8. Foot and Ankle MCQs

A professional wide receiver sustains a severe hyperextension injury to his first MTP joint ('turf toe'). MRI demonstrates a complete disruption of the plantar plate with 4 mm of proximal retraction of the sesamoids. Which of the following is an absolute indication for operative repair in turf toe injuries?

During the physical examination of a patient with a suspected syndesmotic injury, the examiner stabilizes the tibia and externally rotates the foot. This test primarily stresses which of the following syndesmotic ligaments?

A 58-year-old male with long-standing, poorly controlled type 2 diabetes presents with a red, hot, swollen right foot. He denies any recent trauma or systemic symptoms. White blood cell count and ESR are normal. Radiographs reveal soft tissue swelling, periarticular osteopenia, and early fragmentation at the tarsometatarsal joints. What is the most appropriate initial management?

A 40-year-old female presents with a painful bunion. Clinical examination and weight-bearing radiographs demonstrate a hallux valgus angle (HVA) of 28 degrees and an intermetatarsal angle (IMA) of 11 degrees. The first tarsometatarsal joint shows no hypermobility. Which of the following procedures is most appropriate?

A 35-year-old woman complains of burning pain in the plantar aspect of her forefoot that radiates into her third and fourth toes. Symptoms worsen with tight shoes and improve when barefoot. A Mulder's click is present. Which of the following best describes the underlying histologic pathology of her condition?

A 32-year-old male sustains an acute Achilles tendon rupture. He is managed with a functional rehabilitation protocol. Compared to surgical repair, which of the following is true regarding his expected outcome?

A 24-year-old football player sustains an axial load injury to a plantarflexed foot. Clinical examination reveals plantar ecchymosis. Weight-bearing radiographs demonstrate a 3 mm diastasis between the base of the first and second metatarsals. What is the most appropriate surgical management for a purely ligamentous injury in this patient?

A 55-year-old woman presents with medial ankle pain and a progressive flatfoot deformity. She can perform a single-leg heel rise but it is painful and accompanied by hindfoot valgus. On examination, the deformity is entirely flexible. Which of the following procedures is most appropriate?

During open reduction and internal fixation of a pronation-external rotation ankle fracture, the syndesmosis is found to be unstable after fibular fixation. Two trans-syndesmotic screws are placed. According to recent evidence, what is the recommendation regarding routine removal of these screws?

A 60-year-old diabetic male presents with a red, hot, swollen unilateral foot. There are no open ulcers. To clinically differentiate acute Charcot arthropathy from a deep infection, which of the following bedside tests is most useful?

A 45-year-old woman presents with a symptomatic hallux valgus deformity. Radiographs show a hallux valgus angle (HVA) of 26 degrees and an intermetatarsal angle (IMA) of 11 degrees. Clinical examination reveals hypermobility of the first tarsometatarsal joint. What is the most appropriate surgical procedure?

A 60-year-old man complains of severe pain and stiffness in his right great toe. Examination reveals less than 10 degrees of dorsiflexion with pain throughout the entire range of motion. Radiographs show joint space obliteration and large dorsal osteophytes of the first MTP joint. What is the most reliable surgical treatment for pain relief?

A 55-year-old female presents with progressive medial ankle pain and a severe flatfoot deformity. Examination reveals a flexible hindfoot and forefoot abduction with greater than 30 percent talonavicular uncoverage on weight-bearing radiographs. She cannot perform a single-leg heel rise. What is the most appropriate surgical management for this Stage IIb adult acquired flatfoot deformity?

A 22-year-old collegiate football player sustains a hyperplantarflexion injury to his midfoot. He complains of severe midfoot pain and inability to bear weight. Non-weight-bearing radiographs of the foot appear completely normal. What is the most appropriate next step in confirming the diagnosis of a subtle Lisfranc injury?

A 40-year-old male is undergoing a percutaneous repair of an acute Achilles tendon rupture. During the passage of sutures in the proximal aspect of the tendon, which nerve is at the greatest risk of iatrogenic injury, and what is its typical anatomical relationship to the tendon?

When performing open reduction and internal fixation of a displaced intra-articular calcaneus fracture with a flattened Bohler angle, what is the primary biomechanical and anatomical goal of the reconstruction?

A 45-year-old female presents with a painful bunion. Radiographs reveal a hallux valgus angle (HVA) of 45 degrees, an intermetatarsal angle (IMA) of 18 degrees, and obvious hypermobility at the first tarsometatarsal (TMT) joint on clinical exam. What is the most appropriate surgical intervention?

A 28-year-old downhill skier sustains an acute lateral ankle injury characterized by a popping sensation and subsequent retromalleolar pain. Examination reveals a subluxating peroneus brevis tendon. What is the most common mechanism of injury leading to acute disruption of the superior peroneal retinaculum (SPR)?

A 60-year-old male with poorly controlled diabetes presents with a unilaterally red, hot, and swollen foot. There is no open ulceration. Radiographs show early bone fragmentation and joint subluxation at the tarsometatarsal joints. Inflammatory markers are mildly elevated. What is the most appropriate initial management?