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8. Foot and Ankle MCQs

Practice Set 228 of 353

This practice set contains high-yield board review questions covering key concepts in 8. Foot and Ankle. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 4541

Topic: 8. Foot and Ankle

A 28-year-old male undergoes open reduction and internal fixation for a displaced talar neck fracture sustained in a fall from a height. At his 8-week postoperative follow-up, an AP radiograph of the ankle demonstrates a distinct, continuous subchondral radiolucent band across the dome of the talus. What is the clinical significance of this radiographic finding?

. It represents the early stages of avascular necrosis of the talar body
. It indicates early hardware loosening and impending fixation failure
. It is a sign of deep infection and osteomyelitis of the talus
. It indicates that the talar body has maintained sufficient vascular supply
. It is pathognomonic for post-traumatic subtalar osteoarthritis

Correct Answer & Explanation

. It indicates that the talar body has maintained sufficient vascular supply

Explanation

The finding described is the Hawkins sign. It appears as a subchondral radiolucent band in the talar dome on an AP or mortise radiograph of the ankle, typically seen 6 to 8 weeks following a talar neck fracture. This radiolucency represents subchondral bone resorption (disuse osteopenia), which can only occur if the bone has an intact blood supply. Therefore, the presence of a positive Hawkins sign is a highly reliable indicator of preserved vascularity to the talar body, effectively ruling out early extensive avascular necrosis (AVN). The absence of this sign does not guarantee AVN, but its presence is a reassuring sign of viability.

Question 4542

Topic: 8. Foot and Ankle

Historically, acute Achilles tendon ruptures were treated surgically to minimize re-rupture rates, despite higher rates of soft-tissue complications. Based on high-quality randomized controlled trials (e.g., Willits et al.) utilizing modern early functional rehabilitation protocols, which of the following statements most accurately reflects the current understanding of operative versus non-operative management?

. Operative treatment offers a statistically significant reduction in re-rupture rates regardless of the rehabilitation protocol used
. Non-operative treatment results in a significant permanent loss of plantarflexion strength compared to operative treatment
. There is no clinically significant difference in re-rupture rates when early functional weight-bearing rehabilitation is utilized
. Operative treatment is associated with an unacceptably high rate of sural nerve injury even with modern percutaneous techniques
. Non-operative management requires a minimum of 12 weeks of strict non-weight-bearing to achieve comparable outcomes

Correct Answer & Explanation

. There is no clinically significant difference in re-rupture rates when early functional weight-bearing rehabilitation is utilized

Explanation

Recent high-quality, level I evidence (most notably the RCT by Willits et al.) has dramatically shifted the paradigm for treating acute Achilles tendon ruptures. When an early functional rehabilitation protocol (early weight-bearing and early mobilization in a brace) is employed, there is no statistically or clinically significant difference in the re-rupture rates between operative and non-operative groups. Furthermore, non-operative management avoids surgical complications such as deep infections and wound breakdown. Functional outcomes and strength are also comparable. Thus, non-operative treatment with functional rehab is increasingly favored for acute ruptures.

Question 4543

Topic: Midfoot & Hindfoot

A 38-year-old warehouse worker sustains a crush injury to his foot. Radiographs and a subsequent CT scan demonstrate a highly comminuted, intra-articular fracture-dislocation involving the first, second, and third tarsometatarsal joints (Lisfranc injury). The articular surfaces of the medial and middle cuneiforms are extensively fragmented and impacted. What is the most appropriate definitive surgical management to minimize the need for future procedures?

