8. Foot and Ankle MCQs

A 30-year-old female presents with severe bunion pain. Weight-bearing radiographs reveal a hallux valgus angle of 45 degrees, an intermetatarsal angle of 18 degrees, and clinical hypermobility of the first ray. Which of the following surgical procedures is most appropriate to provide durable correction?

A 62-year-old male with end-stage ankle arthritis presents to discuss surgical options. He has a history of type II diabetes and peripheral neuropathy. Which of the following is considered an absolute contraindication to primary total ankle arthroplasty (TAA) in this patient?

A 25-year-old competitive athlete sustains a purely ligamentous Lisfranc injury. He undergoes operative stabilization. Compared to open reduction and internal fixation (ORIF) with screws, what is the primary advantage of performing a primary arthrodesis for this specific injury pattern?

A 32-year-old male undergoes ORIF for a Hawkins Type II talar neck fracture. At his 8-week follow-up, an AP radiograph of the ankle demonstrates a distinct subchondral lucency in the talar dome. What does this radiographic finding signify?

A 40-year-old weekend warrior opts for a minimally invasive repair of an acute Achilles tendon rupture. To avoid injury to the sural nerve during percutaneous suture passage, the surgeon must be especially cautious to avoid which quadrant of the proximal tendon stump?

A 50-year-old female presents with Stage IIb adult acquired flatfoot deformity, characterized by a flexible hindfoot and greater than 40% talonavicular uncoverage on radiographs. Which combination of procedures is the most appropriate surgical management?

A 60-year-old male with Coughlin Grade 3 hallux rigidus undergoes a first metatarsophalangeal (MTP) joint arthrodesis. What is the optimal position for the arthrodesis to maximize postoperative function and footwear compatibility?

In the surgical treatment of Stage IIb adult-acquired flatfoot deformity, an Evans lateral column lengthening osteotomy is performed. What is the primary biomechanical consequence of this procedure on the adjacent midfoot joints?

A 24-year-old athlete sustains a pure ligamentous Lisfranc injury with instability of the first, second, and third tarsometatarsal joints. Based on prospective randomized data, which of the following provides the most reliable long-term functional outcome?

When utilizing the extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, the vascular supply to the full-thickness lateral flap is primarily provided by which of the following?

When performing an arthrodesis of the first metatarsophalangeal (MTP) joint for end-stage hallux rigidus, what is the optimal position of fusion to ensure maximal postoperative walking function?

Recent randomized controlled trials comparing operative and non-operative management of acute Achilles tendon ruptures demonstrate that utilizing an early functional rehabilitation protocol in non-operatively managed patients results in:

A 45-year-old runner presents with chronic medial heel pain. Examination reveals maximal tenderness over the medial calcaneal tuberosity and radiating pain along the course of the first branch of the lateral plantar nerve. This nerve primarily provides motor innervation to which muscle?

A 55-year-old patient with poorly controlled diabetes presents with a red, hot, swollen foot without an open ulcer. Radiographs show periarticular debris, fragmentation, and subluxation of the midfoot. According to the Eichenholtz classification, what is the appropriate stage and initial management?

A 28-year-old male presents with an acutely swollen knee after a severe hyperextension injury. Examination reveals a positive Lachman, positive posterior drawer, and gross varus/valgus instability. His ankle-brachial index (ABI) is measured at 0.85. What is the most appropriate next step in management?

Figures 17a through 17c show the radiographs of a 38-year-old man following a motorcycle accident. The posterior portion of the talus extruded through a posterolateral wound. The extruded talar body is visible in the wound along with some road debris. Management should now consist of surgical irrigation, debridement, and

A 36-year-old woman is wearing an ankle-foot orthosis for a foot drop secondary to spastic hemiplegia following a postpartum stroke 2 years ago. Knee and hip motion and strength are within normal ranges. She has undergone multiple rounds of physical therapy but has seen no improvement over the past several months. No improvement has been recorded by electromyography (EMG) studies over the past year. Examination reveals a 5-degree plantar flexion contracture with clonus, heel varus, and compensatory knee hyperextension when standing. She has 4/5 power in the tibialis anterior and gastrocnemius soleus complex with resistance testing. Everters are 2/5 to resistance testing. EMG gait studies show that the tibialis anterior demonstrates activity during both swing and stance phase that is increased during swing phase. Premature firing of the triceps surae is noted when positioning the foot in equinus prior to floor contact. What is the most appropriate management?

In the surgical management of a displaced Hawkins III talar neck fracture, the surgeon must be mindful of the blood supply to the talar body. Which of the following arteries provides the dominant blood supply to the body of the talus?

A 24-year-old collegiate offensive lineman sustains a purely ligamentous Lisfranc injury with 3 mm of displacement between the medial cuneiform and the base of the second metatarsal. What is the most appropriate definitive management?

A 45-year-old roofer falls 15 feet, sustaining a displaced intra-articular calcaneus fracture. During the standard lateral extensile approach for open reduction and internal fixation, the surgeon must reduce the displaced fragments to the 'constant' fragment. Which anatomical structure is this fragment primarily attached to?