8. Foot and Ankle MCQs

A 38-year-old male undergoes percutaneous repair of an acute Achilles tendon rupture. Compared to traditional postoperative immobilization in a cast, early functional rehabilitation with immediate weight-bearing in a functional brace is associated with which of the following?

A 55-year-old woman presents with progressive flatfoot deformity. Examination shows she is unable to perform a single-leg heel rise, has forefoot abduction with a 'too many toes' sign, and flexible hindfoot valgus. Which of the following surgical procedures is most appropriate?

A 24-year-old male athlete presents with severe midfoot pain and plantar ecchymosis following an axial load injury to a plantarflexed foot. Weight-bearing radiographs demonstrate a 2 mm diastasis between the first and second metatarsal bases. What is the primary stabilizing ligament of this articulation, and what is its anatomic origin and insertion?

A 35-year-old recreational basketball player sustains an acute Achilles tendon rupture. After discussing treatment options, he elects to pursue nonoperative management utilizing a functional rehabilitation protocol. Compared to traditional open surgical repair, what is the most likely outcome of functional nonoperative management?

A 42-year-old roofer falls 15 feet, sustaining a closed, displaced intra-articular calcaneus fracture (Sanders type III). You plan an open reduction and internal fixation utilizing an extensile lateral approach. Which of the following arteries is the primary blood supply to the full-thickness subperiosteal flap raised in this approach?

A 21-year-old collegiate wide receiver sustains a fracture of the fifth metatarsal at the metaphyseal-diaphyseal junction. To ensure proper trajectory of an intramedullary screw and avoid lateral cortex penetration, what is the ideal starting point on the fifth metatarsal?

A 19-year-old female track athlete presents with insidious onset, ill-defined midfoot pain. A CT scan confirms a partial stress fracture of the tarsal navicular in the sagittal plane.

In which anatomical zone of the navicular do these stress fractures most commonly occur, and what is the primary reason?

A 26-year-old professional soccer player sustains an external rotation ankle injury. Radiographs show medial clear space widening but no fracture. MRI demonstrates disruption of the anterior inferior tibiofibular ligament (AITFL) and interosseous membrane. During operative stabilization, what is the most appropriate ankle position while placing the syndesmotic fixation?

A 22-year-old football running back suffers a hyperextension injury to his first metatarsophalangeal (MTP) joint. Examination reveals marked swelling, ecchymosis, and inability to bear weight. MRI shows a complete tear of the plantar plate with proximal retraction of the sesamoids. Which of the following is an absolute indication for operative repair?

A 45-year-old man sustains a closed ankle fracture. Radiographs demonstrate a transverse medial malleolus fracture, a high proximal fibular fracture (Maisonneuve), and widening of the tibiofibular syndesmosis. According to the Lauge-Hansen classification, what is the mechanism of injury?

A 30-year-old skier presents with lateral ankle pain and a snapping sensation posterior to the lateral malleolus after a twisting fall. Examination reveals visible subluxation of the peroneal tendons over the lateral malleolus with resisted active eversion.

This pathology is most directly associated with incompetence of which anatomical structure?

A 62-year-old man with diabetes mellitus has had a persistent 2-cm ulcer under the third metatarsal head for the past 4 months. He reports that he has had similar ulcers twice before, and both healed with nonsurgical management. He has used multiple types of commercial walking braces, shoes, and commercial dressings without resolution. He is insensate to the Semmes-Weinstein 5.07 monofilament. When the wound is probed with culture swab, there is no communication with the metatarsal head. Radiographs, bone scans, and laboratory studies reveal no evidence of osteomyelitis. What is the most predictable method of accomplishing wound healing without recurrence?

A 25-year-old female sustains a closed Hawkins Type III fracture of the talar neck after a fall from a height. She undergoes prompt open reduction and internal fixation. What is the approximate expected rate of avascular necrosis (AVN) of the talar body for this specific fracture pattern?

In a patient presenting with a purely ligamentous Lisfranc injury (disruption of the tarsometatarsal joint complex without associated metatarsal base fractures), which of the following is the most appropriate, evidence-based surgical treatment to optimize functional outcomes and minimize the need for hardware removal?

A 33-year-old male sustains a high-energy injury to his foot and ankle. Radiographs and CT demonstrate a Hawkins Type III talar neck fracture. Based on the vascular anatomy of the talus, what is the approximate published risk of developing avascular necrosis (AVN) of the talar body?

A 28-year-old male sustains a high-energy dorsiflexion injury to his right foot. Radiographs demonstrate a talar neck fracture with dislocation of both the subtalar and tibiotalar joints, while the talonavicular joint remains intact. What is his Hawkins classification and approximate risk of avascular necrosis (AVN)?

A 30-year-old male sustains a multi-ligamentous knee injury (KD III) following a tackle. On arrival, his foot is warm and pink, but the dorsalis pedis pulse is weakly palpable compared to the contralateral side. The Ankle-Brachial Index (ABI) is 0.85. What is the next most appropriate step in management?

A 40-year-old male undergoes open reduction and internal fixation of a displaced intra-articular calcaneus fracture utilizing a standard extensile lateral approach. The viability of the full-thickness, 'no-touch' fasciocutaneous flap created during this approach relies primarily on the vascular supply from which of the following arteries?

A 24-year-old athlete sustains a hyperplantarflexion injury to his foot and presents with severe midfoot pain and plantar ecchymosis. Weight-bearing radiographs demonstrate a 3 mm diastasis between the base of the first and second metatarsals. The primary ligamentous structure disrupted in this injury (the Lisfranc ligament) anatomically originates from the:

A 28-year-old male sustains a Hawkins Type III talar neck fracture. Which of the following describes the anatomic displacement and the primary blood supply at greatest risk?