Menu

8. Foot and Ankle MCQs

Practice Set 135 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 2681

Topic: Forefoot

A 13-year-old girl with hallux valgus reports pain after playing basketball. Radiographs show a hallux valgus angle of 20 degrees, an intermetatarsal angle of 11 degrees, a distal metatarsal articular angle of 10 degrees, and a congruent joint. Management should consist of

. shoe wear modification.
. proximal crescentic osteotomy with distal soft-tissue realignment.
. Mitchell osteotomy.
. chevron osteotomy.
. Keller procedure.

Correct Answer & Explanation

. shoe wear modification.

Explanation

Shoe wear modification is the most appropriate management based on the patient's age, high activity level, and relatively minor symptoms. She also has a mild hallux valgus. Normal radiographic measurements are an intermetatarsal angle of less than 9 degrees, a hallux valgus angle of less than 15 degrees, and a distal metatarsal articular angle of less than 9 degrees. Surgical procedures should be reserved for patients with more severe or progressive deformities. Stephens HM: Bunions, in Fitzgerald RH, Kaufer H, Malkani AL (eds): Orthopaedics. St Louis, MO, Mosby, 2002, pp 1510-1519.

Question 2682

Topic: 8. Foot and Ankle

Examination of a 12-year-old girl with a painful flatfoot deformity reveals tenderness in the region of the sinus tarsi and no appreciable subtalar motion. Radiographs are shown in Figures 48a through 48c. Two attempts to relieve her symptoms by cast immobilization fail to relieve the pain. Management should now consist of

. triple arthrodesis.
. manipulation of the foot under general anesthesia.
. continued nonsurgical management until the synchondrosis ossifies.
. resection of the coalition and interposition with the extensor digitorum brevis.
. a medial closing wedge osteotomy of the calcaneus.

Correct Answer & Explanation

. resection of the coalition and interposition with the extensor digitorum brevis.

Explanation

Surgical treatment is indicated for a symptomatic tarsal coalition that has failed to respond to nonsurgical management. In this patient, the radiographs reveal a calcaneonavicular coalition and no degenerative changes. The patient is symptomatic, and two attempts at use of a short leg walking cast have failed to provide relief. For calcaneonavicular coalitions, good results have been reported following resection and interposition of the extensor digitorum brevis. A retrospective study of this procedure achieved good to excellent results in 58 of 75 feet (77%). Degenerative arthritis or persistent pain following resection of a coalition is a reasonable indication for a triple arthodesis. A medial closing wedge osteotomy of the calcaneus may be indicated for a rigid flatfoot with severe valgus deformity. There are no studies documenting the long-term effectiveness of a manipulation under general anesthesia for this condition. Gonzalez P, Kumar SJ: Calcaneonavicular coalition treated by resection and interpostion of the extensor digitorum brevis muscle. J Bone Joint Surg Am 1990;72:71-77.

Question 2683

Topic: 8. Foot and Ankle

A 58-year-old woman sustained a ruptured Achilles tendon 1 year ago, and management consisted of an ankle-foot orthosis. She now reports increasing difficulty with ambulation and increasing pain. An MRI scan shows a 6-cm defect in the right Achilles tendon. Management should now consist of

. continued use of an ankle-foot orthosis.
. direct repair of the Achilles tendon.
. V-Y repair of the Achilles tendon.
. transfer of the plantaris tendon.
. Achilles tendon turndown with flexor hallucis longus tendon transfer.

Correct Answer & Explanation

. Achilles tendon turndown with flexor hallucis longus tendon transfer.

Explanation

With a gap of less than 4 cm, a V-Y repair would be appropriate without a tendon transfer. For gaps greater than 5 cm, a lengthening with augmentation is the most appropriate treatment. Therefore, the treatment of choice is an Achilles tendon turndown with flexor hallucis longus tendon transfer. The plantaris tendon is not a strong enough repair, and direct repair is not possible given the large defect in the Achilles tendon. Continued use of the ankle-foot orthosis will not provide adequate relief for this patient.

