8. Foot and Ankle MCQs

A 55-year-old male presents with dorsal foot pain localized to the first metatarsophalangeal (MTP) joint. Examination reveals a dorsal osteophyte and pain primarily at the end-ranges of dorsiflexion, with preserved mid-range motion (Coughlin Stage 2 Hallux Rigidus). Non-operative measures have failed. What is the most appropriate surgical treatment?

A 58-year-old patient with long-standing, poorly controlled diabetes presents with an acutely swollen, erythematous, and warm unilateral foot. Radiographs demonstrate periarticular fragmentation and debris at the tarsometatarsal joints. Elevation of the limb for 10 minutes leads to resolution of the erythema. What is the best initial management?

A 14-year-old boy is evaluated for recurrent ankle sprains and a rigid, painful flatfoot. On physical exam, subtalar motion is severely restricted. Which radiographic view is most sensitive for diagnosing the most likely pathology?

When comparing outcomes of Total Ankle Arthroplasty (TAA) versus ankle arthrodesis for end-stage ankle osteoarthritis, TAA has been shown in long-term studies to have which of the following relative advantages?

A 24-year-old snowboarder lands hard following a jump, sustaining a forceful dorsiflexion and inversion injury to the ankle. He has lateral ankle pain mimicking a severe sprain, but radiographs reveal a fracture. Which of the following fractures is pathognomonic for this mechanism?

A 45-year-old runner with recalcitrant plantar fasciitis undergoes a complete surgical release of the plantar fascia. Post-operatively, she complains of new-onset, severe lateral midfoot pain and a visibly flatter arch. This complication is most directly related to which of the following pathomechanical changes?

A 35-year-old male sustains a purely ligamentous Lisfranc injury. Current evidence suggests that when compared to open reduction and internal fixation (ORIF), primary arthrodesis of the first, second, and third tarsometatarsal joints for this specific injury pattern results in:

A 45-year-old woman complains of painful bunions. Weight-bearing radiographs reveal a hallux valgus angle (HVA) of 38 degrees and an intermetatarsal angle (IMA) of 16 degrees. There is no hypermobility of the first tarsometatarsal joint. What is the most appropriate surgical management?

A 55-year-old male presents with dorsal midfoot and first toe pain. Examination reveals a palpable dorsal osteophyte and restricted, painful dorsiflexion of the first metatarsophalangeal (MTP) joint. Radiographs show moderate joint space narrowing with large dorsal osteophytes, but the plantar joint space is preserved. He has failed nonoperative management. What is the most appropriate surgical treatment?

A 50-year-old woman presents with medial ankle pain and a progressively flattening arch. She is able to perform a single-leg heel rise but it is weak and painful. She has a flexible flatfoot deformity. Nonoperative management with a custom orthosis has failed. What is the most appropriate surgical intervention?

A 58-year-old diabetic patient presents with a swollen, erythematous, and warm right foot without open ulcerations. Laboratory studies show normal white blood cell count and slightly elevated ESR. Radiographs demonstrate fragmentation and subluxation of the midfoot. What is the most appropriate initial management?

In the Sanders classification for intra-articular calcaneus fractures, the severity and type are determined primarily by which of the following radiographic or advanced imaging views?

Which of the following is true regarding functional bracing (early functional rehabilitation) compared to surgical repair for acute Achilles tendon ruptures?

A 42-year-old female presents with severe pain in the forefoot, often described as feeling like she is walking on a pebble. The pain is worst in narrow shoes and relieves when barefoot. Examination reveals a palpable click when the metatarsal heads are squeezed together while applying plantar pressure to the webspace. Which webspace is most commonly affected?

A 62-year-old woman with end-stage post-traumatic ankle osteoarthritis is considering total ankle arthroplasty (TAA). Which of the following is considered an absolute contraindication to TAA?

A 48-year-old male runner complains of heel pain that is worst with the first few steps in the morning. Examination reveals point tenderness at the medial tuberosity of the calcaneus. Initial management has included rest, NSAIDs, and a prefabricated shoe insert, with minimal improvement after 4 weeks. What is the most appropriate next step in management?

Tarsal tunnel syndrome involves entrapment of the tibial nerve or its branches. The boundaries of the tarsal tunnel include the medial malleolus anteriorly, the calcaneus laterally, and which structure superficially?