Midfoot & Hindfoot MCQs

A 55-year-old woman reports medial ankle pain and a progressively collapsing arch over the past year. Examination reveals a flexible flatfoot deformity and an inability to perform a single-leg heel rise on the affected side. Radiographs show no degenerative joint disease. What is the most appropriate surgical management if conservative care fails?

A 28-year-old competitive runner sustains a subtle midfoot injury. Weight-bearing radiographs demonstrate 3 mm of diastasis between the medial and middle cuneiforms with no associated fractures. According to recent literature, what is the most appropriate definitive management for this purely ligamentous injury?

A 62-year-old man with poorly controlled diabetes presents with an acutely swollen, erythematous, and warm right foot without ulcers. Radiographs reveal fragmentation of the midfoot. WBC count is normal. What is the most appropriate initial management?

A 55-year-old female presents with progressive flattening of her left foot. On examination, she is unable to perform a single-leg heel rise, and her hindfoot is in valgus but passively correctable. AP radiographs show 45% talonavicular uncoverage. What is the most appropriate surgical intervention?

A 52-year-old woman presents with medial ankle pain and a progressive flatfoot deformity. Examination reveals a flexible hindfoot with inability to perform a single-leg heel rise. Standing radiographs show greater than 40% uncoverage of the talonavicular joint. What is the best surgical management?

A 40-year-old manual laborer sustains a purely ligamentous Lisfranc injury involving the first, second, and third tarsometatarsal (TMT) joints. Which surgical treatment has shown superior long-term functional outcomes and lower reoperation rates for this specific injury pattern?

A 55-year-old woman presents with a progressive flatfoot deformity. She reports pain localized medially along the posterior tibial tendon and laterally within the sinus tarsi. On examination, she is completely unable to perform a single-leg heel rise on the affected side. Weight-bearing radiographs demonstrate 45% uncovering of the talar head on the AP view and severe talonavicular sag on the lateral view. What is the most appropriate surgical management for this patient?

A 52-year-old woman presents with progressive medial ankle pain and a new-onset flatfoot deformity. On examination, she has a flexible hindfoot, a 'too many toes' sign, and is unable to perform a single-leg heel rise. Weight-bearing radiographs reveal a flexible pes planovalgus deformity with >40% talonavicular uncoverage on the AP view, indicative of significant forefoot abduction. What is the most appropriate surgical management for this stage of posterior tibial tendon dysfunction (Stage IIb)?

A 55-year-old man with a 15-year history of poorly controlled type 2 diabetes and profound peripheral neuropathy presents with a red, hot, swollen right foot. He denies trauma. He is afebrile with normal white blood cell count and inflammatory markers. Radiographs reveal fragmentation, periarticular debris, and subluxation of the midfoot joints. There are no skin ulcerations. What is the most appropriate initial management?

A 55-year-old woman presents with progressively worsening right foot pain. On examination, she has a flexible flatfoot, a positive 'too-many-toes' sign, and an inability to perform a single-limb heel raise. Radiographs reveal uncovering of the talonavicular joint of 45% indicating severe forefoot abduction. What is the most appropriate surgical treatment algorithm for this stage of adult acquired flatfoot deformity?

A 52-year-old woman presents with progressive medial ankle pain and flattening of her left foot arch over the past year. On examination, she is unable to perform a single-leg heel rise on the left. Weight-bearing radiographs reveal a talonavicular uncoverage of 45%, a Meary's angle of 15 degrees apex plantar, and no subtalar or talonavicular arthrosis. Which of the following surgical combinations is most appropriate for her condition?

A 48-year-old female presents with stage IIb posterior tibial tendon dysfunction and a flexible flatfoot deformity. Reconstruction requires stabilization of the spring ligament complex. Which of the following bands of the spring ligament complex is the strongest, providing the most critical support to the talar head?

A 13-year-old boy presents with recurrent right ankle sprains and a rigid, painful flatfoot. Clinical examination reveals a lack of subtalar motion and peroneal spasticity. Computed tomography confirms a large, osseous talocalcaneal coalition involving the middle facet. The coalition involves approximately 60% of the posterior subtalar joint surface area, and there are moderate osteoarthritic changes in the posterior facet. What is the most appropriate surgical management?

A 22-year-old collegiate football player sustains a high-energy foot injury. Advanced imaging reveals a purely ligamentous Lisfranc injury with complete disruption of the Lisfranc ligament complex and dorsal subluxation of the 1st, 2nd, and 3rd tarsometatarsal (TMT) joints. Based on recent prospective evidence, which of the following is the most appropriate primary surgical management?

A 24-year-old professional football player sustains an acute, purely ligamentous Lisfranc injury involving the first, second, and third tarsometatarsal joints. Which of the following surgical treatments has been shown to yield the best long-term functional outcomes for this specific injury pattern?

A 34-year-old man sustains a displaced fracture of the talar neck with subluxation of the subtalar joint, while the tibiotalar and talonavicular joints remain congruent (Hawkins Type II). He undergoes prompt open reduction and internal fixation. Which of the following is the most reliable early radiographic indicator that osteonecrosis of the talar body will NOT occur?