Question 2684

Topic: 8. Foot and Ankle

A 16-year-old boy has a symptomatic flatfoot deformity that is causing pain, skin breakdown, and shoe wear problems. Shoe modification and an orthosis have failed to provide relief. Examination reveals hindfoot valgus, talonavicular sag, and forefoot abduction that are all passively correctable. Treatment should consist of

Foot & Ankle Board Review 2000: High-Yield MCQs (Set 2) - Figure 11

. medial soft-tissue tightening.
. medial soft-tissue tightening with lateral column lengthening.
. medial soft-tissue tightening with talonavicular fusion.
. medial displacement osteotomy with flexor digitorum longus transfer into the tarsal navicular.
. triple arthrodesis with lateral column lengthening.

Correct Answer & Explanation

. medial soft-tissue tightening with lateral column lengthening.

Explanation

The patient has a supple planovalgus deformity that is passively fully correctable, and nonsurgical management has failed to provide relief. Lateral column lengthening with medial soft-tissue tightening will correct the deformity and maintain a flexible foot. Arthrodesis is not recommended for a supple, correctable deformity because of loss of motion and long-term degeneration of surrounding joints. Medial displacement calcaneal osteotomy is generally reserved for an adult-acquired flexible flatfoot. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 613-631. Evans D: Calcaneo-valgus deformity. J Bone Joint Surg Br 1975;57:270-278.

Question 2685

Topic: 8. Foot and Ankle

A 17-year-old high school football player injures his right ankle during a game. Examination reveals swelling and a closed ankle deformity, with normal foot circulation and sensation. Radiographs are shown in Figures 10a and 10b. In addition to closed reduction, management should include

. cast immobilization.
. delayed fixation of the medial malleolus.
. immediate fixation of the medial malleolus and plating of the fibula.
. immediate fixation of the medial malleolus, plating of the fibula, and placement of a syndesmotic screw.
. immediate fixation of the medial malleolus and placement of a syndesmotic screw.

Correct Answer & Explanation

. immediate fixation of the medial malleolus and plating of the fibula.

Explanation

The examination and radiographs reveal a closed fracture-dislocation of the ankle with tibiofibular diastasis. Immediate fixation of the medial malleolus and plating of the fibula are indicated. If residual tibiofibular diastasis occurs with lateral translation of the fibula after plating, a syndesmotic screw is placed to stabilize the syndesmosis. Ankle fracture-dislocations associated with a proximal fibular fracture (Maisonneuve fracture) require syndesmotic fixation, but the fibula is not plated. Unstable ankle fractures require surgical treatment. If swelling is severe (fracture blisters, loss of skin wrinkling), a compressive splint is applied and surgery is delayed for 5 to 7 days. Browner BD, Jupiter JB, Levine AM, Trafton PG: Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 1887-1957.

Question 2686

Topic: 8. Foot and Ankle

A 32-year-old woman has left second toe dactylitis (sausage toe). Radiographs show a "pencil in cup" distal interphalangeal joint deformity. Examination reveals that subtalar motion is markedly reduced. What is the most likely diagnosis?

Foot & Ankle 2006 Practice Questions: Set 1 (Solved) - Figure 35

. Rheumatoid arthritis
. Lyme disease
. Psoriatic arthritis
. Crohn's disease arthropathy
. Gout

Correct Answer & Explanation

. Psoriatic arthritis

Explanation

The patient's clinical picture is considered the classic presentation for psoriatic arthritis. The other answers are not applicable for the constellation of findings. Jahss MH: Disorders of the Foot and Ankle, ed 2. Philadelphia, PA, WB Saunders, 1991, pp 1691-1693.

Question 2687

Topic: 8. Foot and Ankle

An active 47-year-old woman with rheumatoid arthritis reports forefoot pain and deformity and has difficulty with shoe wear. Examination reveals hallux valgus and claw toes. A radiograph is shown in Figure 10. What is the most appropriate surgical treatment?

Foot & Ankle 2006 Practice Questions: Set 1 (Solved) - Figure 33

. Distal chevron osteotomy bunionectomy with lesser metatarsal head resections
. Proximal first metatarsal osteotomy with flexor-to-extensor tendon transfer for the lesser toes
. First metatarsophalangeal arthrodesis with lesser metatarsal head resections
. First tarsometatarsal realignment arthrodesis (Lapidus procedure) with flexor-to-extensor tendon transfer for the lesser toes
. Resection of the base of the hallux proximal phalanx (Keller procedure) with flexor-to-extensor tendon transfer for the lesser toes

