Professional Documents
Culture Documents
A 42 year-old athletic female presents with the mass shown on the photograph. The mass
developed six months ago, is painful with activity and has been getting larger. An attempt at
aspiration failed to withdraw fluid.
Correct Answer: B
Suggested Reading:
Blume PA, Moore JC, Novicki DC. Digital mucoid cyst excision by using the bilobed flap
technique and arthroplastic resection. J Foot Ankle Surg. Jan-Feb 2005;44(1):44-8
1
ABPOPPM In-Training Exam
Radiographs of a 45 year-old male who is status-post motor vehicle accident, with multiple
fractures of the lower extremity, are shown.
A. Tension band
B. Lag screw
C. Crossed Kirschner wire
D. Dynamic compression plate
E. Neutralization plate
Correct Answer: A
Suggested Reading:
Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the
patella. J Bone Joint Surg Br. Nov 2003;85(8):1155-60
2
ABPOPPM In-Training Exam
A 44 year-old male who underwent fasciotomy of the forearm for compartment syndrome
following a motor vehicle accident is returned to the OR 48 hours later for repair of the
fasciotomy, as shown in the photograph.
Correct Answer: B
Suggested Reading:
Feliciano DV, Cruse PA, Spjut-Patrinely V, et al. Fasciotomy after trauma to the extremities. Am
J Surg. Dec 1988;156(6):533-6
Sheridan GW, Matsen FA 3rd. Fasciotomy in the treatment of the acute compartment
syndrome. J Bone Joint Surg Am. Jan 1976;58(1):112-5
3
ABPOPPM In-Training Exam
While performing surgical correction of brachymetatarsia with iliac bone autograft, the bone graft
is dropped on the operating room floor.
Which of the following is the most appropriate treatment of the graft prior to insertion into the
surgical site?
A. Autoclave sterilization
B. Rinsing in copious sterile saline solution for 15 minutes
C. Flash freezing
D. Soaking in iodine solution for 15 minutes
E. Rinsing in sequential dilutions of antimicrobial solution
Correct Answer: E
Suggested Reading:
Joseph WS, Kosinski MA. Prophylaxis in lower-extremity infectious diseases. Clin Podiatr Med
Surg. Oct 1996;13(4):647-60
Clemens MW, Parikh P, Hall MM, Attinger CE. External fixators as an adjunct to wound
healing. Foot Ankle Clin. Mar 2008;13(1):145-56
4
ABPOPPM In-Training Exam
A 63 year-old patient with DM1 has undergone transmetatarsal amputation for ischemic
ulcerations of the digits.
Which of the following types of postoperative contractures must be planned for peri-operatively?
A. Forefoot/midfoot varus
B. Ankle equinus
C. Forefoot/midfoot valgus
D. Knee flexion
E. Dropfoot
Correct Answer: B
Suggested Reading:
Bevilacqua NJ, Rogers LC, DellaCorte MP, Armstrong DG. The narrowed forefoot at 1 year: an
advanced approach for wound closure after central ray amputations. Clin Podiatr Med
Surg. Jan 2008;25(1):127-33
Murdoch G, Wilson AB Jr, eds. Amputation: Surgical Practice and Patient Management. St
Louis, Mo: Butterworth-Heinemann Medical; 1996
5
ABPOPPM In-Training Exam
This is a three month post-operative radiograph of a 29 year-old male who sustained a Weber
type B ankle fracture that was treated with ORIF using two cortical screws as shown.
A. Normal healing
B. Delayed union
C. Syndesmostic widening
D. Soft tissue calcification
E. Screw loosening
Correct Answer: C
Suggested Reading:
Tandeter HB, Shvartzman P. Acute ankle injuries: clinical decision rules for radiographs. Am
Fam Physician. Jun 1997;55(8):2721-8
Clanton TO, Porter DA. Primary care of foot and ankle injuries in the athlete. Clin Sports
Med. Jul 1997;16(3):435-66
6
ABPOPPM In-Training Exam
A 45 year-old female presents with an iatrogenic hallux varus, as shown on the radiograph.