. Closed reduction and percutaneous pinning with K-wires
. Open reduction and internal fixation (ORIF) with transarticular solid screws
. Open reduction and internal fixation (ORIF) using dorsal spanning plates
. Primary arthrodesis of the first, second, and third tarsometatarsal joints
. External fixation spanning the midfoot to allow secondary healing

Correct Answer & Explanation

. Primary arthrodesis of the first, second, and third tarsometatarsal joints

Explanation

While Open Reduction and Internal Fixation (ORIF) has historically been the standard for bony Lisfranc injuries, primary arthrodesis is strongly indicated in specific scenarios to avoid post-traumatic osteoarthritis and subsequent revision surgery. The classic indications for primary arthrodesis of the medial columns (1st, 2nd, and 3rd TMT joints) in Lisfranc injuries include purely ligamentous injuries and injuries with severe, non-reconstructable intra-articular comminution. Given the extensive fragmentation and impaction of the articular surfaces in this patient, ORIF would almost certainly lead to early joint degeneration. Primary arthrodesis yields better mid- to long-term functional outcomes in this specific highly comminuted pattern.

Question 4544

Topic: 8. Foot and Ankle

A 12-year-old boy presents with a history of recurrent ankle sprains and a painful, rigid flatfoot. Radiographs demonstrate an 'anteater nose' sign on the lateral view. A CT scan confirms the diagnosis of a calcaneonavicular coalition. After 6 months of failed conservative management including casting, surgical resection is planned. To minimize the risk of coalition recurrence post-resection, which of the following autologous structures is most commonly utilized as interpositional material?

. Flexor hallucis longus (FHL) tendon
. Extensor digitorum brevis (EDB) muscle belly
. Peroneus brevis tendon
. Abductor hallucis muscle belly
. Plantaris tendon

Correct Answer & Explanation

. Extensor digitorum brevis (EDB) muscle belly

Explanation

The 'anteater nose' sign on a lateral radiograph is pathognomonic for a calcaneonavicular coalition. When conservative management fails, surgical resection of the coalition is indicated. To prevent re-ossification and recurrence of the coalition, interposition of biological material into the resection gap is a standard step. For a calcaneonavicular coalition, the extensor digitorum brevis (EDB) muscle belly is mobilized from its proximal attachment and interposed into the defect. In contrast, for talocalcaneal (middle facet) coalitions, a fat graft or a split portion of the flexor hallucis longus (FHL) tendon is typically used for interposition.

Question 4545

Topic: 8. Foot and Ankle

A 58-year-old male with a 15-year history of poorly controlled type 2 diabetes presents with a unilaterally swollen, red, and warm right foot. He reports no preceding trauma and denies fevers or chills. On examination, he has bounding pedal pulses and loss of protective sensation to the 5.07 Semmes-Weinstein monofilament. The erythema improves significantly when the leg is elevated for 10 minutes. Radiographs demonstrate early fragmentation and subluxation at the tarsometatarsal joints.

What is the most appropriate initial management for this condition?

. Intravenous antibiotics and emergent surgical debridement
. Total contact casting and strict non-weight-bearing
. Open reduction and internal fixation of the midfoot
. Below-knee amputation
. Magnetic resonance imaging to rule out osteomyelitis prior to any intervention

Correct Answer & Explanation

. Total contact casting and strict non-weight-bearing

Explanation

This patient presents with an acute Eichenholtz stage I Charcot arthropathy. The classic presentation includes a red, hot, swollen foot in a patient with peripheral neuropathy (most commonly diabetic). The distinguishing clinical feature from infection (osteomyelitis or cellulitis) is that the erythema in Charcot arthropathy typically resolves significantly with elevation of the extremity, whereas infectious erythema does not. Radiographs showing early fragmentation and subluxation confirm the diagnosis. The cornerstone of initial management in the acute phase is immobilization and offloading, ideally with total contact casting (TCC), to prevent further deformity and progression. Antibiotics and debridement are inappropriate as this is an inflammatory, not infectious, process. Surgery (ORIF or arthrodesis) is generally reserved for the chronic/coalescent phase if significant instability or non-plantigrade foot deformity persists.

Question 4546

Topic: 8. Foot and Ankle

A 32-year-old female sustains a purely ligamentous Lisfranc injury following a twisting event while horseback riding. Weight-bearing radiographs reveal 4 mm of diastasis between the medial cuneiform and the base of the second metatarsal, without evidence of osseous avulsions. She undergoes primary arthrodesis of the first, second, and third tarsometatarsal joints. Compared to open reduction and internal fixation (ORIF), what is the expected clinical advantage of primary arthrodesis for this specific injury pattern?

