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Forefoot MCQs

Practice Set 17 of 17

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

Question 321

Topic: Forefoot

A 70-year-old active woman presents with severe pain with weightbearing at the first metatarsophalangeal (MTP) joint. She underwent bunion surgery 25 years ago. Radiographs demonstrate severe first MTP joint arthrosis, a shortened first ray, and a prominent retained screw from a prior osteotomy. Conservative management has failed. What is the most reliable surgical option to provide long-term pain relief and restore function?

. First MTP joint arthrodesis
. Silicone implant arthroplasty
. Resection arthroplasty (Keller procedure)
. Revision first metatarsal osteotomy
. Cheilectomy

Correct Answer & Explanation

. First MTP joint arthrodesis

Explanation

Correct Answer: AThis patient presents with a failed prior bunion surgery resulting in severe first MTP joint arthrosis and a shortened first ray. The gold standard salvage procedure for a failed hallux valgus surgery with severe degenerative joint disease is a first MTP joint arthrodesis. Arthrodesis provides reliable, long-term pain relief, restores the weightbearing function of the first ray, and corrects any residual or recurrent deformity. Silicone implant arthroplasty has a high rate of failure, implant fracture, and reactive synovitis. A Keller resection arthroplasty can lead to further shortening of the first ray, transfer metatarsalgia, and a "cock-up" deformity. Cheilectomy is indicated for early-stage hallux rigidus without severe joint space narrowing, not for end-stage arthrosis following failed surgery.

Question 322

Topic: Forefoot

A 70-year-old woman presents with severe pain at the first metatarsophalangeal (MTP) joint. She underwent a bunion correction with screw fixation 25 years ago. Radiographs demonstrate severe degenerative joint disease of the first MTP joint with a prominent intra-articular screw. Conservative management, including stiff-soled shoes and intra-articular injections, has failed. What is the most reliable surgical option for long-term pain relief and functional improvement?

. Screw removal and Keller resection arthroplasty
. Screw removal and silicone implant arthroplasty
. Screw removal and first MTP joint arthrodesis
. Screw removal and cheilectomy
. Screw removal and synthetic hemiarthroplasty

Correct Answer & Explanation

. Screw removal and first MTP joint arthrodesis

Explanation

Correct Answer: CThis patient presents with end-stage arthritis of the first MTP joint (hallux rigidus) following a prior bunion surgery. First MTP joint arthrodesis is the gold standard and most reliable surgical option for severe first MTP arthritis, particularly in the setting of a failed prior surgery (salvage procedure). It provides excellent, durable pain relief and restores the weight-bearing function of the first ray. Keller resection arthroplasty can lead to transfer metatarsalgia, a "cock-up" deformity, and weakness of push-off. Silicone implant arthroplasty has historically high failure rates, risk of silicone synovitis, and bone loss. Cheilectomy is indicated for early-stage hallux rigidus with preserved joint space, not end-stage disease.

Question 323

Topic: Forefoot

A 70-year-old active woman presents with severe pain with weightbearing over the first metatarsophalangeal (MTP) joint. She underwent a bunion correction 25 years ago. Radiographs demonstrate severe first MTP joint arthrosis with a prominent retained screw from the prior procedure. Conservative management has failed. Which of the following is the most reliable surgical option to provide long-term pain relief and functional improvement?

. First MTP joint arthrodesis
. Silicone implant arthroplasty
. Resection arthroplasty (Keller procedure)
. Cheilectomy
. First MTP total joint arthroplasty

Correct Answer & Explanation

. First MTP joint arthrodesis

Explanation

Correct Answer: AFirst MTP joint arthrodesis is the gold standard for the treatment of end-stage hallux rigidus and for the salvage of failed hallux valgus surgery. It provides reliable, long-term pain relief and restores the weightbearing function of the first ray. Silicone implant arthroplasty has historically been associated with high failure rates, silicone synovitis, and significant bone loss, making it a poor choice. A Keller resection arthroplasty involves resecting the base of the proximal phalanx; while it relieves pain, it destabilizes the joint, leading to a "cock-up" deformity and transfer metatarsalgia, and is generally reserved for low-demand, elderly patients. Cheilectomy is indicated for early-stage hallux rigidus without severe joint space narrowing. Total joint arthroplasty of the first MTP has higher complication and revision rates compared to arthrodesis.