Correct Answer: A
Suggested Reading:
Vanore JV, Christensen JC, Kravitz SR, et al. Diagnosis and treatment of first
metatarsophalangeal joint disorders. Section 3: hallux varus. J Foot Ankle Surg. May-
Jun 2003;42(3):137-42
Lagaay PM, Hamilton GA, Ford LA, Williams ME, Rush SM, Schuberth JM. Rates of revision
surgery using Chevron-Austin osteotomy, Lapidus arthrodesis, and closing base wedge osteotomy
for correction of hallux valgus deformity. J Foot Ankle Surg. Jul-Aug 2008;47(4):267-72
7
ABPOPPM In-Training Exam
An 82 year-old female with rheumatoid arthritis is scheduled to undergo pan metatarsal head
resection with first MTP joint arthrodesis. DEXA scan densitometry testing is obtained which
confirms severe osteoporosis. Radiograph is shown.
A. Infection
B. Delayed bone healing
C. Hematoma
D. Hallux varus
E. Failure of fixation
Correct Answer: E
Suggested Reading:
Brunner CF, Weber BG. Special Techniques in Internal Fixation. Berlin: Springer-Verlag;. 1982
Muller ME, Allgower JM, Schneider R, Willenegger H. Manual of Internal Fixation, 3rd
ed. Berlin: Springer-Verlag;. 1992
8
ABPOPPM In-Training Exam
While performing a lateral release during hallux valgus surgery the tendon of the first dorsal
interosseous muscle is severed.
Correct Answer: A
Suggested Reading:
Bouché RT, Heit EJ. Combined plantar plate and hammertoe repair with flexor digitorum longus
tendon transfer for chronic, severe sagittal plane instability of the lesser metatarsophalangeal
joints: preliminary observations. J Foot Ankle Surg. Mar-Apr 2008;47(2):125-37
Trnka HJ, Gebhard C, Muhlbauer M, et al. The Weil osteotomy for treatment of dislocated lesser
metatarsophalangeal joints: good outcome in 21 patients with 42 osteotomies. Acta Orthop
Scand. Apr 2002;73(2):190-4
9
ABPOPPM In-Training Exam
Based on the suspected diagnosis, which of the following is indicated at this time?
Correct Answer: D
Suggested Reading:
Banks AS, Downey MS, Martin DE, Miller S, eds. McGlamry's Comprehensive Textbook of
Foot and Ankle Surgery. 3rd ed. New York: Lippincott, Williams & Wilkins; 2001
Gerbert J, ed. Textbook of Bunion Surgery. 2nd ed. Mt Kisco, NY: Futura Publishing
Company;. 1991
10
ABPOPPM In-Training Exam
A 32 year-old male with DM2 returns to the ED 72 hours following I&D of a deep space
infection. The wound had been packed open to enable daily local wound care. The patient has
noticed significant bleeding from the surgical site after bearing full weight on the foot.
Examination reveals arterial pulsatile bleeding. Pre-operative total Hgb was 11g/dl. After
surgical repair of the acute arterial bleed Hgb is noted to be 7.8 g/dl.
A. Dextran
B. 0.9 percent sodium chloride solution (normal saline: NS)
C. Fresh frozen plasma
D. Packed red blood cells
E. Observation for 48 hours
Correct Answer: D
Suggested Reading:
Dutton RP, Carson JL. Indications for early red blood cell transfusion. J
Trauma. Jun 2006;60:S35-S40
Isbister JP. Blood Component Therapy. In: Fink MP, Abraham E, Vincent JL, Kochanek
PM. Textbook of Critical Care. Philadelphia: Elsevier Saunders; 2005:1427-1435
11
ABPOPPM In-Training Exam
These are the radiographs of a 26 year-old male, in good health, who presented to the ED 30
minutes after a gunshot wound to the right foot. A 2.0 cm. entrance wound is located on the
dorsum of the first MTP joint.
Initial care for the patient should include all the following EXCEPT:
Correct Answer: B
Suggested Reading:
Pfaff JA, Moore GP. Reducing risk in emergency department wound management. Emerg Med
Clin North Am. Feb 2007;25(1):189-201
Resnick CD, Fallat LM. Puncture wounds: therapeutic considerations and a new classification. J
Foot Surg. Mar-Apr 1990;29(2):147-53
12
ABPOPPM In-Training Exam
A three year-old female is presented with a parental complaint of wide feet that do not fit into any
shoes. Radiographs are obtained. The fourth intermetatarsal angle is measured at 23 degrees.
Correct Answer: C
Suggested Reading:
Ajis A, Koti M, Maffulli N. Tailor's bunion: a review. J Foot Ankle Surg. May-
Jun 2005;44(3):236-45
Cohen BE, Nicholson CW. Bunionette deformity. J Am Acad Orthop Surg. May 2007;15(5):300-
7
13
ABPOPPM In-Training Exam
A 52 year-old female presents with a three month history of pain and swelling about the medial
aspect of the ankle. She denies any history of trauma.
