8. Foot and Ankle MCQs

A 17-year-old patient presents with pain in the second toe. Pain becomes worse with exercise and has been present for 6 months. On examination, swelling is present around the metatarsophalangeal joint, and pain is present over the joint and upon squeezing the forefoot. Radiographic evaluation demonstrates a lucency in the second metatarsal head. The most likely cause of this condition is:

An 11-year-old girl presents with chronic foot pain. Her mother notes that her daughter has had flatfeet since birth, but the condition is worsening. The patient has aching in her foot, the arch of her foot, and her leg with walking and activities. She has been treated for 3 years with various orthotic arch supports. The foot is mobile and flexible on examination. Radiographs (Slide 1 and Slide 2) and a photograph (Slide 3) of her foot are presented. Which of the following surgical treatment alternatives is unacceptable in this patient:

A 12-year-old girl was successfully treated for a flexible flatfoot deformity on the left foot. A clinical photograph (Slide 1) of her foot and a lateral radiograph (Slide 2) are presented. What is the purpose of the implant noted under the talus in the radiograph:

The patient presented (Slide 1 and Slide 2) has a hereditary sensory motor neuropathy. Based upon the photographs, a surgeon should be able to determine the pattern of muscle weakness. Weakness in which muscle is most likely the cause of this deformity:

You are planning a tendon transfer to help correct deformity in a patient with hereditary sensory motor neuropathy. Which of the following muscles will be used for the transfer based upon the clinical appearance of the foot (Slide 1 and Slide 2):

Which combination of muscle weakness is typically associated with hereditary sensory motor neuropathy:

A 42-year-old man with diabetes presents for treatment of a swollen foot (Slide). He does not recall the onset of swelling, and he states that his foot is not painful. On examination, the foot is hot to touch and swollen. Upon radiographic examination, no deformities are evident. Which of the following treatment options should be used next:

A 29-year-old woman presents for treatment of a swollen foot. Although her foot is not painful, it has been swollen for 2 weeks. The patient walks into the office without any assistive device. On examination, the foot is swollen and warm. The patient does not have protective sensation in the foot, and she denies a history of diabetes and does not have a clinically relevant medical history. A radiograph of her foot is presented (Slide). Which of the following tests will be most helpful in determining the etiology of her condition:

A patient with diabetes and severe peripheral neuropathy has been treated for a C harcot ankle deformity for 9 months (Slide 1, Slide 2, and Slide 3). An ankle foot orthosis has been used for 4 months. No skin breakdown occurred in the brace. Swelling is present but has decreased over the past month. Ankle range of motion is limited, and crepitus is present upon examination of the ankle. Which surgical procedure is most consistent with the future treatment of this patient:

An 83-year-old woman presents for treatment of a painful second toe deformity. The hallux, the bunion, and the third toe are not painful. A fixed crossover toe deformity is present (Slide), with a dislocation of the second metatarsophalangeal joint noted radiographically. Which procedure is likely to give the patient rapid pain relief:

A 60-year-old man experiences pain under the lesser metatarsal heads. Prominence of the metatarsal heads under the second, third, and fourth metatarsal is noted, as well as associated fixed claw toe deformities (Slide). The etiology of the foot pain is:

A patient presents with a claw toe deformity (Slide). What is the strongest flexor of the metatarsophalangeal joint, which in this patient is not functioning adequately:

A 54-year-old woman presents for treatment of an ulcer (Slide). She has diabetes, no protective sensation, and slight deformity of the foot. There is no inflammation of the foot and no purulent drainage. Slight serous oozing is present daily. Initial evaluation and treatment should consist of:

A 63-year-old patient underwent a triple arthrodesis for correction of flatfoot deformity. He presents with continued ankle pain, as well as a hindfoot valgus deformity. The ankle deformity is flexible, and the joint can be reduced. All of the following are reasonable surgical alternatives as a single or staged procedure with the exception of:

A 34-year-old patient presents for treatment of painful ankle arthritis. Deformity of the ankle is present with posttraumatic arthritis and 20° of varus deformity as a result of erosion of the distal tibial plafond. There is minimal motion of the subtalar joint, and the forefoot is plantigrade. You plan an ankle arthrodesis. In addition to the position of the ankle arthrodesis, what additional procedure should you consider:

A 26-year-old woman presents for treatment of ankle arthritis following trauma. She is an active individual despite her arthritis. On examination, her foot is fixed in equinus, no ankle motion is present, and the motion in the subtalar joint is normal. Ankle arthritis is noted radiographically. In a preoperative discussion, she states the desire to have as mobile a foot as possible, wear high heel shoes, and participate in realistic exercise activities. You perform an ankle arthrodesis. What is the ideal position for the arthrodesis:

A 22-year-old man has experienced pain in his foot and ankle for 10 years. His radiographs are presented (Slide 1 and Slide 2). The foot is flexible, and pain is present in the sinus tarsi and along the medial border of the foot. With the subtalar joint held in a reduced neutral position, the forefoot is in 15° of supination. You attempt orthotic arch supports and when these do not alleviate his pain, a brace is suggested. He refuses to wear a brace. You plan an osteotomy of the calcaneus with lengthening bone graft at the neck of the calcaneus (lateral column lengthening). The most common complication following this procedure is:

A 44-year-old obese man presents for treatment of acute ankle pain. He does not have a history of trauma or a systemic history of note. His opposite foot has had multiple episodes of acute pain in the past, lasting from 3 to 5 days. On examination, the ankle is warm, swollen, and exquisitely tender to palpation and any range of motion (Slide1, Slide 2, and Slide 3). Concerned about the source of pain, you aspirate the joint and send the sample for analysis. You expect to find:

This patient presents for treatment of a painful hallux varus deformity following correction of hallux valgus deformity (Slide). All of the following procedures may be acceptable surgical alternatives for correction of deformity with the exception of:

Which of the following is true concerning Achilles tendon ruptures: