DEX IOT DAY TEST NEWEST ACTUAL

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DEX IOT DAY TEST NEWEST ACTUAL

EXAM 150 QUESTIONS AND CORRECT

DETAILED ANSWERS (VERIFIED ANSWERS)

|ALREADY GRADED A

1. What is flatfoot (pes planus)?: Collapse of the medial longitudinal arch due

to progression degeneration of the Posterior tibial tendon. If left untreated the deformity can advance into arthritis in the joints associated in the midfoot and hindfoot leading to fusion.

2. What is the function of the Posterior tibial tendon (PTT)?: Maintain the

talonavicular joint at the apex of the three arches.

3. How does the foot change as the disorder progresses?: It becomes more

rigid.

4. What other structures can be damaged due to tendon dysfunction?:

Spring ligament, talocalcaneal ligaments, deltoid ligament, plantar fascia, and other soft-tissue structures.

• What is necessary for the development of the characteristic planovalgus

deformity of AAFD?: Failure of multiple stabilizers, depressed plantar-flexed

talus bone, hindfoot and/or midfoot valgus, and an everted flattened forefoot.

6. What are the commonly used metrics for the longitudinal arch?: Meary

angle (A), calcaneal inclination angle (B), and calcaneal-fifth metatarsal angle (C).

7. What is mearys angle?: Angle between the long axis of the talus and the

long axis of the first metatarsal

8. What is the calcaneal inclination angle: Angle between the line at the

plantar calc surface and the horizontal plane

9. What is calc-5th metatarsal angel: Angle between the line at the plantar

surface and the line at the inferior 5th met shaft

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• What are the standard Meary angle (A), calcaneal inclination angle (B),

and calcaneal-fifth metatarsal angle (C).: 0 (Parallel), 20 - 30, 150-165

11. What is hindfoot valgus?: Abnormal outward angulation of the hindfoot.

12. What is forefoot abduction?: Abnormal outward angulation of the forefoot.

13. What is the talocalcaneal angle (kite angle)?: Angle between the line

bisecting the head and neck of the talus and the line parallel to the lateral surface of the calcaneus

14. What is the talus first metatarsal alignment axis?: Line drawn along the

long axis of the talus, extended into the forefoot, its orientation compared with that of the first metatarsal shaft

• What is the talonavicular angle?: Angle between the articular surface of the

talar head and the articular surface of the proximal navicular bone

16 What are the normal values for talocalcaneal angle (kite angle), talus first metatarsal alignment, talonavicular angle?: >25 - 40, Talar axis angled slightly lateral to 1st met shaft, parallel (0).

• What starts the path towards flat foot deformity?: Swelling or slight tear of

the PTT (Posterior Tibial Tendon). This is not enough to lead to substantial deformity on its own

18. How does injury to a persons PTT lead to flat foot?: The injured PTT leads

to increased strain on the other stabilizers of the ankle. This all combined can then lead to noticeable predictable deformity

19. What are the other stabilizers affected by flatfoot deformity?: Spring

ligament and talocalcaneal ligaments.

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20. What are the symptoms of stage I AAFD?: Posteromedial ankle pain, PTT

tenderness, decreased endurance.

21. Is alignment or function of the foot altered in stage 1 AAFD?: No, there

may be some swelling in patients with tenosynovitis however

22. What is tenosynovitis?: Inflammation of a tendon and its synovial sheath

23. Is tendon length normal in stage I AAFD?: Yes.

24. What is the treatment for stage I AAFD?: Conservative treatment with

medications, injections, and physical therapy.

25. When is tenosynovectomy needed for stage I AAFD?: For recalcitrant

disease.

26. What characterizes stage II AAFD?: Flexible deformity with diminished

space below the arch while weight bearing

27. What are the functional impairments in stage II AAFD?: Weakness of

inversion and inability to perform single-leg heel rise.

28. How is the single leg heel raise test for stage II AAFD performed?: Patient

stands on toes, first on both feet and then on a single foot.

• What do you see during the single leg heel raise test that confirms flat

foot?: Normally, the heel swings into varus position as it rises; when the PTT

is insufficient, the heel fails to invert or the patient is unable to perform the maneuver.

30. What happens to the heel in stage II disease during the test?: Heel fails

to invert or the patient is unable to perform the maneuver.

31. What is the rotational deformity in stage II disease?: Hindfoot and heel

valgus, mild in early stage II.

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32. What is the 'too many toes' sign in stage II disease?: Visualization of

more than one lateral toe from behind during weight bearing.

33. What are the three types of procedures for stage II disease?: Soft tissue,

bone, or both.

34 When are posterior tibial tendon débridement and reattachment options?:

If the native tendon is functional and salvageable.

35. What are the staples of soft-tissue repair in stage II disease?: Tendon

transfers using flexor hallucis longus or flexor digitorum longus tendon.

36. What can the transferred tendon do in soft-tissue repair?: Work along with

a diseased PTT or replace a completely torn one.

37. What are other soft-tissue procedures for stage II disease?: Augmentation

of the spring ligament and/or lengthening of the Achilles tendon.

38. What is medializing calcaneal osteotomy?: A procedure used to treat

AAFD by restoring Achilles alignment. Not usually done alone

39. What is the goal of a medializing calcaneal osteotomy?: Restores Achilles

alignment medial to the subtalar axis, allowing it to function as a hindfoot inverter, relieving strain on the native or reconstructed medial structures.

40. What is subtalar hyperpronation?: Excessive inward rolling of the foot.

41. How can subtalar hyperpronation be addressed?: With placement of a

subtalar implant.

42. When is medial column stabilization surgery necessary?: When the talus

bone is substantially uncovered.

• What are the commonly used procedures for medial column stabilization

surgery?: Talonavicular, navicular-cuneiform, and/or first tarsometatarsal

arthrodesis. (Lapidus Procedure)

• What is fixed dorsiflexion of the first ray?: When the first toe is stuck in a

bent position.

45. How can fixed dorsiflexion of the first ray be remedied?: With an opening

wedge osteotomy.

46. What is the purpose of an opening wedge osteotomy?: To re-create the

medial arch.

47. What is AAFD?: Acquired Adult Flatfoot Deformity.

48. What is a cotton osteotomy?: Medial Cuneiform opening wedge osteotomy.

Helps to create an arch in the foot

49. What is an Evans osteotomy?: Lateral column lengthening procedure in the

calcaneus