Examination reveals:
• the patient is able to perform single limb raises on the painful extremity
• full subtalar and ankle joint ranges of motion of the are available without pain or
crepitation
• tenderness upon palpation along the course of the tibialis posterior tendon, both posterior
and inferior to the medial malleolus
• plain radiographs are normal
• MRI identifies longitudinal tearing with tendinosis as shown
A. Triple arthrodesis
B. Subtalar joint arthrodesis
C. Cast immobilization for 8-12 weeks
D. Flexor digitorum longus tendon transfer
E. Synovectomy and primary repair of the tibialis posterior tendon
Correct Answer: C
Suggested Reading:
Anzilotti K Jr, Schweitzer ME, Hecht P, Wapner K, Kahn M, Ross M. Effect of foot and ankle
MR imaging on clinical decision making. Radiology. Nov 1996;201(2):515-7
Erickson SJ, Johnson JE. MR imaging of the ankle and foot. Radiol Clin North
Am. Jan 1997;35(1):163-92
Feighan J, Towers J, Conti S. The use of magnetic resonance imaging in posterior tibial tendon
dysfunction. Clin Orthop Relat Res. Aug 1999;(365):23-38
14
ABPOPPM In-Training Exam
A 62 year-old male with rheumatoid arthritis suffered the ulceration shown secondary to an
episode of acute vasculitis. After treatment of the vasculitis with steroids, surgical debridement is
planned, with application of a Vacuum Assisted Closure (VAC) device.
Correct Answer: A
Suggested Reading:
Singh N, Armstrong DG, Lipsky BA. Preventing Foot Ulcers in Patients With Diabetes. JAMA
2005;293:217-28
Armstrong DG, Lavery LA; Diabetic Foot Study Consortium. Negative pressure wound therapy
after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet
2005;366: 1704-10
15
ABPOPPM In-Training Exam
The patient whose radiographs are shown is scheduled for ORIF of the fracture. Past medical
history is significant for a prior anaphylactic reaction to penicillin, requiring resuscitation.
A. Cephalexin (Keflex) 2g IV
B. Clindamycin (Cleocin) 600mg IV
C. Metronidazole (Flagyl) 500mg IV
D. Ticarcillin/clavulanate (Timentin) 3.1g IV
E. Ciprofloxacin (Cipro) 500mg IV
Correct Answer: B
Suggested Reading:
A report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect
Control 1996;24:380-8
16
ABPOPPM In-Training Exam
A 27 year-old male presents three months after "twisting his foot in a hole". Initial radiographs
were read as unremarkable. He is still symptomatic at the base of the first metatarsal. Repeat
radiographs are as shown.
Correct Answer: C
Suggested Reading:
Bennell, K. L., S. A. Malcolm, S. A. Thomas, et al. Risk factors for stress fractures in track and
field athletes. A twelve-month prospective study. Am. J. Sports Med. 24:810-818, 1996
Mulier T, Reynders P, Sioen W, van den Bergh J, de Reymaeker G, Reynaert P, Broos P The
Treatment of Lisfranc Injuries Acta Orthopaedica Belgica 63(2):82-90, 1997 Jun
17
ABPOPPM In-Training Exam
Correct Answer: C
Bellew SG, Quartarolo N, Janniger CK. Childhood warts: an update. Cutis. 2004;73:379-384
18
ABPOPPM In-Training Exam
Which of the following intravenous solutions is recommended for the peri-operative care of an
otherwise healthy surgical patient undergoing elective appendectomy?
Correct Answer: A
Suggested Reading:
Rahbari NN, Zimmerman JB, Schmidt T, et al: Meta-analysis of standard, restrictive, and
supplemental fluid administration in colorectal surgery. Br J Surg 96:331, 2009
Kehlet H, Wilmore DW: Evidence-based surgical care and the evolution of fast track surgery.
Ann Surg 248:189, 2008
19
ABPOPPM In-Training Exam
Correct Answer: C
Suggested Reading:
Miller WE, Lichtblau PO: The smashed heel. South Med J 58:1229-1237, 1965
Miller WE: Pain and impairment considerations following treatment of disruptive os calcis
fractures. Clin Orthop 177:82-86, 1983
20
ABPOPPM In-Training Exam
While on general surgery rotation, orders are being written for post-operative care of a patient
who underwent exploratory laparotomy.