. Lower functional outcome scores at 2 years
. Higher rate of hardware failure
. Decreased rate of subsequent operations
. Earlier time to full weight-bearing
. Preservation of normal midfoot kinematics

Correct Answer & Explanation

. Decreased rate of subsequent operations

Explanation

Current orthopedic literature (e.g., Ly and Coetzee, Henning et al.) supports primary arthrodesis for purely ligamentous Lisfranc injuries because the ligamentous healing potential is poor compared to osseous injuries. ORIF of purely ligamentous injuries is associated with a high rate of hardware failure, loss of reduction, and subsequent post-traumatic arthritis requiring secondary salvage arthrodesis. Primary arthrodesis significantly decreases the rate of subsequent operations (such as hardware removal and revision fusion) and provides comparable or superior functional outcomes in purely ligamentous patterns. It does not lead to earlier weight-bearing, as fusion still requires extended immobilization to heal.

Question 4547

Topic: 8. Foot and Ankle

A 62-year-old man with end-stage post-traumatic ankle osteoarthritis is being evaluated for a total ankle arthroplasty (TAA). Which of the following patient factors is considered an absolute contraindication to performing a TAA?

. Age greater than 60 years
. Body mass index of 32 kg/m2
. Prior open reduction and internal fixation of a bimalleolar ankle fracture
. Significant peripheral neuropathy with loss of protective sensation
. Concomitant ipsilateral subtalar arthritis

Correct Answer & Explanation

. Significant peripheral neuropathy with loss of protective sensation

Explanation

Absolute contraindications to total ankle arthroplasty (TAA) include active infection, severe peripheral vascular disease, inadequate soft tissue envelope, neuroarthropathy (Charcot joint), and significant peripheral neuropathy with loss of protective sensation. Neuropathy results in a lack of joint proprioception and pain feedback, leading to rapid implant loosening, subsidence, and catastrophic failure. Age over 60 is actually an ideal demographic for TAA due to lower functional demands. A BMI of 32 is a relative, but not absolute, contraindication. Prior ORIF and concomitant subtalar arthritis are common in this population and can be managed (e.g., with hardware removal or staged/concurrent subtalar fusion).

Question 4548

Topic: Forefoot

A 45-year-old female presents with a progressive and painful bunion deformity. Clinical examination demonstrates notable hypermobility in the sagittal plane at the first tarsometatarsal (TMT) joint. Weight-bearing radiographs reveal a Hallux Valgus Angle (HVA) of 42 degrees and an Intermetatarsal Angle (IMA) of 18 degrees. Based on these findings, which surgical procedure is most appropriate to address her deformity and prevent recurrence?

. Distal chevron osteotomy
. First TMT arthrodesis (Lapidus procedure)
. Akin osteotomy alone
. Keller resection arthroplasty
. Proximal opening wedge osteotomy without TMT addressing

Correct Answer & Explanation

. First TMT arthrodesis (Lapidus procedure)

Explanation

The patient has a severe hallux valgus deformity (IMA > 15 degrees, HVA > 40 degrees) associated with first TMT joint hypermobility. A first TMT arthrodesis (the Lapidus procedure) is the procedure of choice in this scenario. It provides powerful correction of large intermetatarsal angles and inherently addresses the hypermobility at the TMT joint, which, if left untreated, is a common cause of hallux valgus recurrence. Distal osteotomies (like the Chevron) are typically reserved for mild to moderate deformities (IMA < 13 degrees) without hypermobility. A Keller arthroplasty is generally reserved for elderly, low-demand patients with severe deformity and arthritis.

