8. Foot and Ankle MCQs

A 52-year-old male with poorly controlled diabetes presents with a swollen, erythematous, and warm left foot without a history of trauma. Pedal pulses are bounding. Radiographs demonstrate fragmentation of the tarsometatarsal joints with bone debris and early subluxation. What is the most appropriate initial step in management?

A 16-year-old male presents with bilateral progressive cavovarus foot deformities. A Coleman block test normalizes hindfoot alignment. Neurological examination reveals depressed deep tendon reflexes. The pathogenesis of this deformity in Charcot-Marie-Tooth disease is primarily driven by which of the following muscle imbalances?

A 22-year-old elite track athlete develops focal midfoot pain over the dorsal 'N spot'. A CT scan confirms a non-displaced stress fracture of the central third of the tarsal navicular. The high risk of nonunion in this specific anatomic location is secondary to a vascular watershed zone formed between which two arteries?

A 14-year-old boy presents with recurrent ankle sprains and rigid flatfeet. A lateral weight-bearing radiograph demonstrates a prominent 'C-sign' and a talar beak.

Based on the most likely diagnosis, which specific anatomical structure is most commonly involved in this pathology?

A 68-year-old male is considering surgical intervention for end-stage ankle osteoarthritis. He has a history of well-controlled diabetes and hypertension. Which of the following conditions is considered an absolute contraindication for a primary total ankle arthroplasty (TAA)?

Based on recent Level I evidence comparing operative and non-operative management of acute Achilles tendon ruptures using early functional rehabilitation protocols, which of the following statements is most accurate?

A 26-year-old female presents with progressive bilateral cavovarus foot deformity. A Coleman block test is performed. When her heel and lateral column are placed on the block while the first metatarsal is allowed to plantarflex freely, the hindfoot varus corrects to a neutral position. What is the primary initial step in the surgical reconstruction of this deformity?

When performing a minimally invasive repair for an acute Achilles tendon rupture, the sural nerve is at highest risk of iatrogenic injury. At what approximate distance proximal to the calcaneal tuberosity insertion does the sural nerve cross the lateral border of the Achilles tendon?

A 55-year-old diabetic patient presents with a swollen, erythematous, and warm unilateral foot without systemic signs of infection. Radiographs show periarticular fragmentation, subluxation, and bony debris around the midfoot. According to the Eichenholtz classification, what is the most appropriate initial management?

A 62-year-old female presents with flatfoot deformity. Examination reveals a flexible hindfoot valgus, but she is unable to perform a single-leg heel raise. Radiographs demonstrate significant forefoot abduction with a talonavicular uncoverage angle of 40 degrees. Which surgical intervention is most appropriate?

A 22-year-old track athlete presents with insidious onset of vague dorsal midfoot pain. Examination reveals focal tenderness at the "N-spot". CT scan confirms an incomplete stress fracture in the central third of the tarsal navicular. What anatomic factor primarily contributes to the high risk of nonunion in this specific region?

When utilizing the extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, preserving the blood supply to the lateral soft tissue flap is critical. Which artery provides the primary vascular supply to the apex of this flap?

A patient with Charcot-Marie-Tooth disease presents with a symptomatic cavovarus foot. A Coleman block test is performed, and the hindfoot varus corrects to a neutral alignment when the first metatarsal is allowed to plantarflex off the block. What does this indicate, and what surgical step is essential?

A 14-year-old female dancer presents with pain and swelling over the second metatarsophalangeal joint. Radiographs show flattening, sclerosis, and early fragmentation of the second metatarsal head. What is the primary underlying pathophysiology of this condition?

A 65-year-old male with severe post-traumatic ankle osteoarthritis is evaluated for a total ankle arthroplasty (TAA). Which of the following conditions is generally considered an absolute contraindication for a primary TAA?

A 30-year-old male falls from a ladder and sustains an isolated lateral subtalar dislocation. Closed reduction in the emergency department under conscious sedation is unsuccessful. What anatomical structure is most likely blocking the reduction?

A 28-year-old male is involved in a high-speed motor vehicle collision and sustains a severe traumatic knee dislocation resulting in a complete foot drop.

Given the mechanism and neurological deficit, which adjacent vascular structure is most critically at risk and requires emergent evaluation?

A 30-year-old construction worker drops a heavy steel beam on his midfoot, sustaining a severe Lisfranc fracture-dislocation.

In the emergency department, he complains of significant numbness over the dorsal aspect of the first web space of his foot. Which nerve is most likely compromised, and what is its anatomic course relative to the injury?