Correct Answer: D
Suggested Reading:
Brandt LJ, Prather CM, Quigley EMM, et al. Systematic review on the management of
constipation in North America. Am J Gastroenterol 2005;100(Suppl 1):S5-22
Hamilton JW, Wagner J, Burdick BB, et al. Clinical evaluation of methylcellulose as a bulk
laxative. Dig Dis Sci 1988;33:993-8
21
ABPOPPM In-Training Exam
Which of the following characterizes the full thickness (third degree) burn on his leg?
Correct Answer: D
Suggested Reading:
Feller I, Tholen D, Cornell RG. Improvements in burn care, 1965 to 1979. JAMA
1980;244:2074-78
Greenbaum AR, Horton JB, Williams CJ, et al. Burn injuries inflicted on children or the elderly: a
framework for clinical and forensic assessment. Plast Reconstr Surg 2006;118:46-58
22
ABPOPPM In-Training Exam
This is a lateral radiograph of a 14 year-old female being worked up for surgical correction of a
flexible flat foot deformity.
A. Talonavicular joint
B. Naviculocuneiform joint
C. Cuneiform first metatarsophalangeal joint (MTPJ)
D. Calcaneocuboid joint
E. Ankle joint
Correct Answer: A
Suggested Reading:
Evans AM. The flat-footed child -- to treat or not to treat: what is the clinician to do?. J Am
Podiatr Med Assoc. Sep-Oct 2008;98(5):386-93
Cohen BE, Ogden F. Medial column procedures in the acquired flatfoot deformity. Foot Ankle
Clin. Jun 2007;12(2):287-99, vi.
23
ABPOPPM In-Training Exam
This is the radiograph of a 53 year-old female complaining of a painful, stiff, first MTP joint that
has been developing over the past three to five years. Ten years previously she underwent "some
type of surgery for arthritis" in her great toe.
Which of the following best describes the cause of silicone hemi-implant failure in this patient?
Correct Answer: C
Suggested Reading:
Vanore, J.V., O'Keefe, R.G., and Pikscher, I.: Silastic Implant Arthroplasty: Complications and
Their Classification. J. Amer. Podiatry Assoc. Vol. 74, No. 9, 423-433, 1984
Vanore, J.V and Montross, W..: Chapter --: First MTP joint implants, In McGlamry’s
Comprehensive Textbook of Foot and Ankle Surgery, 4th Edition, Lippincott Williams &
Wilkins., New York, expected publication 2009
24
ABPOPPM In-Training Exam
These are the radiographs of a 32 year-old long distance runner who sustained an intra-articular
fracture of the first proximal phalanx as shown.
Correct Answer: D
Suggested Reading:
Muller ME, Allgower JM, Schneider R, Willenegger H. Manual of Internal Fixation, 3rd
ed. Berlin: Springer-Verlag;. 1992
First Ray Injuries ;John D. Maskill, Donald R. Bohay, John G. Anderson;Foot and Ankle Clinics
March 2006 (Vol. 11, Issue 1, Pages 143-163)
25
ABPOPPM In-Training Exam
A 44 year-old farmer presents to the ED four hours after sustaining a degloving injury while
working on his tractor. He is diaphoretic with a pulse rate of 84 BPM. His oral temperature is
37.4 degrees C. No osseous damage is present.
Correct Answer: C
Suggested Reading:
Prakash Chandran, Ravindra Puttaswamaiah, Mandeep Singh Dhillon, Shivender Singh Gill;
Management of Complex Open Fracture Injuries of the Midfoot With External FixationJournal of
Foot and Ankle Surgery September 2006 (Vol. 45, Issue 5, Pages 308-315)
James L. Thomas, Edwin L. Blitch, D. Martin Chaney, Kris A. Dinucci, Kimberly Eickmeier,
Laurence G. Rubin, Mickey D. Stapp, John V. Vanore, Diagnosis and Treatment of Forefoot
Disorders. Section 5. Trauma Clinical Practice Guideline Forefoot Disorders Panel ;Journal of
Foot and Ankle Surgery March 2009 (Vol. 48, Issue 2, Pages 264-272)
26
ABPOPPM In-Training Exam
Which of the following complications would you discuss with her preoperatively specific to the
anatomy in the surgical area?