Question 4549

Topic: 8. Foot and Ankle
A 28-year-old male is involved in a high-speed motor vehicle collision and sustains a Hawkins Type III talar neck fracture. Which of the following best describes the typical disruption of the blood supply to the talar body in this specific injury pattern?
. The artery of the tarsal canal remains fully preserved, minimizing the risk of avascular necrosis
. Only the deltoid branches from the posterior tibial artery are disrupted
. The blood supplies from the dorsalis pedis, artery of the tarsal canal, and artery of the tarsal sinus are all disrupted
. The robust intraosseous anastomoses prevent avascular necrosis regardless of extraosseous injury
. The posterior tibial artery provides the sole remaining intact blood supply

Correct Answer & Explanation

. The blood supplies from the dorsalis pedis, artery of the tarsal canal, and artery of the tarsal sinus are all disrupted

Explanation

A Hawkins Type III fracture is a talar neck fracture with dislocation of the talar body from both the subtalar joint and the tibiotalar (ankle) joint. The blood supply to the talar body is derived from three main sources: the artery of the tarsal canal (branch of posterior tibial), the artery of the tarsal sinus (anastomosis of branches from dorsalis pedis and peroneal), and the deltoid branches. In a Type III injury, the severe displacement and double dislocation typically rupture all three major sources of extraosseous blood supply (the capsular attachments carrying the dorsalis pedis branches, the artery of the tarsal canal, and the artery of the tarsal sinus), leading to a nearly 100% risk of avascular necrosis (AVN) of the talar body if not promptly reduced.

Question 4550

Topic: 8. Foot and Ankle

A 40-year-old recreational tennis player sustains an acute Achilles tendon rupture. After a thorough discussion, he elects to undergo non-operative management incorporating an early functional rehabilitation protocol. Compared to acute open surgical repair, which of the following is true regarding his expected clinical outcome?

. He has a significantly higher risk of a re-rupture
. He has a higher risk of sural nerve injury
. His re-rupture risk is comparable, with a lower risk of wound complications
. He will likely experience a 50% permanent deficit in plantar flexion strength
. He will have an increased risk of deep venous thrombosis compared to surgical patients

Correct Answer & Explanation

. His re-rupture risk is comparable, with a lower risk of wound complications

Explanation

Historically, non-operative treatment of Achilles tendon ruptures using prolonged cast immobilization was associated with a higher re-rupture rate compared to operative repair. However, high-quality modern evidence (e.g., Willits et al.) has demonstrated that when non-operative management is combined with an early, dynamic functional rehabilitation protocol (early weight-bearing in a functional brace), the re-rupture rates are statistically equivalent to operative repair. Furthermore, non-operative management completely avoids surgical complications such as wound breakdown, deep infection, and iatrogenic sural nerve injury.

Question 4551

Topic: 8. Foot and Ankle

A 14-year-old boy presents with bilateral rigid flatfeet and a history of recurrent ankle sprains. Examination demonstrates severe restriction of subtalar motion and peroneal spasticity. On the lateral weight-bearing radiograph of the foot, a distinct 'C-sign' is identified. What is the most likely diagnosis, and which anatomical structures are fused?

. Calcaneonavicular coalition; the anterior process of the calcaneus and the navicular
. Talocalcaneal coalition; the middle facet of the subtalar joint
. Talonavicular coalition; the talar head and the navicular
. Syndesmotic diastasis; the distal tibia and the fibula
. Accessory navicular syndrome; the posterior tibial tendon and the navicular

Correct Answer & Explanation

. Talocalcaneal coalition; the middle facet of the subtalar joint

Explanation

The clinical presentation of a rigid flatfoot, peroneal spasticity, and restricted subtalar motion in an adolescent is classic for a tarsal coalition. The 'C-sign' on a lateral radiograph is a radiological hallmark of a talocalcaneal coalition. It is formed by the continuous bony bridge between the talar dome and the sustentaculum tali of the calcaneus, typically indicating a coalition at the middle facet of the subtalar joint. A calcaneonavicular coalition, conversely, is best visualized on a 45-degree internal rotation oblique radiograph and is associated with the 'anteater nose' sign.

