8. Foot and Ankle MCQs

A football player presents with severe pain and swelling at the plantar aspect of the first MTP joint after a forced hyperextension injury. MRI confirms a complete rupture of the plantar plate with retraction of the sesamoids. What is the most appropriate treatment?

A 45-year-old female twists her ankle. X-rays show an isolated displaced lateral malleolus fracture with a medial clear space of 6 mm on the gravity stress view. What does the widened medial clear space indicate?

A 55-year-old male with post-traumatic end-stage ankle osteoarthritis and a normal BMI is deciding between total ankle arthroplasty (TAA) and ankle arthrodesis. Which of the following is an absolute contraindication to total ankle arthroplasty?

A 24-year-old athlete sustains an external rotation ankle injury. Radiographs are normal, but weight-bearing causes pain. MRI shows disruption of the anterior inferior tibiofibular ligament (AITFL). During surgical fixation, what is the most appropriate position of the ankle when tightening the syndesmotic screws?

A 35-year-old male sustains an acute Achilles tendon rupture. He opts for nonoperative management utilizing a functional rehabilitation protocol. Compared to standard surgical repair, what is the expected clinical outcome regarding re-rupture and wound complications?

A 20-year-old track athlete presents with chronic midfoot pain. A CT scan reveals a non-displaced stress fracture of the central third of the navicular. What anatomical factor contributes most to the high risk of nonunion in this specific area?

A 28-year-old football player presents with severe midfoot pain after a hyper-plantarflexion injury. An AP radiograph demonstrates a 'fleck sign' in the first intermetatarsal space. This radiographic sign represents an avulsion fracture at the attachment of a ligament that connects which two bones?

A 55-year-old female presents with progressive medial ankle pain and a new-onset flatfoot deformity. Examination shows weakness with single-leg heel rise but a flexible hindfoot that corrects to neutral. What is the most appropriate surgical intervention?

A 60-year-old diabetic male presents with a swollen, erythematous, and warm unilateral foot without an open ulcer or signs of systemic infection. Radiographs show osseous fragmentation and joint subluxation at the midfoot. What is the most appropriate initial management?

A 45-year-old female presents with a painful bunion. Weight-bearing 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. Which surgical procedure is most indicated?

A 12-year-old boy complains of frequent ankle sprains and has a rigid, painful flatfoot. Oblique radiographs of the foot reveal an elongated anterior process of the calcaneus, commonly known as the 'anteater sign.' This finding points to which diagnosis?

A 15-year-old female cross-country runner complains of localized, progressive pain in her forefoot over the second metatarsophalangeal joint. Radiographs show flattening, sclerosis, and fragmentation of the second metatarsal head. What is the most likely diagnosis?

A 65-year-old female with long-standing, poorly controlled rheumatoid arthritis presents with severe forefoot pain, significant hallux valgus, and dorsal dislocation of the lesser metatarsophalangeal joints. What is the classic surgical reconstruction for this advanced presentation?

During open reduction and internal fixation of a Weber C ankle fracture, the surgeon performs an intraoperative external rotation stress test (Cotton test) that demonstrates widening of the medial clear space. This finding indicates disruption of the syndesmosis and incompetence of which other critical structure?

A 45-year-old teacher presents with severe heel pain, notably worst during her first steps out of bed in the morning. Examination shows localized tenderness over the medial calcaneal tubercle. She has tried NSAIDs for 2 weeks with minimal relief. What is the next most appropriate step in management?

When utilizing an extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, which nerve is at the greatest risk of iatrogenic injury during the surgical exposure?

A 35-year-old female sustains a purely ligamentous Lisfranc injury. She is an active runner who wishes to return to high-impact activities. Which surgical management strategy is associated with the best mid-to-long-term functional outcomes and the lowest reoperation rate?

A 15-year-old male with Charcot-Marie-Tooth disease presents with a rigid bilateral pes cavovarus deformity. During examination, a Coleman block test is performed, and the hindfoot varus completely corrects to neutral. This clinical finding indicates that the hindfoot deformity is primarily driven by which of the following?

A 55-year-old female presents with medial foot pain and progressive flattening of her arch. She is unable to perform a single-leg heel rise. Examination reveals flexible hindfoot valgus and midfoot abduction. Which surgical intervention is most appropriate for this stage of Adult Acquired Flatfoot Deformity (Stage II)?