Correct Answer & Explanation

. First metatarsophalangeal arthrodesis with lesser metatarsal head resections

Explanation

Rheumatoid arthritis commonly affects the metatarsophalangeal joints, which become destabilized with time resulting in hallux valgus and dislocated lesser claw toes. The result is metatarsalgia as the dislocated claw toes "pull" the fat pad distally. Severe hallux valgus reduces first ray load, which compounds the metatarsalgia because the load is transferred to the lesser metatarsal heads. First metatarsophalangeal arthrodesis restores weight bearing medially and corrects the painful bunion. Metatarsal head resection slackens the toe tendons to allow correction of the claw toes by whatever means necessary and decreases plantar load over the forefoot. Rheumatoid arthritis in the first metatarsophalangeal joint will continue to progress if osteotomies or a Lapidus procedure are performed. Keller resection arthroplasty increases transfer metatarsalgia and reduces push-off power during gait. Flexor-to-extensor tendon transfer of the lesser toes does not address the metatarsalgia and does not correct the dislocation of the metatarsophalangeal joint. Coughlin MJ: Arthritides, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Mosby, 1999, p 572.

Question 2688

Topic: 8. Foot and Ankle

A 42-year-old athletic trainer has a persistent popping sensation about the lateral ankle associated with weakness and pain following a remote injury. Deficiency in what structure directly leads to this pathology?

Anatomy 2008 Practice Questions: Set 1 (Solved) - Figure 15

. Lateral talar process
. Superior peroneal retinaculum
. Inferior peroneal retinaculum
. Extensor retinaculum
. Crural fascia

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

The patient has instability of the peroneal tendon. The superior peroneal retinaculum is the primary retaining structure preventing peroneal subluxation. It is a thickening of fascia that arises off the posterior margin of the distal 1 to 2 cm of the fibula and runs posteriorly to blend with the Achilles tendon sheath. The inferior peroneal retinaculum attaches to the peroneal tubercle of the calcaneus and is not involved in this pathology. A deficient groove in the posterior distal fibula may also be a contributing factor in the development of the condition.

Question 2689

Topic: 8. Foot and Ankle
A 37-year-old man with a history of congenital flatfoot reports worsening pain on the medial aspect of his ankle for the past year. The pain is worse with weight bearing and is better with rest and the use of an ankle brace. What findings are shown on the MRI scans shown in Figures 18a through 18c?
. The flexor digitorum longus tendon is ruptured.
. The posterior tibial tendon has a normal appearance.
. The posterior tibial tendon has a physiologic amount of fluid in its sheath.
. The posterior tibial tendon is completely ruptured and retracted (type III tear).
. The posterior tibial tendon has a chronic longitudinal split with enlargement (type II tear).

Correct Answer & Explanation

. The posterior tibial tendon has a chronic longitudinal split with enlargement (type II tear).

Explanation

The MRI scans reveal an enlarged posterior tibial tendon, with degenerative signal within the tendon and an excessive amount of fluid in its sheath. This is a type II tear, which is the most commonly seen tear.

Question 2690

Topic: 8. Foot and Ankle

A 38-year-old man underwent a transtibial amputation for chronic posttraumatic foot and ankle pain and chronic calcaneal osteomyelitis. Postoperative radiographs are seen in Figures 41a and 41b. What is the proposed purpose of the surgical modification seen in the radiographs?

. Reduces shrinkage of the residual limb
. Creates a more stable platform for load transfer
. Reduces wound healing complications by avoiding the soft-tissue dissection necessary to transect the fibula at a level proximal to the tibia
. Connecting bone strut provides an attachment point for more effective myodesis
. Allows a more proximal resection level to decrease tension on the wound

Correct Answer & Explanation

. Creates a more stable platform for load transfer

Explanation

The Ertl modification of a below-knee amputation has been proposed to create a more stable "platform" to aid in transferring the load of weight bearing between the residual limb and the prosthetic socket. It is felt that a stable platform allows total contact loading over an enlarged stable surface area. Early studies have suggested that this modification may enhance the patient's perceived functional outcome. Pinzur MS, Pinto MA, Saltzman M, et al: Health-related quality of life in patients with transtibial amputation and reconstruction with bone bridging of the distal tibia and fibula. Foot Ankle Int 2006;27:907-912.