Question 4552

Topic: Midfoot & Hindfoot
A 55-year-old female presents with a painful, progressive flatfoot deformity. On examination, she is completely unable to perform a single-leg heel raise on the affected side. Her hindfoot rests in valgus but is manually correctable to neutral. Weight-bearing anteroposterior radiographs demonstrate >40% lateral subluxation (uncovering) of the talonavicular joint. In addition to a flexor digitorum longus (FDL) transfer to the navicular, which of the following osseous procedures is most appropriate?
. Triple arthrodesis
. Medial displacement calcaneal osteotomy combined with lateral column lengthening
. Isolated subtalar arthrodesis
. First tarsometatarsal arthrodesis (Lapidus)
. Isolated gastrocnemius recession

Correct Answer & Explanation

. Medial displacement calcaneal osteotomy combined with lateral column lengthening

Explanation

This patient has Stage IIb posterior tibial tendon dysfunction (PTTD), characterized by a flexible hindfoot valgus deformity and significant forefoot abduction (indicated by >40% talonavicular uncovering on the AP view). An isolated FDL transfer and medial displacement calcaneal osteotomy (MDCO) can address the hindfoot valgus but are insufficient to correct the severe forefoot abduction. Therefore, a lateral column lengthening (e.g., Evans osteotomy or calcaneocuboid distraction arthrodesis) must be added to swing the forefoot medially and restore talonavicular coverage. A triple arthrodesis is reserved for Stage III PTTD, where the deformity has become rigid.

Question 4553

Topic: Ankle Trauma & Sports

A 25-year-old professional soccer player undergoes operative fixation for a syndesmotic injury utilizing a flexible suture-button construct. Compared to traditional rigid syndesmotic screw fixation, what is a recognized clinical or biomechanical advantage of the suture-button construct?

. Absolute rigid immobilization of the distal tibiofibular joint, promoting primary bone healing
. Decreased need for routine implant removal
. Lower risk of superficial postoperative infection
. Faster bone healing of concomitant medial malleolus fractures
. Necessity for removal prior to initiating weight-bearing

Correct Answer & Explanation

. Decreased need for routine implant removal

Explanation

Flexible suture-button constructs for syndesmotic injuries provide dynamic stabilization, allowing physiological micromotion at the distal tibiofibular joint during weight-bearing. This mimics the native syndesmosis better than rigid screws. A primary clinical advantage of the suture-button construct is the decreased need for routine implant removal. Traditional syndesmotic screws often require a second surgery for removal due to the risk of screw breakage or patient discomfort during the resumption of physiological motion with weight-bearing. Suture buttons do not promote 'primary bone healing' of the syndesmosis (which is a ligamentous structure) and do not have an inherent effect on medial malleolus bone healing.

Question 4554

Topic: 8. Foot and Ankle

A 19-year-old male presents with bilateral progressive foot deformities characterized by high arches, claw toes, and varus hindfeet. He reports frequent lateral ankle sprains. The Coleman block test demonstrates a flexible hindfoot. Which of the following best describes the classic muscle imbalance contributing to this patient's deformity?

. Overpull of the tibialis anterior relative to the peroneus longus
. Overpull of the peroneus brevis relative to the peroneus longus
. Weakness of the tibialis anterior and peroneus brevis with overpowering by the peroneus longus and tibialis posterior
. Overpull of the intrinsic foot muscles causing a dynamic flatfoot
. Spasticity of the gastrocnemius-soleus complex only

Correct Answer & Explanation

. Weakness of the tibialis anterior and peroneus brevis with overpowering by the peroneus longus and tibialis posterior

Explanation

This patient has a classic cavovarus foot deformity, typical of Charcot-Marie-Tooth (CMT) disease. The pathophysiology involves selective muscle weakness. The tibialis anterior and peroneus brevis weaken early. The relatively spared, stronger peroneus longus overpowers the weak tibialis anterior, causing plantarflexion of the first ray (forefoot valgus). Concurrently, the strong tibialis posterior overpowers the weak peroneus brevis, driving the hindfoot into varus.

