 2000: High-Yield MCQs (Set 2) - Figure 3

. Triple arthrodesis
. Isolated flexor digitorum longus transfer
. Flexor digitorum longus transfer with medial displacement calcaneal osteotomy
. Debridement and direct repair of the posterior tibial tendon
. Repair of the spring ligament

Correct Answer & Explanation

. Flexor digitorum longus transfer with medial displacement calcaneal osteotomy

Explanation

The patient has a stage II posterior tibial tendon tear with a supple foot; therefore, the treatment of choice is flexor digitorum longus transfer with medial displacement calcaneal osteotomy. Triple arthrodesis is not indicated, and isolated tendon transfer will stretch out in the face of persistent heel valgus. Direct repair of the posterior tibial tendon or repair of the spring ligament is not sufficient to correct the deformity. Myerson MS, Corrigan J: Treatment of posterior tibial tendon dysfunction with flexor digitorum longus tendon transfer and calcaneal osteotomy. Orthopedics 1996;19:383-388.

Question 2656

Topic: 8. Foot and Ankle

A 75-year-old woman began a walking program 2 months after undergoing right total knee arthroplasty. She had to stop the program after 4 weeks because of hindfoot pain and ankle swelling. Radiographs are shown in Figures 42a and 42b. What is the most likely diagnosis?

. Plantar fasciitis
. Osteochondral lesion of the talus
. Heel spur
. Insufficiency fracture of the calcaneus
. Chondrocalcinosis of the ankle joint

Correct Answer & Explanation

. Insufficiency fracture of the calcaneus

Explanation

It is often tempting to assign a diagnosis of plantar fasciitis in patients with hindfoot pain. In this patient, the radiographs confirm a diagnosis of a calcaneal insufficiency fracture. The dense condensation of bone on the lateral view confirms the diagnosis. There is no radiographic evidence of a heel spur, osteochondral lesions, or chondrocalinosis. Resnick D: Diagnosis of Bone and Joint Disorders, ed 3. Philadelphia, PA, WB Saunders, 1995, p 2591. Kearon C: Natural history of venous thromboembolism. Semin Vasc Med 2001;1:27-37.

Question 2657

Topic: 8. Foot and Ankle

Figures 45a through 45c show the radiograph, CT scan, and MRI scan of a 15-year-old boy who has lateral ankle pain. What is the most likely diagnosis?

. Stress fracture of the calcaneus
. Rupture of the plantar fascia
. Early traumatic arthritis of the subtalar joint
. Calcaneonavicular fibrous coalition
. Disruption of the os peroneum

Correct Answer & Explanation

. Calcaneonavicular fibrous coalition

Explanation

The elongated anterior process of the calcaneus reaching distally toward the navicular is an abnormal finding. Instead of viewing the rounded, blunt distal anterior process of the calcaneus, a bridge extends to the navicular, albeit incomplete. These findings are consistent with a fibrous coalition. CT can reveal a stress fracture of the calcaneus, arthritis of the subtalar joint with subchondral cysts, or an os peroneal bone disruption in the peroneus longus, but those entities are not shown here. The plantar fascia is intact. Richardson EG: Sesamoids and accessory bones of the foot, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Mosby, 1999, pp 702-732.

Question 2658

Topic: 8. Foot and Ankle

Figures 51a through 51c show the radiographs of a 7-year-old soccer player who reports a gradual onset of midfoot pain that began shortly after the start of soccer season. He states that the pain is worse with activity and is partially alleviated by rest. Examination reveals soft-tissue swelling, and tenderness and warmth in the region of the talonavicular and navicular cunieform joints. Management should consist of

. biopsy.
. curettage and bone grafting.
. open reduction and fixation.
. immobilization with a long leg cast and no weight bearing.
. immobilization with a short leg walking cast or fracture boot.

Correct Answer & Explanation

. immobilization with a short leg walking cast or fracture boot.

Explanation

Osteochondrosis of the tarsal navicular (Kohler disease) is an infrequent cause of midfoot pain in children, and the etiology is unknown. The typical radiographic findings include flattening and irregular ossification of the tarsal navicular. The medial cunieform and talus maintain their normal articular contours. The acute process is best treated with rest and immobilization. A short leg walking cast results in relief of pain and a quicker return to activity compared with orthotics, although long-term success is similar with either method of treatment. Children may return to activities when the symptoms subside. The radiographic appearance of the talus begins to normalize by about 8 to 10 months following the onset of symptoms.

Question 2659

Topic: 8. Foot and Ankle

A 42-year-old woman sustained a closed, displaced talar neck fracture in a motor vehicle accident. Which of the following is an avoidable complication of surgical treatment?

. Posttraumatic arthritis of the subtalar joint
. Posttraumatic arthritis of the ankle joint
. Malunion of the talus
. Osteonecrosis of the talus
. Complex regional pain syndrome

Correct Answer & Explanation

. Malunion of the talus

Explanation

Malunion of the talus is a devastating complication that leads to malpositioning of the foot and subsequent arthrosis of the subtalar joint complex. This is considered an avoidable complication in that accurate surgical reduction will minimize its development. Posttraumatic arthritis of the subtalar joint, osteonecrosis of the talus, posttraumatic arthritis of the ankle joint, and complex regional pain syndrome all may develop as a result of the initial traumatic event and may not be avoidable despite anatomic reduction. Rockwood and Green's Fractures in Adults, ed 5. Philadelphia, PA, Lippincott, Williams and Wilkins, 2001, pp 2091-2132.

Question 2660

Topic: 8. Foot and Ankle

Figures 23a and 23b show the radiograph and clinical photograph of a patient who reports a reduced ability to flex the interphalangeal joint of her great toe after undergoing a Chevron-Akin bunionectomy. What is the most likely cause?

. Interphalangeal joint arthritis
. Laceration of the flexor hallucis longus tendon
. Sesamoid entrapment
. Metatarsal malunion
. Phalangeal malunion

Correct Answer & Explanation

. Laceration of the flexor hallucis longus tendon

Explanation

The flexor hallucis longus tendon is at risk during a Chevron-Akin osteotomy because of its close relationship to the base of the proximal phalanx. The radiograph reveals a reduced ability to flex the interphalangeal joint secondary to the flexor hallucis longus laceration. The other complications are not supported by the radiograph. Tollison ME, Baxter DE: Combination chevron plus Akin osteotomy for hallux valgus: Should age be a limiting factor? Foot Ankle Int 1997;18:477-481.

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