8. Foot and Ankle MCQs

A 60-year-old patient with poorly controlled type 2 diabetes presents with a unilaterally swollen, red, and warm foot without any open ulceration or history of trauma. Radiographs reveal fragmentation and periarticular debris around the tarsometatarsal joints.

What is the gold standard initial management?

A 22-year-old alpine skier reports a painful "snapping" sensation behind his lateral malleolus during a run. Examination reveals swelling and tenderness posterior to the lateral malleolus, with visible subluxation of tendons upon resisted foot eversion. Which retinacular structure is most likely disrupted?

A 45-year-old woman complains of burning pain in the third web space of her foot, which radiates into her toes. A "click" is palpated when compressing the metatarsal heads together (Mulder's sign). She has failed conservative management. When proceeding with surgical excision, what is the primary advantage of a dorsal approach over a plantar approach?

A 30-year-old runner presents with deep, aching ankle pain 6 months after a severe ankle sprain. MRI confirms an osteochondral lesion on the posteromedial aspect of the talar dome. Based on classic descriptions of injury mechanics, this specific lesion is most commonly caused by which of the following mechanisms?

A patient presents with burning and tingling on the plantar aspect of the foot, which worsens at night. Tinel's sign is positive over the posteromedial ankle. Tarsal tunnel syndrome is suspected. This syndrome is caused by entrapment of which nerve beneath which anatomic structure?

A 14-year-old boy presents with bilateral cavovarus feet. A Coleman block test is performed by placing his heel and lateral border of the foot on a block, allowing the first metatarsal to hang free. Upon doing so, his hindfoot varus corrects to neutral. What does this test result indicate regarding his deformity?

A 68-year-old man with end-stage post-traumatic ankle arthritis is discussing surgical options with his orthopedic surgeon. He is considering a total ankle arthroplasty (TAA) versus an ankle arthrodesis. Which of the following conditions is considered an absolute contraindication to performing a total ankle arthroplasty?

A 22-year-old collegiate football player sustains a high-energy axial load injury to his plantarflexed foot. Weight-bearing radiographs and MRI confirm a purely ligamentous Lisfranc injury with 3 mm of widening between the medial and middle cuneiforms. What is the most appropriate surgical management to minimize the risk of long-term disability and reoperation?

A 35-year-old man sustains a Hawkins Type III talar neck fracture following a motor vehicle collision. Which of the following blood vessels, which provides the dominant blood supply to the talar body, is most likely disrupted in this injury?

A 45-year-old woman presents with a symptomatic hallux valgus deformity. Clinical examination reveals profound hypermobility of the first tarsometatarsal (TMT) joint. Which of the following surgical procedures is most appropriate to address both the deformity and the underlying pathomechanics?

A 28-year-old aggressive skier experiences a sudden "pop" behind her lateral malleolus while aggressively edging. She now reports a painful snapping sensation over the lateral ankle with active dorsiflexion and eversion. Disruption of which of the following structures is the primary cause of this condition?

A 55-year-old woman presents with progressive medial ankle pain and a new-onset flatfoot deformity. She is unable to perform a single-limb heel rise on the affected side, but her hindfoot remains passively correctable to neutral. What is the most appropriate surgical treatment?

An 18-year-old man with Charcot-Marie-Tooth disease presents with bilateral progressive cavovarus foot deformities. A Coleman block test demonstrates that the hindfoot varus is fully correctable. Which of the following muscle imbalances is the primary driver of the plantarflexed first ray in this patient?

A 50-year-old man undergoes surgical debridement for chronic, refractory insertional Achilles tendinopathy with a prominent Haglund's deformity. Intraoperatively, extensive calcifications are removed, resulting in detachment of 60% of the Achilles tendon insertion. What is the most appropriate next step in the procedure?

During a pronation-external rotation (PER) injury of the ankle, the distal tibiofibular syndesmosis is subjected to significant stress. Which of the following syndesmotic ligaments is typically the first to rupture in this sequence?

A 60-year-old man presents with dorsal midfoot pain during push-off. Radiographs reveal a dorsal osteophyte at the first metatarsophalangeal (MTP) joint, mild dorsal joint space narrowing, but preservation of the plantar articular cartilage (Coughlin and Shurnas Grade 2). He has failed conservative management. What is the most appropriate surgical intervention?

A 55-year-old patient with poorly controlled type 2 diabetes presents with a unilaterally swollen, erythematous, and warm foot. There are no skin breaks or ulcers, and inflammatory markers are normal. Radiographs demonstrate fragmentation, periarticular debris, and subluxation at the tarsometatarsal joints. What is the most appropriate immediate management?

During the surgical reconstruction of a severe Lisfranc injury, anatomic restoration of the primary Lisfranc ligament is essential. What are the correct anatomical attachments of this ligament?

A 45-year-old woman presents with severe hallux valgus. Clinical examination reveals hypermobility of the first tarsometatarsal (TMT) joint. Radiographs show an intermetatarsal angle (IMA) of 19 degrees and a hallux valgus angle (HVA) of 45 degrees. Which of the following surgical procedures is most appropriate?

A 55-year-old woman presents with a flexible flatfoot deformity, marked forefoot abduction, and an inability to perform a single-leg heel raise. Radiographs demonstrate more than 40% uncoverage of the talar head. What is the most appropriate surgical management for this Stage IIb posterior tibial tendon dysfunction?