Question 4555

Topic: 8. Foot and Ankle

A 65-year-old female with severe post-traumatic ankle osteoarthritis is considering surgical options. She has a history of poorly controlled type 2 diabetes and peripheral neuropathy, lacking protective sensation in her distal extremities. In evaluating her for a total ankle arthroplasty (TAA) versus ankle arthrodesis, which of the following is an absolute contraindication to TAA in this patient?

. Age over 60 years
. Post-traumatic etiology of arthritis
. Neuropathic joint disease and absence of protective sensation
. Body Mass Index of 29
. Osteoarthritis involving the subtalar joint

Correct Answer & Explanation

. Neuropathic joint disease and absence of protective sensation

Explanation

Absolute contraindications to total ankle arthroplasty (TAA) include active infection, severe peripheral vascular disease, inadequate soft-tissue envelope, neuropathic joint disease (Charcot arthropathy), and absent protective sensation. Charcot and lack of sensation predictably lead to catastrophic early failure of the implant. Age over 60 is actually an ideal indication for TAA, as younger, high-demand patients wear out implants faster. Subtalar arthritis may be an indication for a combined procedure or arthrodesis, but not an absolute contraindication to TAA.

Question 4556

Topic: Midfoot & Hindfoot
A 55-year-old female presents with a painful, progressive flatfoot deformity. Examination shows a valgus hindfoot, prominent medial eminence, and 'too many toes' sign laterally. She has 45% uncovering of the talonavicular joint on weight-bearing AP radiographs. She is unable to perform a single-leg heel raise. The hindfoot remains flexible to manual reduction. Which of the following surgical procedures is most appropriate for this patient?
. FDL to navicular transfer and medial displacement calcaneal osteotomy alone
. Triple arthrodesis
. FDL transfer, medial displacement calcaneal osteotomy, and lateral column lengthening
. Isolated subtalar arthrodesis
. Gastrocnemius recession and orthotic management only

Correct Answer & Explanation

. FDL transfer, medial displacement calcaneal osteotomy, and lateral column lengthening

Explanation

This patient has Stage IIb adult acquired flatfoot deformity (posterior tibial tendon dysfunction). Stage IIb is characterized by a flexible hindfoot with significant forefoot abduction (>40% talonavicular uncovering). Appropriate operative management requires correcting both the hindfoot valgus and the forefoot abduction. This is reliably achieved with a flexor digitorum longus (FDL) transfer, a medializing calcaneal osteotomy, and a lateral column lengthening (e.g., Evans osteotomy). Triple arthrodesis is reserved for rigid (Stage III) deformities.

Question 4557

Topic: 8. Foot and Ankle

A 28-year-old female sustains an axial load to a plantarflexed foot. Weight-bearing radiographs show a 4 mm diastasis between the medial and middle cuneiforms and bases of the 1st and 2nd metatarsals. No fractures are identified on computed tomography.

According to current literature, which of the following treatments provides the most predictable long-term functional outcome with the lowest rate of reoperation for this specific injury pattern?

. Closed reduction and cast immobilization for 8 weeks
. Open reduction and internal fixation (ORIF) with transarticular screws
. Primary arthrodesis of the first, second, and third tarsometatarsal joints
. Dorsal spanning bridge plating without articular disruption
. Primary arthrodesis of the medial column and rigid screw fixation of the lateral column

Correct Answer & Explanation

. Primary arthrodesis of the first, second, and third tarsometatarsal joints

Explanation

The scenario describes a purely ligamentous Lisfranc injury. Multiple studies (most notably by Ly and Coetzee) have demonstrated that primary arthrodesis of the medial columns (1st, 2nd, and 3rd TMT joints) yields superior functional outcomes and significantly lower reoperation rates compared to ORIF for purely ligamentous injuries. ORIF in this setting is associated with high rates of hardware failure, loss of reduction, and painful post-traumatic arthritis requiring salvage arthrodesis.

