8. Foot and Ankle MCQs

A 60-year-old female presents with progressive dorsal foot pain and a rigid first metatarsophalangeal (MTP) joint. Radiographs show a loss of joint space, subchondral sclerosis, and a large dorsal osteophyte. The patient wishes to attempt conservative management. Which orthotic or shoe modification is most effective for managing this condition?

A 45-year-old runner presents with chronic posterior heel pain exacerbated by running uphill. MRI reveals insertional Achilles tendinopathy with calcification and greater than 50% tendon degeneration, alongside a prominent Haglund deformity. Nonoperative management has failed. Which surgical intervention is most appropriate?

Based on recent randomized controlled trials, primary arthrodesis is most strongly recommended over open reduction internal fixation (ORIF) for which type of acute Lisfranc injury?

A 62-year-old male presents with big toe pain. Examination reveals less than 10 degrees of dorsiflexion at the first MTP joint with pain at the mid-range of motion. Radiographs show significant joint space narrowing, dorsal osteophytes, and a flattened metatarsal head. Which treatment is considered the gold standard for this advanced (Grade 3/4) hallux rigidus?

A 55-year-old diabetic patient presents with an acute, warm, swollen, and erythematous midfoot. Radiographs show fragmentation and early collapse of the midfoot with no open ulcers. Infection is ruled out. According to the Eichenholtz classification, what is the most appropriate initial management for this Stage I Charcot arthropathy?

A 22-year-old male with Charcot-Marie-Tooth disease presents with a symptomatic cavovarus foot. On examination, a Coleman block test is performed by placing a 1-inch block under the lateral border of the foot, allowing the first ray to drop off. This maneuver results in complete correction of the hindfoot varus to neutral. Based on this finding, which of the following is the most appropriate foundational surgical step?

A purely ligamentous Lisfranc injury is highly unstable due to the inherent bony anatomy of the midfoot. The absence of which of the following normal anatomic structures primarily predisposes the foot to this specific diastasis?

A 55-year-old patient undergoes surgical debridement for chronic insertional Achilles tendinopathy. During the procedure, the surgeon excises the retrocalcaneal exostosis (Haglund's deformity) and debrides severely degenerated tendon tissue. At the conclusion of the debridement, it is noted that 65% of the Achilles tendon insertion has been removed. What is the most appropriate next step in management?

A 24-year-old athlete undergoes an MRI of the ankle for chronic pain, revealing a deep, cup-shaped osteochondral lesion of the talus. Based on the standard mnemonic "DIAL a PIMP", what is the most likely location and corresponding mechanism of injury for this specific morphology of lesion?

A 40-year-old female is evaluated for surgical management of a moderate hallux valgus deformity. Preoperative weight-bearing radiographs demonstrate a congruous first metatarsophalangeal (MTP) joint, but the Distal Metatarsal Articular Angle (DMAA) is abnormally elevated at 25 degrees. If the surgeon performs a simple medial eminence excision and a standard proximal chevron osteotomy without modifying the DMAA, what is the most likely complication?

A 22-year-old football player presents with severe midfoot pain after his foot was axially loaded in plantarflexion. A weight-bearing AP radiograph reveals widening between the first and second metatarsal bases with a distinct "fleck sign". This pathognomonic radiographic sign represents an avulsion fracture at which of the following anatomical attachments?

A 30-year-old male sustains a severely comminuted, displaced intra-articular calcaneus fracture. The surgeon elects to proceed with open reduction and internal fixation via an extensile lateral approach. Which nerve is at greatest risk of iatrogenic injury during the dissection of the inferior horizontal limb of this surgical approach?

A 55-year-old poorly controlled diabetic patient presents with a painless, swollen, erythematous right foot. Radiographs reveal extensive subchondral fragmentation, subluxation of the midfoot joints, and intra-articular debris without evidence of bony consolidation. According to the Eichenholtz classification, what stage of Charcot arthropathy does this represent?

According to the Lauge-Hansen classification for ankle fractures, a Supination-External Rotation (SER) injury follows a predictable sequence of structural failure. What is the first structure to fail in this specific mechanism?

A 45-year-old recreational basketball player feels a "pop" in his posterior ankle followed by weakness in plantarflexion. He is diagnosed with an acute Achilles tendon rupture. The tear occurs in the "watershed" zone, an area of relative hypovascularity. Where is this zone anatomically located relative to the calcaneal insertion?

A 52-year-old obese female presents with a progressive, painful flatfoot deformity. Examination reveals she is unable to perform a single-leg heel rise. Weight-bearing radiographs show a flexible deformity with greater than 40% talonavicular uncoverage but no significant degenerative joint changes. This is consistent with Stage IIb adult acquired flatfoot deformity. Which of the following is the most appropriate reconstructive surgical plan?

A 45-year-old female presents with severe pain over the medial eminence of her great toe. Radiographs demonstrate a Hallux Valgus Angle (HVA) of 45 degrees, an Intermetatarsal Angle (IMA) of 18 degrees, and clinical examination reveals marked hypermobility of the first tarsometatarsal (TMT) joint. Which of the following surgical procedures is most appropriate to provide durable correction?