Question 2691

Topic: 8. Foot and Ankle

Following ankle arthroscopy performed through a posterolateral portal, a patient notes numbness on the lateral half of the heel pad of the foot. What is the most likely injured structure?

. Sural nerve
. Lateral plantar nerve
. Lateral calcaneal nerve
. First branch of the lateral plantar nerve
. Deep peroneal nerve

Correct Answer & Explanation

. Lateral calcaneal nerve

Explanation

The lateral calcaneal nerve is a branch of the sural nerve that runs along the lateral border of the Achilles tendon to innervate the lateral heel pad. Ankle arthroscopy involves posterior portals that hug the Achilles tendon to avoid the main trunks of the sural nerve and tibial nerve; however, the lateral calcaneal branch remains potentially vulnerable. The first branch of the lateral plantar nerve is actually a medial structure that partially innervates the plantar fascia and the abductor digiti quinti. The deep peroneal nerve is anterior to the ankle. Sitler DF, Amendola A, Bailey CS, et al: Posterior ankle arthroscopy: An anatomic study. J Bone Joint Surg Am 2002;84:763-769.

Question 2692

Topic: 8. Foot and Ankle

A 7-year-old girl reports foot pain and has difficulty ambulating. History reveals that she fell off a scooter 1 week ago, and there is possible exposure to a tick bite. A radiograph is shown in Figure 29. What is the best course of action?

Foot & Ankle 2000 Practice Questions: Set 3 (Solved) - Figure 5

. Consultation with an infectious disease specialist
. Symptomatic treatment, with a full return to activities in 4 to 6 weeks
. Cast immobilization for 6 to 12 weeks with the expectation of full recovery
. A rheumatologic work-up with the expectation of significant long-term sequelae
. Bone biopsy

Correct Answer & Explanation

. Cast immobilization for 6 to 12 weeks with the expectation of full recovery

Explanation

The child has Kohler's disease. This is a self-limiting osteochondritis of the navicular. It is treated symptomatically with initial cast immobilization for 6 to 12 weeks, followed possibly by orthotic management. Findings shown in the radiograph usually will normalize within 1 year, and there are no long-term sequelae. Borges JL, Guille JT, Bowen JR: Kohler's bone disease of the tarsal navicular. J Pediatr Orthop 1995;15:596-598.

Question 2693

Topic: 8. Foot and Ankle

A 15-year-old boy with a type I hereditary sensory motor neuropathy (Charcot-Marie-Tooth disease) reports recurrent ankle sprains and significant pain in the hindfoot and midfoot despite orthotic management. Examination reveals that he walks with a drop foot and has dynamic clawing of the toes. Clinical photographs of the left foot are shown in Figure 7. Management should consist of

Pediatrics 2001 Practice Questions: Set 1 (Solved) - Figure 10

. revision of the current orthotics.
. metatarsal osteotomies to correct cavus.
. a sliding calcaneal osteotomy to correct hindfoot varus.
. triple arthrodesis, with anterior transfer of the posterior tibialis.
. extensor transfer to the metatarsal necks, soft-tissue releases, and anterior transfer of the posterior tibialis tendon.

Correct Answer & Explanation

. extensor transfer to the metatarsal necks, soft-tissue releases, and anterior transfer of the posterior tibialis tendon.

Explanation

The clinical photographs show a patient with a type I hereditary sensory motor neuropathy who has cavus feet with a flexible hindfoot. The Coleman block test shows that the hindfoot corrects into valgus. To prevent progressive cavus, patients with this condition may benefit from soft-tissue releases at a younger age while the foot is flexible. Once there is fixed deformity, combined soft-tissue and bone procedures usually are necessary. Metatarsal osteotomies will correct the cavus, but will do nothing for the drop foot. Transfer of the extensor hallucis longus to the neck of the first metatarsal and modified transfer of the extensor digitorum longus to the dorsum of the foot will prevent further claw toes and improve foot dorsiflexion. Anterior transfer of the posterior tibialis tendon will also aid in dorsiflexion. Calcaneal osteotomy should be reserved for fixed hindfoot varus that does not correct with block testing, and triple arthrodesis should be avoided as long as possible because the long-term outcome is poor. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, Ill, American Academy of Orthopaedic Surgeons, 1999, pp 235-245. Coleman SS: Complex Foot Deformities in Children. Philadelphia, Pa, Lea & Febiger, 1983, pp 147-165.