Question 4558

Topic: 8. Foot and Ankle

During open reduction and internal fixation of a severe pronation-external rotation (PER-4) ankle fracture, a syndesmotic screw is planned. To optimize anatomic reduction, the surgeon must be aware of the normal anatomy and biomechanics of the distal tibiofibular joint. Which of the following statements is true regarding the distal tibiofibular syndesmosis?

. The anterior inferior tibiofibular ligament (AITFL) is the strongest ligament of the syndesmotic complex
. The syndesmosis widens slightly during ankle dorsiflexion to accommodate the wider anterior talar dome
. A syndesmotic screw should be directed anteriorly from the fibula to the tibia parallel to the joint line
. The interosseous ligament provides the primary resistance to superior displacement of the fibula
. Rigid fixation of the syndesmosis with a quadricortical screw must be retained permanently

Correct Answer & Explanation

. The syndesmosis widens slightly during ankle dorsiflexion to accommodate the wider anterior talar dome

Explanation

The talar dome is trapezoidal in shape, being wider anteriorly than posteriorly. During ankle dorsiflexion, the wider anterior portion of the talus engages the mortise, causing the syndesmosis to widen slightly (about 1-2 mm) and the fibula to externally rotate. The posterior inferior tibiofibular ligament (PITFL) is the strongest ligament. Syndesmotic screws are typically directed 20-30 degrees anteriorly (from posterolateral to anteromedial) to accommodate the normal anatomy of the fibula relative to the tibia.

Question 4559

Topic: 8. Foot and Ankle

A 52-year-old male presents with dorsal foot pain and stiffness of the big toe. Physical examination reveals a palpable dorsal exostosis and restricted dorsiflexion of the first MTP joint. Radiographs confirm joint space narrowing, subchondral sclerosis, and a large dorsal osteophyte (Coughlin and Shurnas Grade 2). Conservative measures have failed. Which of the following surgical interventions is most appropriate for preserving joint motion while relieving symptoms?

. Cheilectomy
. Arthrodesis of the first MTP joint
. Keller resection arthroplasty
. Lapidus procedure
. Metatarsal head resurfacing implant

Correct Answer & Explanation

. Cheilectomy

Explanation

Hallux rigidus is osteoarthritis of the first MTP joint. For early to moderate stages (Coughlin and Shurnas Grade 1 or 2) where the patient desires preservation of motion and experiences pain primarily from dorsal impingement, a cheilectomy (resection of the dorsal osteophyte and the dorsal 25-30% of the metatarsal head) is the procedure of choice. Arthrodesis is the gold standard for severe disease (Grades 3 and 4) with pain throughout the range of motion.

Question 4560

Topic: 8. Foot and Ankle

A 42-year-old woman presents with progressive medial deviation and pain of her great toe 8 months following a bunionectomy. Physical examination reveals a hallux valgus angle of -15 degrees. She actively plantarflexes the interphalangeal joint to compensate for the inability of the metatarsophalangeal (MTP) joint to purchase the ground. Radiographs reveal medial subluxation of the proximal phalanx on the metatarsal head. Which of the following technical errors during the index procedure is the most common cause of this complication?

. Excessive medial capsular plication and staking of the metatarsal head
. Failure to release the adductor hallucis and lateral sesamoid suspensory ligament
. Plantar translation of the metatarsal capital fragment
. Inadequate resection of the medial eminence
. Under-correction of the intermetatarsal angle

Correct Answer & Explanation

. Excessive medial capsular plication and staking of the metatarsal head

Explanation

The patient is presenting with iatrogenic hallux varus. The most common technical causes include 'staking' the metatarsal head (resecting the medial eminence past the sagittal groove, which destabilizes the medial sesamoid), excessive medial capsulorrhaphy, and over-release of the lateral collateral ligament. Failure to release the adductor hallucis or inadequate resection would lead to under-correction or recurrence of hallux valgus, not hallux varus.

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