Question 324

Topic: Forefoot

A 68-year-old female presents with progressive medial forefoot pain and difficulty with shoe wear. Clinical examination reveals a prominent medial eminence and lateral deviation of the great toe. Based on epidemiological data, what is the approximate prevalence of this condition in adults over the age of 65?

. 5%
. 15%
. 23%
. 35%
. 50%

Correct Answer & Explanation

. 35%

Explanation

Correct Answer: 35%Forefoot deformities such as hallux valgus are exceedingly common and their prevalence increases with age. According to the provided text, hallux valgus affects approximately 23% of adults aged 18-65 and over 35% in those over the age of 65. This high prevalence in the older population frequently necessitates surgical correction due to progressive pain and difficulty with shoe wear.

Question 325

Topic: Forefoot

A 68-year-old female presents with medial forefoot pain and difficulty with shoe wear. Examination reveals a prominent medial eminence and lateral deviation of the great toe. When counseling the patient on the epidemiology of her condition, which of the following statistics is most accurate regarding the prevalence of this deformity in adults over the age of 65?

. Approximately 10%
. Approximately 15%
. Approximately 23%
. Greater than 35%
. Greater than 50%

Correct Answer & Explanation

. Approximately 23%

Explanation

Correct Answer: DAccording to the provided text, forefoot deformities such as hallux valgus are highly prevalent in the adult population. The text explicitly states that hallux valgus affects approximately 23% of adults aged 18-65 and over 35% in those over the age of 65. This progressive deformity often requires surgical correction due to pain and difficulty with shoe wear, highlighting its significant impact on the aging population.

Question 326

Topic: Forefoot

A 50-year-old runner presents with dorsal midfoot pain. Examination reveals a dorsal exostosis at the first metatarsophalangeal joint with pain only at the extreme of dorsiflexion. Radiographs show a preserved joint space with mild dorsal osteophytes. What is the most appropriate surgical treatment if conservative measures fail?

. First MTP joint arthrodesis
. Silicone implant arthroplasty
. Cheilectomy
. Keller resection arthroplasty
. Lapidus procedure

Correct Answer & Explanation

. Cheilectomy

Explanation

This patient has early-stage hallux rigidus (Coughlin and Shurnas Grade 1 or 2) characterized by preserved joint space and pain primarily at the extremes of motion. Cheilectomy (removal of the dorsal osteophytes and the dorsal third of the metatarsal head) is the preferred initial surgical treatment.

Question 327

Topic: Forefoot

A 45-year-old female presents with a painful bunion. Weight-bearing radiographs demonstrate a hallux valgus angle (HVA) of 45 degrees, an intermetatarsal angle (IMA) of 18 degrees, and hypermobility of the first tarsometatarsal (TMT) joint. Which of the following procedures is most appropriate?

. Distal chevron osteotomy
. Proximal crescentic osteotomy with distal soft tissue release
. First TMT joint arthrodesis (Lapidus procedure)
. First metatarsophalangeal (MTP) joint arthrodesis
. Akin osteotomy alone

Correct Answer & Explanation

. First TMT joint arthrodesis (Lapidus procedure)

Explanation

A Lapidus procedure (first TMT arthrodesis) is indicated for severe hallux valgus combined with first ray hypermobility. It robustly corrects the severe intermetatarsal angle and stabilizes the hypermobile medial column.

Question 328

Topic: Forefoot

A 28-year-old professional football player suffers a hyperdorsiflexion injury to his great toe. Examination shows gross instability of the first MTP joint, and a palpable defect proximal to the sesamoids. What is the most likely diagnosis and recommended management?

. Grade 1 Turf Toe; stiff-soled shoe and taping
. Grade 2 Turf Toe; walking boot for 4 weeks
. Grade 3 Turf Toe; surgical repair of the plantar plate
. Sesamoid fracture; excision of the fragmented sesamoid
. Hallux rigidus; cheilectomy

Correct Answer & Explanation

. Grade 3 Turf Toe; surgical repair of the plantar plate

Explanation

A hyperdorsiflexion injury with gross instability, a palpable defect, and proximal sesamoid migration indicates a Grade 3 turf toe (complete plantar plate rupture). In an elite athlete, surgical repair is indicated to restore joint stability and push-off strength.

