Paediatric orthopaedics: relapsed clubfoot with dynamic supination: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Paediatric orthopaedics: relapsed clubfoot with dynamic supination

Sample item

A 4-year-old whose clubfoot was corrected by the Ponseti method now shows dynamic supination of the forefoot during gait, with a strongly firing tibialis anterior and a flexible foot. Which procedure is appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Transfer of tibialis anterior to the lateral cuneiform

Relapse with dynamic supination is caused by overpull of the tibialis anterior and is treated by transferring it to the lateral cuneiform, often after recasting to regain correction. Extensive release is reserved for rigid failures and arthrodesis for severe, rigid deformities in older children.

Option by option

  • A. Triple arthrodesis

    Triple arthrodesis is for rigid residual deformity in older children.

  • B. Posteromedial soft tissue release

    A full soft tissue release is not required for a flexible relapse.

  • C. Repeat Achilles tenotomy

    The foot is not in equinus, so repeat tenotomy is not indicated.

  • D. Transfer of tibialis anterior to the lateral cuneiform (correct)

    Correct. Moving the tibialis anterior laterally balances the foot.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Transfer of tibialis anterior to the lateral cuneiform. Relapse with dynamic supination is caused by overpull of the tibialis anterior and is treated by transferring it to the lateral cuneiform, often after recasting to regain correction.

Why is "Triple arthrodesis" not the answer?

Triple arthrodesis is for rigid residual deformity in older children.

Why is "Posteromedial soft tissue release" not the answer?

A full soft tissue release is not required for a flexible relapse.

Why is "Repeat Achilles tenotomy" not the answer?

The foot is not in equinus, so repeat tenotomy is not indicated.

What concept does this question test?

It tests Paediatric orthopaedics: relapsed clubfoot with dynamic supination in Orthopaedics. Extensive release is reserved for rigid failures and arthrodesis for severe, rigid deformities in older children.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric orthopaedics: relapsed clubfoot with dynamic supination?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.