Question 2694

Topic: 8. Foot and Ankle
Figures 4a through 4c show the radiographs of a 43-year-old woman who sustained a twisting injury to her right ankle. She has ankle pain and tenderness medially and laterally. To help determine the optimal treatment, an external rotation stress radiograph of the ankle is obtained. This test is designed to evaluate the integrity of what structure?
. Posterior talofibular ligament
. Distal tibiofibular syndesmosis
. Anterior talofibular ligament
. Deltoid ligament
. Calcaneofibular ligament

Correct Answer & Explanation

. Deltoid ligament

Explanation

In the presence of a supination external rotation-type fracture of the distal fibula (Weber type B), stability of the ankle is best assessed by performing an external rotation stress AP view of the ankle. This test is used to assess the integrity of the deltoid ligament. The presence of a deltoid ligament rupture results in instability and generally is best managed surgically. The gravity stress test can also be used.

Question 2695

Topic: 8. Foot and Ankle

Figures 2a and 2b show the clinical photograph and radiograph of a 16-year-old cheerleader who fell on her left lower extremity while performing a pyramid. Following adequate sedation, closed reduction is performed, but an incomplete reduction is noted. What structure is most likely preventing a reduction?

. Extensor digitorum brevis
. Anterior talofibular
. Posterior tibial tendon
. Anterior tibial tendon
. Peroneus brevis tendon

Correct Answer & Explanation

. Peroneus brevis tendon

Explanation

The stretched peroneus brevis muscle and tendon follow anterior to the fibula and are most likely incarcerated with reduction. The anterior talofibular ligament is too small to prevent reduction of the ankle joint itself. The extensor digitorum brevis originates from the talus; therefore, it is not involved in the tibiotalar joint. The posterior tibial tendon lies medially and would not be interposed into the ankle joint. Similarly, the anterior tibialis tendon also would not be involved. Pehlivan O, Akmaz I, Solakoglu C, et al: Medial peritalar dislocation. Arch Orthop Trauma Surg 2002;122:541-543.

Question 2696

Topic: 8. Foot and Ankle

A 75-year-old woman reports foot pain and states that her foot has become progressively "flatter" in the past 3 years. Custom inserts and physical therapy have failed to provide relief. Examination reveals a flexible hindfoot and mild heel cord contracture. The patient is able to perform a single limb heel rise. Weight-bearing radiographs are shown in Figures 21a through 21d. What is the most appropriate surgical management?

. Posterior tibial tendon debridement and synovectomy
. Tendon transfer, spring ligament repair, and heel cord lengthening
. Tendon transfer, lateral column lengthening, and heel cord lengthening
. Realignment triple arthrodesis and heel cord lengthening
. Medial column arthrodesis and heel cord lengthening

Correct Answer & Explanation

. Medial column arthrodesis and heel cord lengthening

Explanation

The patient has end-stage midfoot arthritis, with a secondary flatfoot deformity through the midfoot. The ability to perform a single limb heel rise indicates that the posterior tibial tendon is functioning, and the weight-bearing radiographs show normal calcaneal pitch and talar head coverage, thus confirming that the flatfoot deformity is isolated to the midfoot. Therefore, the most appropriate treatment is medial column arthrodesis and heel cord lengthening. The other listed procedures are not indicated because they are used in the management of adult flatfoot from posterior tibial tendon insufficiency. Toolan BC: Midfoot arthrodesis: Challenges and treatment alternatives. Foot Ankle Clin 2002;7:75-93.

Question 2697

Topic: Forefoot

Examination of a 28-year-old woman reveals a moderate hallux valgus deformity and a prominence of the medial eminence. She reports that she can participate in all activities, wear 3-inch heels with minimal discomfort, and walk in a 1-inch heel with no pain. However, she is concerned that the deformity will get worse and requests recommendations regarding surgical correction. What is the best course of action?

. Hallux valgus correction
. Custom orthosis to prevent further deformity
. Observation only
. Steroid injection to decrease inflammation
. Extra-depth shoes

Correct Answer & Explanation

. Observation only

Explanation

Because the patient is essentially asymptomatic, the most appropriate course of action is observation. Prophylactic hallux valgus surgery is not medically indicated. Steroid injection would only risk infection, as well as joint and capsule damage. There are no data to support the use of a custom orthosis to delay the progression of a hallux valgus deformity. Special shoe wear or an extra-depth shoe is not necessary and is unlikely to be accepted by the patient. Donley BG, Tisdel CL, Sferra JJ, Hall JO: Diagnosing and treating hallux valgus: A conservative approach for a common problem. Cleve Clin J Med 1997;64:469-474.

