8. Foot and Ankle MCQs

A 56-year-old male with a 20-year history of uncontrolled diabetes presents with a swollen, erythematous, and warm left foot. Radiographs reveal fragmentation at the tarsometatarsal joints. The neurovascular theory of Charcot arthropathy suggests that this bone destruction is primarily mediated by:

A 48-year-old male presents with sharp, stabbing left heel pain that is most severe with the first few steps in the morning. Examination reveals localized tenderness at the medial tuberosity of the calcaneus. What is the most effective initial stretching exercise for long-term relief of this condition?

A 52-year-old male presents with chronic posterior heel pain. Radiographs demonstrate a prominent posterosuperior calcaneal tuberosity and calcification within the Achilles tendon insertion. During surgical debridement via a central tendon-splitting approach, what percentage of the Achilles tendon insertion can typically be detached and reattached without requiring augmentation?

A 22-year-old collegiate football player sustains a purely ligamentous Lisfranc injury.

MRI demonstrates a complete rupture of the Lisfranc ligament. He elects for operative management. Compared to open reduction and internal fixation (ORIF), primary arthrodesis of the first, second, and third tarsometatarsal joints in this patient is associated with:

A 55-year-old woman complains of progressive foot deformity and medial ankle pain. Examination reveals a flexible hindfoot valgus, inability to perform a single-leg heel raise, and forefoot abduction covering 40% of the talar head.

Which surgical procedure is most appropriate for correcting her significant forefoot abduction?

A 60-year-old man with diabetes mellitus presents with a swollen, erythematous, but painless left foot. Radiographs reveal fragmentation and subluxation of the tarsometatarsal joints.

The overlying skin is intact. What is the most appropriate initial management?

A 28-year-old male sustains an isolated lateral malleolus fracture with a syndesmotic rupture. Intraoperatively, after fibular fixation, the syndesmosis is reduced with a clamp. What is the most common malreduction of the distal fibula within the incisura if the clamp is placed too anteriorly on the tibia?

A 68-year-old female with severe end-stage ankle osteoarthritis desires a total ankle arthroplasty (TAA). Which of the following is an absolute contraindication for performing a TAA?

A 50-year-old woman presents with severe hallux valgus.

Her intermetatarsal angle (IMA) is 20 degrees and hallux valgus angle (HVA) is 45 degrees. There is clinical hypermobility of the first tarsometatarsal (TMT) joint. Which of the following procedures is most appropriate?

A 30-year-old male presents with chronic posterolateral ankle pain and a clicking sensation. Examination reveals subluxation of the peroneal tendons over the lateral malleolus with resisted dorsiflexion and eversion. What is the primary anatomic structure that has been compromised?

A 60-year-old female presents with intractable pain at the plantar aspect of the first metatarsal head. Excision of a fragmented medial sesamoid is planned. To prevent postoperative hallux valgus, what soft tissue structure must be meticulously repaired?

A 42-year-old patient undergoes an Achilles tendon repair using a minimally invasive technique.

Postoperatively, he complains of burning numbness over the lateral border of his foot. Which nerve was most likely injured during blind suture passage?

A 25-year-old soccer player sustains an ankle inversion and external rotation injury. Anteroposterior and mortise radiographs show no fracture, but the tibiofibular clear space is 7 mm. What ligament is primarily responsible for the anterior stability of the distal tibiofibular syndesmosis?

A 42-year-old recreational tennis player undergoes conservative management with functional bracing for an acute Achilles tendon rupture. Compared to primary surgical repair, what is the most significant expected difference in clinical outcomes?

A 35-year-old man sustains a purely ligamentous Lisfranc injury. He undergoes open reduction and primary arthrodesis of the first, second, and third tarsometatarsal joints. Compared to open reduction and internal fixation (ORIF), primary arthrodesis for purely ligamentous Lisfranc injuries is most strongly associated with:

A 55-year-old man presents with dorsal midfoot and great toe pain. Examination reveals a painful, restricted dorsiflexion of the first metatarsophalangeal (MTP) joint. Radiographs show a large dorsal osteophyte and preserved plantar joint space.

What is the most appropriate surgical treatment if nonoperative management fails?

A 60-year-old woman presents with progressive flattening of her left medial longitudinal arch and medial ankle pain. On examination, she is unable to perform a single-leg heel rise. Her hindfoot is in valgus but is passively correctable to neutral. What combination of surgical procedures is most commonly indicated?

A 45-year-old woman complains of burning pain in the plantar aspect of her foot, which worsens at night. Tinel's sign is positive posterior to the medial malleolus. The flexor retinaculum forms the roof of the tarsal tunnel. Which of the following structures lies most anteriorly within this tunnel?