8. Foot and Ankle MCQs

A 25-year-old professional soccer player presents after an external rotation injury to his right ankle. On examination, he is tender over the anterior inferior tibiofibular ligament (AITFL) and proximally along the interosseous membrane. The external rotation stress test is markedly positive. Weight-bearing radiographs show a tibiofibular clear space of 7 mm, and an MRI confirms a complete rupture of the AITFL and the interosseous ligament. What is the most appropriate management?

A 28-year-old male is brought to the emergency department after a high-speed motorcycle accident. He has a grossly deformed left knee that spontaneously reduces. Examination reveals a 3+ posterior drawer, 3+ Lachman, and significant varus laxity. Ankle-brachial index (ABI) is 0.85. What is the most appropriate next step in management regarding his vascular status?

A 24-year-old professional hockey player sustains a rotational injury to his right ankle. Radiographs show no fracture and a normal tibiofibular clear space. However, MRI reveals disruption of the anterior inferior tibiofibular ligament (AITFL) and interosseous membrane. Intraoperative fluoroscopy with a Cotton test shows 4 mm of diastasis. Which of the following is the most appropriate management?

A 35-year-old recreational basketball player sustains an acute Achilles tendon rupture 4 cm proximal to the calcaneal insertion. He undergoes surgical repair. During the procedure, whether open or minimally invasive, a specific nerve is at risk of iatrogenic injury. To minimize this risk, the surgeon should be most cautious when dissecting or passing sutures in which anatomic aspect of the Achilles tendon?

A 13-year-old boy presents with recurrent right ankle sprains and a rigid, painful flatfoot. Clinical examination reveals a lack of subtalar motion and peroneal spasticity. Computed tomography confirms a large, osseous talocalcaneal coalition involving the middle facet. The coalition involves approximately 60% of the posterior subtalar joint surface area, and there are moderate osteoarthritic changes in the posterior facet. What is the most appropriate surgical management?

A 32-month-old, obese boy presents with progressive bilateral bowing of the lower extremities.

Standing radiographs reveal bilateral genu varum, metaphyseal beaking, and an exact metaphyseal-diaphyseal angle of 20 degrees. He is diagnosed with Langenskiöld Stage II infantile Blount disease. What is the most appropriate initial management?

A 14-year-old male athlete presents with a rigid left flatfoot and a history of frequent ankle sprains. Examination shows marked restriction of subtalar motion and peroneal spasm.

A lateral weight-bearing radiograph displays an unbroken halo of sclerosis corresponding to the C-sign. Which anatomical region is primarily affected by the underlying pathology?

A 14-year-old boy presents with vague, deep medial hindfoot pain and a history of multiple ankle sprains. Physical examination reveals a rigid flatfoot with marked limitation of subtalar motion and peroneal spasticity. A lateral radiograph of the ankle demonstrates a continuous bony bridge extending from the posterior aspect of the talus to the calcaneus, creating a continuous 'C-sign'. What is the most likely diagnosis, and what is the best advanced imaging modality to define the pathoa-natomy?

A 12-year-old boy presents with a 6-month history of frequent lateral ankle sprains and deep hindfoot pain exacerbated by sports. Examination reveals a rigid flatfoot with absent subtalar motion and peroneal spasticity.

Lateral radiographs of the foot reveal a distinct 'C-sign'. What is the most likely anatomical location of the primary pathology?

A 14-year-old boy with spastic diplegic cerebral palsy presents with severe crouch gait. Physical examination reveals a popliteal angle of 80 degrees, knee flexion contractures of 15 degrees bilaterally, and severe planovalgus foot deformities. Radiographs demonstrate patella alta. Which of the following combinations of surgical procedures is most appropriate to address his knee pathology?

A 2.5-year-old girl is evaluated for bilateral bowlegs. Her BMI is in the 95th percentile. Radiographs reveal a metaphyseal-diaphyseal angle (Drennan's angle) of 18 degrees on the right and 19 degrees on the left. There is prominent medial metaphyseal beaking. What is the most appropriate initial management?

A 4-year-old boy with a history of bilateral idiopathic clubfeet treated successfully with the Ponseti method during infancy presents with recurrent intoeing on the right. During gait evaluation, he demonstrates dynamic supination of the right foot in the swing phase. Passive range of motion shows a supple foot that is easily correctable to neutral. Radiographs are unremarkable. What is the most appropriate next step in management?

A 13-year-old boy presents with chronic, vague midfoot aching and a history of frequent ankle sprains. Examination reveals a rigid, flat right foot with severely limited subtalar motion. Forced inversion elicits significant pain. Lateral foot radiographs demonstrate a 'C-sign'. A subsequent CT scan confirms a coalition involving less than 50% of the posterior facet with no degenerative changes. After failing 6 months of nonoperative management, including immobilization in a short leg cast, what is the recommended surgical procedure?

A 13-year-old boy presents with an insidious onset of right lateral foot pain and a history of recurrent ankle sprains. Examination shows a rigid flatfoot on the right side. A lateral radiograph demonstrates an elongated anterior process of the calcaneus (the "anteater nose" sign). Which of the following physical examination findings is most specific to this diagnosis?

A 13-year-old boy complains of recurrent ankle sprains and deep, aching midfoot pain. Physical examination reveals rigid, flat feet and decreased subtalar motion. Radiographs reveal a 'C-sign' on the lateral view. What is the most likely anatomic location of the pathology?

A 14-year-old boy presents to the emergency department after sustaining a twisting injury to his right ankle while skateboarding. Radiographs and a subsequent CT scan demonstrate a Salter-Harris III fracture of the anterolateral distal tibial epiphysis.

Which of the following ligamentous structures is responsible for avulsing this bony fragment?

A 13-year-old girl presents with a 1-year history of recurrent right ankle sprains and deep lateral hindfoot pain. On physical examination, she has a rigid pes planus deformity with peroneal spasticity and significantly limited subtalar motion.

Oblique radiographs of the right foot reveal an elongated anterior process of the calcaneus, often referred to as the 'anteater nose' sign. What is the most likely diagnosis?

A 30-month-old girl is evaluated for worsening bilateral genu varum and an evolving thrust during gait. Standing radiographs demonstrate medial metaphyseal beaking.

The metaphyseal-diaphyseal angle (MDA) is measured at 18 degrees on both sides. What is the most appropriate initial management?

A 4-week-old boy is undergoing serial casting using the Ponseti method for isolated, idiopathic congenital talipes equinovarus.

After 4 weeks of casts, the forefoot has been successfully abducted to 60 degrees. However, the heel remains in 15 degrees of equinus. What is the next most appropriate step in management?