Correct Answer: A
Suggested Reading:
Salasche SJ, Bernstein G, Senkarik M, eds. Surgical Anatomy of the Skin. Norwalk,
Conn: Appleton & Lange; 1988
Levitsky KA, Alman BA, Jevsevar DS, Morehead J. Digital nerves of the foot: anatomic
variations and implications regarding the pathogenesis of interdigital neuroma. Foot
Ankle. May 1993;14(4):208-14
27
ABPOPPM In-Training Exam
An 82 year-old male is unable to walk comfortably due to the recurrent lesion shown. Orthotics
have not been sufficient in restoring him to his normal activity level. Medical history is positive
for hypertension and osteoporosis. The remainder of his medical history is unremarkable and
non-contributory.
Which of the following is the most appropriate surgical choice for this patient?
Correct Answer: D
Suggested Reading:
Amol Saxena, Tom Krisdakumtorn Return to activity after sesamoidectomy in athletically active
individuals
Foot Ankle Int May 2003 (Vol. 24, Issue 5, Pages 415-9)
R E Van Enoo, E M Cane Tibial sesamoid planing for intractable plantar keratoses; Clin Podiatr
Med Surg Jan 1991 (Vol. 8, Issue 1, Pages 41-7)
28
ABPOPPM In-Training Exam
A neuropathic diabetic presents for care of the condition shown. Ascending cellulitis is present
and the head of the proximal phalanx of the digit is clearly visible protruding through the wound.
MRI findings are negative for osteomyelitis. The patient has an ABI of 0.75.
Following resolution of the ascending cellulitis with the use of IV antibiotics, which of the
following should be scheduled for this patient?
A. Primary closure
B. Interphalangeal fusion
C. Transmetatarsal amputation
D. Digital amputation
E. Open reduction and repair
Correct Answer: D
Suggested Reading:
Bamberger DM. Diagnosis and treatment of osteomyelitis. Compr Ther. Summer 2000;26(2):89-
95.
Perron AD, Brady WJ, Miller MD. Orthopedic pitfalls in the ED: osteomyelitis. Am J Emerg
Med. Jan 2003;21(1):61-7
29
ABPOPPM In-Training Exam
A 71 year-old female presents with the lesion shown, which she first noticed three months ago.
The lesion is painless and has continually enlarged but never ulcerated. No other such lesions are
noted on her body.
Based on the suspected diagnosis, which of the following is the most appropriate course of
action?
Correct Answer: D
Suggested Reading:
Michael S. Downey, Bradley M. Lamm Metastatic Malignant Melanoma to the foot and ankle: A
review of the literature and case report Journal of Foot and Ankle Surgery November 2000 (Vol.
39, Issue 6, Pages 392-401)
Bradley Lemon, Robert Burns; Malignant Melanoma: A literature review and case presentation
Journal of Foot and Ankle Surgery January 1998 (Vol. 37, Issue 1, Pages 48-54)
30
ABPOPPM In-Training Exam
A patient who is 29 days post-operative complains about the inability to bathe normally and
would like the pin (shown in the radiograph) removed.
Correct Answer: C
Suggested Reading:
Christopher F. Hyer, Jason P. Glover, Gregory C. Berlet, Thomas H. Lee Cost Comparison of
Crossed Screws versus Dorsal Plate Construct for First Metatarsophalangeal Joint Arthrodesis ,
12 November 2007 Journal of Foot and Ankle Surgery January 2008 (Vol. 47, Issue 1, Pages 13-
18)
Clifford D. Mah, Alan S. Banks Immediate Weight Bearing Following First Metatarsophalangeal
Joint Fusion with Kirschner Wire Fixation , Journal of Foot and Ankle Surgery November 2008
31
ABPOPPM In-Training Exam
This 76 year-old female complains of pain across the entire forefoot. IPKs are noted sub
metatarsal heads one, two, and four, associated with dislocated MTP joints. Shoe alterations have
not been successful.
Correct Answer: A
Suggested Reading:
Narayan Hulse, Andrew M.C. Thomas Metatarsal Head Resection in the Rheumatoid Foot: 5year
Follow-Up With and Without Resection of the First Metatarsal HeadJournal of Foot and Ankle
Surgery March 2006 (Vol. 45, Issue 2, Pages 107-112)
Abatacept for the treatment of rheumatoid arthritis. National Institute for Health and Clinical
Excellence (NICE) - National Government Agency [Non-U.S.]. 2008 Apr. 29 pages.
