8. Foot and Ankle MCQs

Which of the following statements correctly differentiates the typical characteristics of anterolateral versus posteromedial osteochondral lesions of the talus (OCD)?

A 22-year-old professional football player sustains a turf toe injury while pushing off the line of scrimmage. Examination shows localized tenderness over the plantar aspect of the first metatarsophalangeal (MTP) joint and pain with passive motion. What is the primary mechanism resulting in tearing of the plantar plate complex?

In a displaced intra-articular calcaneus fracture, the anteromedial (sustentaculum tali) fragment typically remains in its anatomic position relative to the talus despite severe displacement of the tuberosity. Which structure is primarily responsible for securing this 'constant' fragment to the talus?

A 65-year-old male presents with severe pain and stiffness in his right great toe. Clinical examination reveals palpable dorsal osteophytes and pain throughout the arc of first MTP joint motion. Radiographs show complete joint space obliteration and dorsal osteophytosis. What is the most reliable definitive surgical treatment?

A 58-year-old patient with poorly controlled type 2 diabetes presents with a chronic, non-healing neuropathic ulcer on the plantar forefoot. Which of the following non-invasive vascular studies indicates the highest likelihood of successful wound healing?

A 45-year-old female complains of sharp, burning pain radiating to her 3rd and 4th toes, worsening with tight-fitting shoes. A positive Mulder's click is elicited. If the offending lesion is surgically excised, what is the classic histologic finding on pathology?

A patient presents with burning pain and numbness on the plantar aspect of the foot that worsens with prolonged standing. Tinel's sign is positive when percussing the retromalleolar groove behind the medial malleolus. Which nerve is compressed within the tarsal tunnel?

A 24-year-old athlete sustains a hyperplantarflexion injury to his foot. On examination, he has significant swelling over the midfoot and plantar ecchymosis. Weight-bearing radiographs demonstrate a 2.5 mm diastasis between the bases of the first and second metatarsals. What is the primary stabilizing structure of the disrupted joint complex?

A 28-year-old man falls from a height and sustains a Hawkins type II fracture of the talar neck. Which of the following best describes the disruption of blood supply associated with this specific injury pattern?

In adult acquired flatfoot deformity (posterior tibial tendon dysfunction), the spring ligament complex is often attenuated. Which specific band of the spring ligament is the primary static stabilizer of the talonavicular joint and is most commonly torn?

A 50-year-old woman presents with dorsal forefoot pain and limited hallux extension. Radiographs show a dorsal osteophyte on the first metatarsal head and joint space narrowing on the dorsal half of the joint, but preservation of the plantar joint space. She has 30 degrees of dorsiflexion. What is the most appropriate surgical intervention if conservative management fails?

When performing an extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, full-thickness flaps are developed. Which nerve is most at risk of iatrogenic injury if the vertical limb of the incision is placed too anteriorly?

A 45-year-old woman complains of burning pain in her forefoot that radiates into her toes, exacerbated by wearing tight shoes. A clinical diagnosis of Morton's neuroma is established. This pathology most commonly occurs in the third intermetatarsal space because:

A collegiate football player presents with severe pain at the base of his great toe after being tackled while his foot was planted and his heel raised. MRI confirms a severe "Turf Toe" injury. Which of the following anatomic structures is primarily disrupted in this condition?

During surgical fixation of a lateral malleolus fracture, the orthopedic surgeon performs a "Cotton test" to dynamically evaluate the integrity of the distal tibiofibular syndesmosis. This intraoperative test involves:

A 65-year-old man undergoes surgical debridement for chronic insertional Achilles tendinopathy with a large Haglund's deformity. Intraoperatively, the surgeon must detach 60% of the Achilles tendon insertion to completely resect the diseased tendinosis and the calcaneal exostosis. What is the most appropriate next step in surgical 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 50-year-old woman presents with progressive medial foot pain and loss of her arch. On examination, she has a flexible valgus hindfoot and pronounced forefoot abduction. Weight-bearing radiographs demonstrate greater than 40% talonavicular uncoverage. What is the most appropriate surgical management?

A 45-year-old woman presents with pain and progressive medial deviation of her great toe one year following a distal chevron osteotomy and lateral soft tissue release for hallux valgus. What intraoperative technical error most commonly contributes to this complication?