8. Foot and Ankle MCQs

A 28-year-old male presents with a suspected syndesmotic injury following an external rotation ankle injury. During intraoperative assessment, a hook test reveals significant diastasis. Biomechanically, which of the following ligaments provides the greatest resistance to diastasis of the distal tibiofibular syndesmosis?

An orthopedic surgeon is performing an extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture. During the inferior horizontal limb of the incision, which neurological structure is at highest risk of iatrogenic injury?

A 22-year-old competitive skier presents with chronic posterolateral ankle pain and a snapping sensation behind the lateral malleolus. Examination demonstrates visible anterior subluxation of the retromalleolar tendons during resisted dorsiflexion and eversion. Attenuation or rupture of which structure is the primary cause of this condition?

A 60-year-old male presents with dorsal foot pain and stiffness of the great toe. Radiographs show a dorsal osteophyte at the first metatarsophalangeal (MTP) joint, but the joint space is relatively preserved with minimal subchondral sclerosis. Pain is reproduced strictly at terminal dorsiflexion. What is the most appropriate surgical treatment?

A 12-year-old boy presents with recurrent ankle sprains and a rigid, painful flatfoot. A lateral weight-bearing radiograph of the foot reveals a continuous bony bridge outlining the posterior talar dome and sustentaculum tali, often referred to as the 'C-sign'. Which of the following is the most appropriate initial management?

A 24-year-old female track athlete complains of vague dorsal midfoot pain that worsens with running. Radiographs are normal, but an MRI demonstrates an incomplete fracture through the central third of the navicular body. The pathophysiology of this fracture is heavily influenced by the region's blood supply. Which of the following best describes the vascularity of the navicular?

A 45-year-old male undergoes surgery for severe insertional Achilles tendinopathy and a large Haglund's deformity. Intraoperatively, after aggressive debridement of calcific tendinosis, approximately 60% of the Achilles tendon insertion is detached. What is the most appropriate next step in surgical management?

A 55-year-old male with poorly controlled type 2 diabetes presents with a red, hot, and swollen right foot. Radiographs demonstrate periarticular debris, osseous fragmentation, and subluxation of the tarsometatarsal joints. No ulcers or wounds are present. According to the Eichenholtz classification, what stage is this, and what is the best initial management?

A 16-year-old female ballet dancer presents with chronic pain localized to the plantar aspect of the second metatarsal head. Radiographs show flattening, sclerosis, and widening of the second metatarsal head. Which of the following is the underlying pathophysiology of this condition?

A 45-year-old distance runner presents with chronic medial heel pain that radiates into the plantar-lateral foot. The pain worsens toward the end of the day and lacks the classic 'first-step' morning stiffness. MRI of the foot is notable for isolated fatty atrophy of the abductor digiti minimi muscle. Entrapment of which nerve is most likely responsible?

A 35-year-old recreational athlete sustains an acute complete Achilles tendon rupture. After discussing treatment options, he opts for nonoperative management. What is the primary advantage of utilizing an early functional rehabilitation protocol compared to traditional cast immobilization?

A 52-year-old woman presents with medial ankle pain and a progressive flatfoot deformity. Examination reveals a flexible hindfoot with inability to perform a single-leg heel rise. Standing radiographs show greater than 40% uncoverage of the talonavicular joint. What is the best surgical management?

A 40-year-old manual laborer sustains a purely ligamentous Lisfranc injury involving the first, second, and third tarsometatarsal (TMT) joints. Which surgical treatment has shown superior long-term functional outcomes and lower reoperation rates for this specific injury pattern?

A 60-year-old woman presents with severe bunion pain. Radiographs reveal an intermetatarsal angle (IMA) of 22 degrees, a hallux valgus angle (HVA) of 55 degrees, and clinical hypermobility of the first tarsometatarsal (TMT) joint. What is the most appropriate surgical procedure?

A 45-year-old construction worker undergoes open reduction and internal fixation of a displaced intra-articular calcaneus fracture using an extensile lateral approach. Postoperatively, he reports numbness along the lateral border of his foot. Which nerve was most likely injured during the exposure?

A 12-year-old boy presents with recurrent ankle sprains and rigid, painful flatfeet. Oblique radiographs demonstrate the "anteater nose" sign. Nonoperative management has failed. What is the best initial operative intervention?

A 65-year-old man with end-stage post-traumatic ankle osteoarthritis is being evaluated for a total ankle arthroplasty (TAA). He has a well-aligned hindfoot but a history of prior osteomyelitis in the distal tibia that was successfully treated 10 years ago. Which of the following is an absolute contraindication to total ankle arthroplasty?

A 55-year-old poorly controlled diabetic patient presents with a warm, swollen, and erythematous right foot. Elevation of the foot above the heart for 10 minutes results in complete resolution of the erythema.

Radiographs reveal early midfoot fragmentation. What is the most appropriate initial management?

A 48-year-old man undergoes a dorsal cheilectomy for Grade 2 hallux rigidus. He reports pain primarily with push-off during terminal stance. To achieve a successful outcome, approximately how much of the dorsal articular surface of the first metatarsal head is typically resected?

A 28-year-old skier experiences a sudden forced dorsiflexion and inversion injury. He presents with pain posterior to the lateral malleolus and a snapping sensation when actively everting the foot. What anatomic structure is compromised in this injury?