8. Foot and Ankle MCQs

A 22-year-old female ballet dancer presents with posteromedial ankle pain, exacerbated by going en pointe. She notes a triggering sensation in her great toe. Which of the following is the most likely diagnosis?

A 68-year-old male presents with an acute Achilles tendon rupture sustained while playing tennis. He has a past medical history of hypertension and well-controlled diabetes. He is moderately active but prefers avoiding surgery. Which of the following is the most appropriate management, considering current evidence regarding nonoperative versus operative treatment in this demographic?

A 55-year-old construction worker presents with end-stage post-traumatic ankle osteoarthritis. He has failed standard NSAID therapy and intra-articular corticosteroid injections. He wishes to delay surgery. Which of the following orthotic modifications is most effective for alleviating his pain during ambulation?

A 24-year-old athlete sustains a purely ligamentous Lisfranc injury involving the first, second, and third tarsometatarsal joints with 3 mm of diastasis, as seen on weight-bearing radiographs.

Based on current literature, which of the following surgical interventions provides the best long-term functional outcome?

A 60-year-old woman complains of severe pain and stiffness in her great toe that limits her walking. Examination reveals less than 10 degrees of dorsiflexion at the first metatarsophalangeal (MTP) joint and mid-arc pain. Radiographs demonstrate severe joint space narrowing, a large dorsal osteophyte, and subchondral sclerosis. What is the gold standard operative treatment?

A 54-year-old woman presents with progressive flattening of her left foot and medial ankle pain. Examination shows a flexible flatfoot, inability to perform a single-limb heel rise, and excessive forefoot abduction. Radiographs show greater than 40% talonavicular uncoverage. What surgical reconstruction is most appropriate?

A 61-year-old male with poorly controlled type 2 diabetes presents with a globally swollen, erythematous, and warm right foot. He denies trauma. Pulses are palpable, and sensation to a 5.07 Semmes-Weinstein monofilament is absent. Radiographs show periarticular debris and early fragmentation at the tarsometatarsal joints. His ESR and CRP are normal. What is the most appropriate initial management?

A 35-year-old construction worker falls from a ladder and sustains a severely displaced, intra-articular calcaneus fracture. He is scheduled for open reduction and internal fixation utilizing a standard extensile lateral approach. During the horizontal limb of the incision, which of the following structures is at greatest risk of iatrogenic injury?

A 24-year-old collegiate football player hyperplantarflexes his foot with an axial load during a tackle. Weight-bearing radiographs reveal a 'fleck sign' and 3 mm of widening between the medial and middle cuneiforms. What is the primary ligamentous restraint that has been disrupted?

A 65-year-old woman with post-traumatic end-stage ankle osteoarthritis is being evaluated for a total ankle replacement (TAR). Which of the following conditions is considered an absolute contraindication for this procedure?

A 40-year-old male sustains an acute, closed Achilles tendon rupture while playing tennis. He is discussing operative repair versus non-operative management with early functional rehabilitation. Based on recent literature, what is the most accurate statement regarding outcomes?

A 55-year-old female presents with progressive medial ankle pain and an acquired flatfoot deformity. Examination reveals a flexible hindfoot valgus, inability to perform a single-leg heel rise, and significant forefoot abduction (Stage IIb posterior tibial tendon dysfunction). Which combination of procedures is most appropriate?

A 45-year-old woman presents with a symptomatic hallux valgus deformity. Radiographs demonstrate a hallux valgus angle (HVA) of 38 degrees, an intermetatarsal angle (IMA) of 18 degrees, and hypermobility at the first tarsometatarsal (TMT) joint. What is the most appropriate surgical treatment?

A 50-year-old man presents with dorsal pain in his great toe, especially during terminal stance phase. Examination reveals pain at the extremes of dorsiflexion, but no pain during mid-range motion. Radiographs reveal dorsal osteophytes at the first MTP joint with mild to moderate joint space narrowing (Coughlin and Shurnas Grade 2). What is the recommended primary surgical intervention after failed conservative care?

A 58-year-old male with poorly controlled diabetes presents with a unilaterally erythematous, warm, and swollen foot. He denies any trauma. Radiographs reveal early fragmentation, periarticular debris, and subluxation of the tarsometatarsal joints. There are no open ulcers. What is the most appropriate initial management?

A 20-year-old cross-country runner presents with an insidious onset of dorsal midfoot pain. Initial radiographs are unremarkable, but an MRI demonstrates a non-displaced fracture in the central third of the tarsal navicular. What is the most appropriate treatment?

A 24-year-old athlete sustains an axial load injury to a plantarflexed foot. Non-weight-bearing radiographs of the foot are interpreted as normal, but the patient has severe midfoot pain and cannot bear weight. What is the next best step in evaluation?

A 62-year-old woman complains of dorsal midfoot pain and limited toe-off during gait. Examination reveals severe pain with hallux dorsiflexion, which is limited to less than 10 degrees. Radiographs show diffuse joint space loss across the entire first metatarsophalangeal joint (Coughlin Stage 3) and prominent dorsal osteophytes. She has failed rigid shoe modifications. What is the best operative management?

A 55-year-old woman presents with progressive flattening of her left foot and medial ankle pain. Examination reveals a flexible hindfoot valgus, an inability to perform a single-leg heel rise, and a positive 'too-many-toes' sign. Conservative management has failed. What is the most appropriate surgical intervention?