8. Foot and Ankle MCQs

During the extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, the surgeon must be careful to protect a neurovascular structure located immediately deep to the peroneal tendons at the level of the calcaneocuboid joint. What is this structure?

A 52-year-old patient with poorly controlled diabetes presents with a red, hot, swollen left foot for 2 weeks. There is no history of trauma. Radiographs show fragmentation, periarticular debris, and subluxation at the midfoot. What is the most appropriate initial management?

A 60-year-old woman complains of progressive medial left ankle pain and a collapsing arch. On examination, she is unable to perform a single-leg heel raise on the left. Radiographs show a talonavicular uncoverage of 30% but preserved joint spaces and flexible hindfoot valgus. Which of the following is the most appropriate surgical treatment?

A 15-year-old boy with Charcot-Marie-Tooth disease presents with bilateral cavovarus foot deformities. A Coleman block test is performed and the hindfoot corrects to neutral. What does this indicate about his deformity?

A 13-year-old boy presents with frequent ankle sprains and rigid flatfeet. Radiographs reveal an elongated anterior process of the calcaneus (the "anteater nose" sign). Which of the following is the most likely diagnosis?

A 28-year-old skier presents with lateral ankle pain and a snapping sensation behind the fibula following an acute dorsiflexion injury. Examination reveals apprehension and palpable subluxation of tendons over the lateral malleolus with resisted eversion. Which structure is most likely injured?

During fixation of a pronation-external rotation ankle fracture, the surgeon performs a Cotton test which demonstrates widening of the medial clear space and the tibiofibular clear space. A syndesmotic screw is planned. Which of the following statements regarding syndesmotic screw fixation is most accurate?

The Lisfranc ligament complex is critical for midfoot stability. Which of the following correctly describes the anatomical attachments of the primary interosseous Lisfranc ligament?

A 42-year-old man sustains a complete acute rupture of the Achilles tendon. The injury occurred in the hypovascular "watershed" region. At what distance proximal to the calcaneal insertion does this hypovascular zone typically occur?

A 28-year-old professional rugby player sustains a purely ligamentous Lisfranc injury after an axial load to a plantarflexed foot. He elects to undergo surgical intervention. According to recent literature, which of the following is the primary advantage of primary arthrodesis over open reduction and internal fixation (ORIF) for this specific injury pattern?

A 55-year-old woman presents with progressive medial foot pain and a "fallen arch." Examination reveals a flexible flatfoot deformity with an inability to perform a single-leg heel rise. Weight-bearing radiographs show 45% uncovering of the talonavicular joint. Which of the following surgical combinations is most appropriate?

A 16-year-old boy with Charcot-Marie-Tooth (CMT) disease presents with bilateral progressive cavovarus foot deformities. A Coleman block test normalizes the hindfoot varus. Which of the following muscle imbalances is the primary initiator of this deformity?

A 32-year-old recreational athlete sustains an acute mid-substance Achilles tendon rupture. He elects to undergo percutaneous surgical repair to minimize scar size. During this procedure, which of the following structures is at greatest risk of iatrogenic injury?

A 52-year-old woman presents with severe bunion pain. Clinical examination demonstrates gross sagittal plane hypermobility of the first tarsometatarsal (TMT) joint. Radiographs show a hallux valgus angle of 42 degrees and an intermetatarsal angle (IMA) of 18 degrees. Which of the following procedures is most appropriate to minimize recurrence?

A trauma surgeon is performing a transolecranon approach for the open reduction and internal fixation of an intercondylar distal humerus fracture (AO type 13-C3). To optimize healing and joint stability, what is the preferred osteotomy shape and orientation?

During a tarsal tunnel release, the surgeon sequentially identifies structures from anteromedial to posterolateral behind the medial malleolus. Which structure lies immediately posterior to the flexor digitorum longus (FDL) tendon?

When harvesting an autogenous structural bone graft from the medial distal tibia, a longitudinal incision is typically made over the medial aspect of the medial malleolus. Which structure is most susceptible to iatrogenic injury during the superficial exposure in this region?

A patient undergoes a minimally invasive percutaneous repair of an acute Achilles tendon rupture using a specialized passing jig. Following surgery, the patient reports severe lateral foot numbness and radiating pain. Entrapment of which nerve by a proximolateral locking suture most likely occurred?

When performing an extensile lateral approach for an intra-articular calcaneus fracture, the peroneal tendons must be mobilized in the full-thickness flap. At the level of the fibular tubercle (trochlea) on the lateral calcaneus, what is the anatomical relationship of the peroneal tendons?

A patient requires a surgical release for tarsal tunnel syndrome. The flexor retinaculum is divided. What is the correct anterior-to-posterior (medial-to-lateral) order of the structures passing behind the medial malleolus?