NGC:006483
32
ABPOPPM In-Training Exam
Correct Answer: B
Suggested Reading:
Scott A. Alter, Roy W. Sprinkle Brodie's abscess: A case report Journal of Foot and Ankle
Surgery March 1995 (Vol. 34, Issue 2, Pages 208-214)
Robert Kelsey, Alex Kor, Flavio Cordano Hematogenous osteomyelitis of the calcaneus in
children: Surgical treatment and use of implanted antibiotic beads Journal of Foot and Ankle
Surgery November 1995 (Vol. 34, Issue 6, Pages 547-555)
33
ABPOPPM In-Training Exam
A 27 year-old male presents with first MTP joint pain recalcitrant to conservative care.
Based on the radiograph shown, which of the following procedures is the most appropriate to
alleviate the patient’s condition?
A. Cheilectomy
B. Joint resection
C. First MTP joint arthrodesis
D. Joint replacement
E. First metatarsal osteotomy
Correct Answer: E
Suggested Reading:
Shannon M. Rush, Jeffrey C. Christensen, Cherie H. Johnson Biomechanics of the first ray. Part
II: Metatarsus primus varus as a cause of hypermobility. A three-dimensional kinematic analysis
in a cadaver model Journal of Foot and Ankle Surgery March 2000 (Vol. 39, Issue 2, Pages 68-
77)
Thomas S Roukis, Adam S Landsman Hypermobility of the first ray: a critical review of the
literature Journal of Foot and Ankle Surgery November 2003 (Vol. 42, Issue 6, Pages 377-390)
34
ABPOPPM In-Training Exam
The interdigital lesion shown is determined to be caused by abutment of the head of the fifth
proximal phalanx against the base of the fourth proximal phalanx.
Resection of the base of the fourth proximal phalanx as an isolated procedure is NOT indicated
because it:
Correct Answer: C
Suggested Readging:
Banks AS, Downey MS, Martin DE, Miller S, eds. McGlamry's Comprehensive Textbook of
Foot and Ankle Surgery. 3rd ed. New York: Lippincott, Williams & Wilkins; 2001.
James L. Thomas, Edwin L. Blitch, D. Martin Chaney, Kris A. Dinucci, Kimberly Eickmeier,
Laurence G. Rubin, Mickey D. Stapp, John V. Vanore, Diagnosis and Treatment of Forefoot
Disorders. Section 1: Digital Deformities Clinical Practice Guideline Forefoot Disorders Panel
Journal of Foot and Ankle Surgery March 2009 (Vol. 48, Issue 2, Pages 230-238)
35
ABPOPPM In-Training Exam
The 42 year-old female shown experiences recurrent infections of the hallux. For the current
episode she has failed to respond to six days of oral dicloxacillin, 1.5 gms/day.
Correct Answer: D
Suggested Reading:
Daniel CR 3rd, Daniel MP, Daniel CM, et al. Chronic paronychia and onycholysis: a thirteenyear
experience. Cutis. Dec 1996;58(6):397-401
Hochman LG. Paronychia: more than just an abscess. Int J Dermatol. Jun 1995;34(6):385-6
36
ABPOPPM In-Training Exam
Pre-operative assessment of the tibial sesamoid position shown in the radiograph is made
Correct Answer: C
Suggested Reading:
Banks AS, Downey MS, Martin DE, Miller S, eds. McGlamry's Comprehensive Textbook of
Foot and Ankle Surgery. 3rd ed. New York: Lippincott, Williams & Wilkins; 2001
Gerbert J, ed. Textbook of Bunion Surgery. 2nd ed. Mt Kisco, NY: Futura Publishing
Company;. 1991
37
ABPOPPM In-Training Exam
Set 1 of 2
Questions 38 and 39 relate to the following clinical scenario:
Based on this history and radiographic findings, which of the following best describes the
mechanism of injury?
A. Pronation abduction
B. Supination external rotation
C. Direct bending
D. Axial loading
E. Crush forces
Correct Answer: D
Suggested Reading:
Scurran BL. Foot and Ankle Trauma. 2nd ed. New York, NY: Churchill Livingstone; 1996
Hesp WL, van der Werken C, Goris RJ. Lisfranc dislocations: fractures and/or dislocations
through the tarso-metatarsal joints. Injury. Jan 1984;15(4):261-6
38
ABPOPPM In-Training Exam
Set 2 of 2
Which of the following elements in the medical/social history would have the greatest impact on
bone healing?