Question 329

Topic: Forefoot

A 40-year-old female presents with a painful bunion. Weight-bearing radiographs reveal a hallux valgus angle of 38 degrees and an intermetatarsal angle of 18 degrees. Clinical examination demonstrates significant hypermobility of the first tarsometatarsal (TMT) joint in the sagittal plane. Which of the following procedures is most appropriate for this patient?

. Distal metatarsal chevron osteotomy
. Proximal crescentic osteotomy with distal soft tissue release
. First tarsometatarsal (Lapidus) arthrodesis
. First metatarsophalangeal joint arthrodesis
. Keller resection arthroplasty

Correct Answer & Explanation

. First tarsometatarsal (Lapidus) arthrodesis

Explanation

The Lapidus procedure (first TMT arthrodesis) is the procedure of choice for moderate-to-severe hallux valgus associated with first ray hypermobility. It successfully addresses the severe intermetatarsal angle while providing rigid stabilization at the apex of the deformity.

Question 330

Topic: Forefoot

Based on epidemiological data, what is the approximate prevalence of hallux valgus in the adult population over the age of 65?

. Less than 10%
. Approximately 15%
. Approximately 23%
. Over 35%
. Over 60%

Correct Answer & Explanation

. Over 35%

Explanation

Correct Answer: Over 35%Hallux valgus is a highly prevalent forefoot deformity. Epidemiological data indicates it affects approximately 23% of adults aged 18-65, and its prevalence increases significantly with age, affecting over 35% of individuals over the age of 65.

Question 331

Topic: Forefoot

According to the provided epidemiological data, what is the approximate prevalence of hallux valgus in adults over the age of 65?

. Less than 10%
. Approximately 23%
. Greater than 35%
. Approximately 50%
. Greater than 65%

Correct Answer & Explanation

. Greater than 35%

Explanation

Correct Answer: Greater than 35%The text explicitly states that forefoot deformities such as hallux valgus affect approximately 23% of adults aged 18-65 and over 35% in those over 65. This highlights the increasing prevalence of this condition in the aging population.

Question 332

Topic: Forefoot

Based on the provided text, what is the approximate prevalence of hallux valgus in the adult population over the age of 65?

. Less than 10%
. Approximately 15%
. Approximately 23%
. Over 35%
. Over 50%

Correct Answer & Explanation

. Over 35%

Explanation

Correct Answer: DAccording to the provided text, forefoot deformities such as hallux valgus are highly prevalent. They affect approximately 23% of adults aged 18-65 and over 35% in the population over the age of 65. This high prevalence underscores the significant burden of this condition, which often requires surgical correction due to pain and difficulty with shoe wear.

Question 333

Topic: Forefoot

According to epidemiological data, what is the approximate prevalence of hallux valgus in adults over the age of 65?

. 10%
. 23%
. 35%
. 50%
. 65%

Correct Answer & Explanation

. 35%

Explanation

Correct Answer: 35%According to the provided text, forefoot deformities such as hallux valgus affect approximately 23% of adults aged 18-65 and over 35% in those over 65. This high prevalence often leads to pain and shoe wear difficulties, frequently requiring surgical correction.

Question 334

Topic: Forefoot

According to the provided epidemiological data, what is the approximate prevalence of hallux valgus in adults over the age of 65?

. 15%
. 23%
. 35%
. 50%
. 65%

Correct Answer & Explanation

. 35%

Explanation

Correct Answer: CThe text explicitly states that forefoot deformities such as hallux valgus affect approximately 23% of adults aged 18-65 and over 35% in those over 65. This high prevalence often necessitates surgical correction due to pain and shoe wear difficulties.

Question 335

Topic: Forefoot

A 45-year-old female presents with severe bunion pain. Radiographs reveal a hallux valgus angle (HVA) of 45 degrees, an intermetatarsal angle (IMA) of 18 degrees, and significant hypermobility of the first tarsometatarsal (TMT) joint. Which of the following procedures is most appropriate?

