8. Foot and Ankle MCQs

Back pain and ipsilateral knee pain are common long-term sequelae of hip arthrodesis. To limit these problems, what position should be avoided during fusion of the hip?

A 12-year-old girl has progressive development of cavus feet. Examination reveals slightly diminished vibratory sensation on the bottom of the foot. Reflexes are 1+ at the knees and ankles. Motor examination shows that all muscles are 5/5 in the foot, except the peroneal and anterior tibial muscles are rated as 4+/5. Which of the following studies is considered most diagnostic?

A 68-year-old woman stepped on a needle while walking barefoot 10 days ago. She is not certain but thinks it is imbedded in her foot, and she notes local tenderness at the puncture site and drainage. Her primary care physician has been treating her with oral antibiotics. A plain radiograph is shown in Figure 38. What is the best course of action?

Figure 30 shows the radiograph of a 38-year-old man who reports persistent pain laterally and plantarly about the fifth metatarsal head. Examination reveals calluses dorsolaterally and plantarly about the fifth metatarsal head. Nonsurgical management has failed to provide relief. Surgical treatment should include

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 24-year-old dancer reports posterior ankle pain when in the "en pointe" position. Examination reveals posteromedial tenderness, no pain reproduction with passive forced planter flexion, and pain with motion of the hallux. What is the most likely diagnosis?

A 47-year-old woman has a right bunion that has been symptomatic despite modifications in shoe wear. She requests surgical correction. An AP radiograph is shown in Figure 37. Treatment should consist of

Figures 5a and 5b show the clinical photograph and radiograph of a patient who has difficulty wearing shoes and has persistent symptoms medially and laterally at the first and fifth metatarsophalangeal joints. Because shoe modifications have failed to provide relief, management should now consist of

Removal of both hallucal sesamoids should be reserved as a salvage procedure because of the high incidence of which of the following postoperative complications?

A 28-year-old man has had a 2-year history of progressive lateral ankle pain. History reveals that he underwent a triple arthrodesis at age 13 for a tarsal coalition. The pain has been refractory to braces, custom inserts, and nonsteroidal anti-inflammatory drugs. Weight-bearing radiographs of the ankle and foot are shown in Figures 3a through 3d. Surgical management should include which of the following?

A 42-year-old man has a symptomatic flatfoot deformity and walks with a slight limp after falling off a scaffold 9 months ago. He also reports that he has had difficulty returning to work. Orthotics have failed to provide relief. Current radiographs are shown in Figures 19a and 19b. To relieve his pain and return the patient to work, treatment should consist of

A 65-year-old woman with a history of diabetes mellitus and plantar ulcers has an erythematous and swollen right foot and ankle. Despite IV antibiotics, the erythema spreads to her lower calf within 24 hours. She has a systolic blood pressure of 80/55 mm Hg and a pulse rate of 120. Laboratory studies show a creatinine level of 1.5 mg. Initial management should consist of

An 83-year-old woman with diabetes mellitus has a history of recurrent infection over the medial aspect of her great toe and has had a painless bunion for the past 45 years. Shoe wear modifications have failed to provide relief. Pedal pulses are palpable. Figures 30a and 30b show the clinical photograph and radiograph. Management should now consist of

Figures 41a and 41b show the radiographs of a 22-year-old woman who has a bunion on her left foot. She denies pain in the foot, but she reports increasing difficulty with shoe wear. Management should consist of

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?

A 35-year-old woman states that she stepped on a piece of glass 6 months ago and reports numbness and shooting pain along the plantar lateral forefoot. She had previously received steroid injections in the 3 to 4 webspace. Examination reveals mild tenderness along the plantar fascia; no Tinel's sign is noted plantar medially and no Mulder's click is noted distally. An MRI scan is shown in Figure 7. What is the most likely cause of the numbness?

Figures 5a and 5b show axial and coronal MRI images of the left ankle of a patient with lateral ankle pain. What is the most likely diagnosis?

A 12-year-old girl who plays softball has chronic lateral hindfoot aching pain that is aggravated by weight-bearing activity. She reports that the pain has recurred after initial improvement with cast immobilization, and it continues to limit her overall level of activity. Radiographs are seen in Figures 40a through 40c. What is the most appropriate surgical treatment?

Figures 18a and 18b show the radiographs of a patient who has pain with walking. On careful questioning, it is determined that the discomfort occurs at push-off, or when the patient attempts to climb stairs. What nonsurgical option is most likely to ameliorate the symptoms?

Figure 7 shows the MRI scan of a 23-year-old competitive rugby player who has anterior ankle pain and swelling. He states that he has been playing for many years and has sprained his ankle several times. Examination will reveal what specific hallmark feature?