Correct Answer: A
Suggested Reading:
Brent D. Haverstock, Vincent J. Mandracchia Cigarette smoking and bone healing: Implications
in foot and ankle surgery Journal of Foot and Ankle Surgery January 1998 (Vol. 37, Issue 1,
Pages 69-74)
Kristopher W. Krannitz, Hon W. Fong, Lawrence M. Fallat, John Kish The Effect of Cigarette
Smoking on Radiographic Bone Healing After Elective Foot Surgery Journal of Foot and Ankle
Surgery September 2009 (Vol. 48, Issue 5, Pages 525-527)
39
ABPOPPM In-Training Exam
Correct Answer: E
Suggested Reading:
Richard T. Bouché, Eric J. Heit ;Combined Plantar Plate and Hammertoe Repair with Flexor
Digitorum Longus Tendon Transfer for Chronic, Severe Sagittal Plane Instability of the Lesser
Metatarsophalangeal Joints: Preliminary Observations Journal of Foot and Ankle Surgery
March 2008 (Vol. 47, Issue 2, Pages 125-137)
Salasche SJ, Bernstein G, Senkarik M, eds. Surgical Anatomy of the Skin. Norwalk,
Conn: Appleton & Lange; 1988
40
ABPOPPM In-Training Exam
Surgery is planned for a 52 year-old male whose significant clinical, biomechanical and
radiographic findings reveal the following:
Based on the information provided, which of the following is the most appropriate combination
of procedures?
Correct Answer: B
Suggested Reading:
Banks AS, Downey MS, Martin DE, Miller S, eds. McGlamry's Comprehensive Textbook of
Foot and Ankle Surgery. 3rd ed. New York: Lippincott, Williams & Wilkins; 2001
Gerbert J, ed. Textbook of Bunion Surgery. 2nd ed. Mt Kisco, NY: Futura Publishing
Company;. 1991
41
ABPOPPM In-Training Exam
A 59 year-old female complaining of "bump pain" presents with the following clinical and
radiographic findings:
Based upon the information provided, which of the following procedures is most indicated?
A. Silver
B. McBride
C. Austin
D. Keller
E. Reverdin-Laird
Correct Answer: C
Suggested Reading:
Banks AS, Downey MS, Martin DE, Miller S, eds. McGlamry's Comprehensive Textbook of
Foot and Ankle Surgery. 3rd ed. New York: Lippincott, Williams & Wilkins; 2001
Gerbert J, ed. Textbook of Bunion Surgery. 2nd ed. Mt Kisco, NY: Futura Publishing
Company;. 1991
42
ABPOPPM In-Training Exam
The patient shown sustained a burn, resulting in a scar as well as limited active dorsiflexion of the
toes. Passive range of motion, however, is unrestricted and pain free.
After excision of the scar which of the following would best restore active dorsiflexion of the
toes?
A. Tendon transfer
B. Split thickness skin graft
C. Full thickness skin graft
D. Free flap
E. Transpositional graft
Correct Answer: D
Suggested Reading:
Gang Zhao, Xue-Cheng Cao, Cheng-Lin Sang, Jin-long Zheng, Jin-Fang Cai Application of a
Fasciocutaneous Free Flap for Treatment of a Severe Soft Tissue Injury of the Foot and Ankle: A
Case Report Corrected Proof, Journal of Foot and Ankle Surgery11 September 2009
Hakan Agir, Cenk Sen, Murat Onyedi Extended Lateral Supramalleolar Flap for Very Distal Foot
Coverage: A Case With Arteriovenous Malformation Journal of Foot and Ankle Surgery July
2007 (Vol. 46, Issue 4, Pages 310-313)
43
ABPOPPM In-Training Exam
A 60 year-old female underwent a bunionectomy at the age of 55 and now presents with the
clinical and radiographic findings shown. She states that only the great toe is symptomatic, and
only when wearing shoe gear. Examination reveals the hallux and lesser digital contractures to be
completely reducible.
Correct Answer: C
Suggested Reading:
Christopher F. Hyer, Jason P. Glover, Gregory C. Berlet, Thomas H. Lee Cost Comparison of
Crossed Screws versus Dorsal Plate Construct for First Metatarsophalangeal Joint Arthrodesis ,
12 November 2007 Journal of Foot and Ankle Surgery January 2008 (Vol. 47, Issue 1, Pages 13-
18)
Clifford D. Mah, Alan S. Banks Immediate Weight Bearing Following First Metatarsophalangeal
Joint Fusion with Kirschner Wire Fixation , Journal of Foot and Ankle Surgery November 2008
44
ABPOPPM In-Training Exam
A 29 year-old active male presents with a rigid hammertoe as shown, determined to have been
caused by a history of flexor substitution.