. Distal chevron osteotomy
. Akin osteotomy alone
. Lapidus procedure (1st TMT arthrodesis)
. Keller resection arthroplasty
. Proximal phalangeal osteotomy

Correct Answer & Explanation

. Lapidus procedure (1st TMT arthrodesis)

Explanation

The Lapidus procedure is indicated for severe hallux valgus deformities (IMA >15 degrees) accompanied by first ray hypermobility, as it addresses the apex of the deformity and stabilizes the medial column.

Question 336

Topic: Forefoot

A 62-year-old male presents with severe pain in his great toe with walking. Radiographs show obliteration of the first metatarsophalangeal (MTP) joint space with large dorsal osteophytes (Coughlin and Shurnas Grade 4 Hallux Rigidus). Physical exam reveals pain at the mid-range of motion. What is the most reliable definitive surgical treatment?

. Dorsal cheilectomy
. First MTP joint arthrodesis
. First MTP joint hemiarthroplasty
. Moberg osteotomy
. Extensor hallucis longus lengthening

Correct Answer & Explanation

. First MTP joint arthrodesis

Explanation

First MTP arthrodesis is the gold standard and most reliable treatment for advanced (Grade 3 or 4) hallux rigidus, especially when there is significant joint space narrowing and pain through the mid-range of motion.

Question 337

Topic: Forefoot

A 45-year-old female presents with a painful bunion. Weight-bearing radiographs show a hallux valgus angle (HVA) of 45 degrees, an intermetatarsal angle (IMA) of 18 degrees, and significant hypermobility at the first tarsometatarsal (TMT) joint. What is the most appropriate surgical intervention?

. Distal chevron osteotomy
. Proximal crescentic osteotomy
. First TMT arthrodesis (Lapidus procedure)
. Metatarsophalangeal joint arthrodesis
. Akin osteotomy alone

Correct Answer & Explanation

. First TMT arthrodesis (Lapidus procedure)

Explanation

A first TMT arthrodesis (Lapidus procedure) is the treatment of choice for severe hallux valgus (IMA >15, HVA >40) associated with first ray hypermobility. It corrects the deformity at its apex and robustly stabilizes the medial column.

Question 338

Topic: Forefoot
A 60-year-old male runner presents with dorsal first metatarsophalangeal (MTP) joint pain. Radiographs demonstrate dorsal osteophytes, <25% joint space remaining, and pain during the mid-arc of motion. According to the Coughlin and Shurnas classification, which of the following is the most reliable definitive treatment?
. First MTP joint cheilectomy
. First MTP joint arthrodesis
. First TMT joint arthrodesis
. First MTP joint arthroplasty
. Moberg osteotomy

Correct Answer & Explanation

. First MTP joint arthrodesis

Explanation

This describes Coughlin and Shurnas Grade 3 hallux rigidus (significant joint space loss, pain with mid-arc of motion). First MTP arthrodesis remains the gold-standard and most reliable definitive treatment, providing excellent pain relief and functional outcomes in active patients.

Question 339

Topic: Forefoot

A 45-year-old female presents with symptomatic hallux valgus. Weight-bearing radiographs reveal a Hallux Valgus Angle (HVA) of 45 degrees, an Intermetatarsal Angle (IMA) of 18 degrees, and clinical hypermobility of the first tarsometatarsal joint. Which procedure is most appropriate?

. Distal chevron osteotomy
. Proximal crescentic osteotomy with distal soft tissue release
. First tarsometatarsal joint arthrodesis (Lapidus procedure)
. Metatarsophalangeal joint arthrodesis
. Keller resection arthroplasty

Correct Answer & Explanation

. First tarsometatarsal joint arthrodesis (Lapidus procedure)

Explanation

The Lapidus procedure (first TMT arthrodesis) is indicated for severe hallux valgus (IMA > 13 degrees, HVA > 40 degrees) associated with first ray hypermobility. Distal osteotomies are insufficient for correcting large intermetatarsal angles and do not address the proximal instability.

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