Question 2698

Topic: 8. Foot and Ankle

The use of posting (a wedge added to the medial or lateral side of an insole) is useful to balance forefoot or hindfoot malalignment. Assuming normal subtalar joint pronation, what is the maximum amount of recommended hindfoot posting?

Foot & Ankle 2000 Practice Questions: Set 1 (Solved) - Figure 27

. 0 degrees
. 1 degree to 2 degrees
. Approximately 5 degrees
. Approximately 10 degrees
. 10 degrees to 15 degrees

Correct Answer & Explanation

. Approximately 5 degrees

Explanation

Generally, patients cannot tolerate more than 5 degrees of hindfoot posting. Donatelli RA, Hurlbert C, Conaway D, et al: Biomechanics foot orthotics: A retrospective study. J Orthop Sports Phys Ther 1988;10:205-212. Michaud TM: Foot Orthoses and Other Forms of Conservative Foot Care. Baltimore, MD, Williams & Wilkins, 1993, pp 61-65, 186.

Question 2699

Topic: 8. Foot and Ankle

A 47-year-old man sustained a degloving injury over the pretibial surface and anterior ankle region in a motor vehicle accident. After debridement and irrigation, there is inadequate tissue for closure of the exposed anterior tibial tendon and tibia. Prior to definitive soft-tissue coverage, management should consist of

. immediate split-thickness skin grafting.
. immediate Xenograft application.
. a vacuum-assisted closure device.
. dressing changes with sulfasalazine cream.
. a cross-leg flap.

Correct Answer & Explanation

. a vacuum-assisted closure device.

Explanation

With soft-tissue loss, local or free flap coverage may be necessary to treat exposed tendon and bone. However, a vacuum-assisted closure device is a good temporizing dressing. It prevents external contamination, reduces edema around the wound, increases oxygen tension in the wound, and promotes the formation of granulation tissue. The use of this negative pressure device has been described in both acute traumatic and in chronic wound scenarios. If sufficient granulation tissue forms, closure may be by split graft, avoiding a more complex coverage procedure. Immediate skin grafting over the exposed anterior tibial tendon and tibia would have a low likelihood of success. Dressing changes with sulfasalazine may be beneficial in a burn wound to assist with removal of skin slough; however, in a granulating wound, the material may be toxic to early epithelialization. Xenograft is a foreign body and should not be applied to an acute contaminated open wound. Historically, a cross-leg flap was a treatment alternative for lower extremity soft-tissue loss; however, its current applications are extremely limited. Webb LX: New techniques in wound management: Vacuum assisted wound closure. J Am Acad Orthop Surg 2002;10:303-311.

Question 2700

Topic: 8. Foot and Ankle
An 8-year-old boy with severe hemophilia A (factor VIII) and no inhibitor is averaging eight transfusions per month for bleeding into the right ankle. Examination shows synovial hypertrophy; range of motion consists of 0 degrees of dorsiflexion and 20 degrees of plantar flexion. The patient's knees, elbows, and left ankle have no restriction of motion. Standing radiographs of the right ankle are shown in Figure 18. Management should consist of
. prophylactic transfusions three times per week.
. application of ankle-foot orthoses.
. ankle synovectomy.
. ankle arthrodesis performed with physeal protection.
. pantalar arthrodesis.

Correct Answer & Explanation

. ankle synovectomy.

Explanation

The patient has bilateral hypertrophic synovitis that is causing repeated hemarthroses and progressive arthropathy. Ankle synovectomy in patients with hemophilia is effective in significantly reducing the rate of joint bleeding and in slowing the progression of the arthropathy; therefore, bilateral synovectomies is the treatment of choice. Range of motion can be effectively maintained after ankle synovectomy. Bracing and prophylactic transfusions would be ineffective at this time. Ankle arthrodesis should be reserved for patients with severe pain. Compared with patients who have juvenile rheumatoid arthritis, patients with hemophilia generally do not have involvement of the subtalar joint and rarely require a pantalar arthrodesis.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page