Which of the following is the most appropriate procedure for correcting the deformity?
Correct Answer: B
Suggested Reading:
Richard T. Bouché, Eric J. Heit ;Combined Plantar Plate and Hammertoe Repair with Flexor
Digitorum Longus Tendon Transfer for Chronic, Severe Sagittal Plane Instability of the Lesser
Metatarsophalangeal Joints: Preliminary Observations Journal of Foot and Ankle Surgery
March 2008 (Vol. 47, Issue 2, Pages 125-137)
AS, Downey MS, Martin DE, Miller S, eds. McGlamry's Comprehensive Textbook of Foot and
Ankle Surgery. 3rd ed. New York: Lippincott, Williams & Wilkins; 2001
45
ABPOPPM In-Training Exam
A closing base wedge osteotomy is scheduled for this patient as part of a hallux valgus repair.
Which of the following is the most important criterion in performing the osteotomy?
Correct Answer: A
Suggested Reading:
JM Schuberth, CH Reilly, and CJ Gudas The closing wedge osteotomy. A critical analysis of
first metatarsal elevation J Am Podiatr Med Assoc 1984 74: 13-24
SA Kempe, D Grapel, and P Hovanec A mathematical approach to closing base wedge osteotomy
J Am Podiatr Med Assoc 1984 74: 601-a-604-a
46
ABPOPPM In-Training Exam
This 82 year-old insulin dependent diabetic has recurrent ulcerations as seen. There is no
evidence of osteomyelitis. The ABI is 1.3. Excision of bone from the third metatarsal region is
suggested.
A. Excision of the bone from the third metatarsal through a dorsal excision
B. Panmetarsal head resection
C. Amputation at level of Lisfrancs joint
D. Complete bed rest and wound-vac therapy for 6 weeks
E. Debride ulcer to bleeding tissue and pack open for drainage
Correct Answer: A
Suggested Reading:.
Page Jeffrey C, Critiquing clinical research of new technologies for diabetic foot wound
management Journal of Foot and Ankle Surgery July 2002 (Vol. 41, Issue 4, Pages 251-259)
Javier La Fontaine, Damieon Brown, Moffatt Adams, Michael VanPelt New and Recurrent
Ulcerations after Percutaneous Achilles Tendon Lengthening in Transmetatarsal Amputation
Journal of Foot and Ankle Surgery May 2008 (Vol. 47, Issue 3, Pages 225-229)
47
ABPOPPM In-Training Exam
The post-operative radiograph shown was obtained immediately following skin closure and
dressing application. The patient is still under anesthesia.
Correct Answer: E
Suggested Reading:
Banks AS, Downey MS, Martin DE, Miller S, eds. McGlamry's Comprehensive Textbook of
Foot and Ankle Surgery. 3rd ed. New York: Lippincott, Williams & Wilkins; 2001
Gerbert J, ed. Textbook of Bunion Surgery. 2nd ed. Mt Kisco, NY: Futura Publishing
Company;. 1991
48
ABPOPPM In-Training Exam
A 52 year-old male has had unilateral subtalar joint pain since childhood but no ankle pain or
pain in the other pedal joints. Standard radiographs identified sclerotic changes along the subtalar
joint as well as mild osteophytic lipping along the dorsal talonavicular and navicular-cuneiform
joints on the affected side. A CT scan revealed the findings shown.
Correct Answer: D
Suggested Reading:
Joby Jacob George Malal, Gopal Hegde, Rupert D. Ferdinand Tarsal Joint Fusion Using Memory
Compression Staples—A Study of 10 Cases Journal of Foot and Ankle Surgery March 2006 (Vol.
45, Issue 2, Pages 113-117)
Christopher R. Payette, Ronald A. Sage, Joseph V. Gonzalez, Mark Sartori, Avinash Patwardhan,
Lori Vrbos Triple Arthrodesis Stabilization: A quantitative analysis of screw versus staple
fixation in fresh cadaveric matched-pair specimens Journal of Foot and Ankle Surgery November
1998 (Vol. 37, Issue 6, Pages 472-480)
49
ABPOPPM In-Training Exam
A. Continue oral antibiotics and daily dressing changes of Betadine soaked gauze
B. Apply a full thickness skin graft
C. Develop an advancement flap
D. Apply a split thickness skin graft
E. Take a free flap from the groin
Correct Answer: D
Suggested Reading:
Ratner D. Skin grafting. From here to there. Dermatol Clin. Jan 1998;16(1):75-90
50