8. Foot and Ankle MCQs

A 52-year-old man who was treated non-operatively for a displaced intra-articular calcaneus fracture 2 years ago now complains of persistent, severe lateral ankle pain and an inability to fit into narrow shoes. Pain is exacerbated by walking on uneven ground. What is the most likely anatomic cause of his current symptoms?

A 24-year-old football player sustains a midfoot injury during a game. Weight-bearing radiographs show 3 mm of widening between the base of the first and second metatarsals. What is the most appropriate definitive management for this purely ligamentous Lisfranc injury in an elite athlete?

A 55-year-old poorly controlled diabetic patient presents with a swollen, erythematous, and warm left foot and ankle but no open wounds. Radiographs demonstrate periarticular debris, fragmentation, and subluxation of the midfoot. What is the most appropriate initial treatment?

A 30-year-old man sustains a lateral subtalar dislocation after a fall from a height. Closed reduction in the emergency department is unsuccessful. Which of the following anatomic structures is most likely blocking the reduction?

A 45-year-old woman presents with medial ankle pain and a progressive flatfoot deformity. Examination reveals a "too many toes" sign and an inability to perform a single-leg heel rise. The deformity is passively correctable. What is the most appropriate surgical treatment after failed conservative measures?

A 14-year-old boy presents with recurrent lateral ankle sprains and rigid flatfeet. Subtalar motion is markedly decreased. Oblique radiographs of the foot reveal an "anteater sign." Which of the following conditions is most likely present?

A 60-year-old man presents with dorsal midfoot pain and limited dorsal extension of the great toe. Radiographs show significant joint space narrowing of the first metatarsophalangeal joint with large dorsal osteophytes. He fails conservative management. What is the most reliable surgical option for long-term pain relief?

A 28-year-old skier experiences a sudden snapping sensation over the lateral aspect of her ankle during a fall. Examination reveals tenderness over the posterior fibula and a palpable subluxation of the tendons with resisted foot eversion. What is the primary anatomical structure injured in this condition?

A 45-year-old obese man receives a third corticosteroid injection for chronic plantar fasciitis. Two weeks later, he feels a sudden "pop" in his heel while walking. He notices decreased arch height and an improvement in his chronic heel pain, but now has lateral column foot pain. What has most likely occurred?

A 40-year-old woman has a symptomatic bunion. Radiographs reveal a hallux valgus angle (HVA) of 45 degrees and an intermetatarsal angle (IMA) of 18 degrees. There is no hypermobility of the first tarsometatarsal joint. What is the most appropriate surgical approach?

A 55-year-old man presents with persistent weakness in ankle plantar flexion 4 months after feeling a 'pop' in his calf during a tennis match. MRI confirms a chronic Achilles tendon rupture with a 6-cm gap between the tendon ends. Which of the following is the most appropriate surgical management for this patient?

A 28-year-old hockey player sustains a high ankle sprain. Intraoperative stress testing reveals gross syndesmotic instability, and the patient undergoes surgical stabilization. Which of the following factors is the most significant predictor of poor long-term clinical outcome and post-traumatic arthritis in this patient?

A 34-year-old man falls from a ladder and sustains a displaced fracture of the talar neck. Radiographs demonstrate displacement of the talar neck with subluxation of the subtalar joint, while the tibiotalar and talonavicular joints remain congruent. According to the Hawkins classification, what is the historically reported risk of avascular necrosis (AVN) of the talar body for this specific injury pattern?

A 60-year-old woman with poorly controlled type 2 diabetes presents with a unilaterally swollen, warm, and erythematous right foot. She denies any open wounds or fevers. Radiographs demonstrate bony fragmentation, periarticular debris, and subluxation of the tarsometatarsal joints. What is the most appropriate initial management for this condition?

A 28-year-old male sustains an unstable syndesmotic injury requiring screw fixation. Which of the following ligaments provides the greatest contribution to the stability of the distal tibiofibular syndesmosis?

A 45-year-old female sustains a closed twisting injury to her right ankle. Radiographs demonstrate a displaced supination-external rotation (SER) IV ankle fracture. During surgical fixation, what is the most critical biomechanical factor in restoring normal tibiotalar contact area and pressures?

A 35-year-old male sustains a trimalleolar ankle fracture. The posterior malleolus fragment involves 15% of the articular surface. Following rigid fixation of the medial and lateral malleoli, intraoperative stress testing reveals persistent syndesmotic instability. What is the most biomechanically stable method to address this?

A 60-year-old diabetic patient undergoes open reduction and internal fixation for a displaced bimalleolar ankle fracture.

What postoperative protocol modification is most strongly recommended for this patient compared to a non-diabetic patient?

A 40-year-old male presents 8 months after non-operative treatment of an ankle fracture. He complains of chronic lateral pain and instability. Radiographs show a healed fibula that is shortened and externally rotated, with a widened medial clear space. What is the most appropriate surgical management?

In a suspected midfoot injury, subtle widening is noted between the 1st and 2nd metatarsal bases.

The critical Lisfranc ligament, responsible for stability in this region, anatomically connects which two structures?