8. Foot and Ankle MCQs

Following open reduction and internal fixation of an ankle fracture with a concomitant syndesmotic injury, intraoperative fluoroscopy suggests adequate reduction of the syndesmosis. However, the surgeon wants to definitively confirm the accuracy of the syndesmotic reduction postoperatively. Which imaging modality is considered the gold standard for assessing syndesmotic reduction?

A surgeon is performing an extensile lateral approach for the open reduction and internal fixation of a displaced intra-articular calcaneus fracture. To minimize the risk of full-thickness skin flap necrosis, the surgeon must be careful to preserve the primary blood supply to the corner of the flap. Which vessel is responsible for this critical vascular supply?

A 16-year-old boy presents with a bilateral symptomatic cavovarus foot deformity. The examiner performs a Coleman block test by placing the patient's lateral foot (heel and lateral border) on a 1-inch block while allowing the first metatarsal to hang off freely into plantarflexion. During this test, the hindfoot varus deformity corrects to a neutral alignment. What does this finding indicate?

A 65-year-old woman with post-traumatic ankle osteoarthritis is being evaluated for a total ankle arthroplasty (TAA). Which of the following conditions is considered an absolute contraindication for this procedure?

A 24-year-old professional American football player sustains a severe hyperextension injury to his great toe on artificial turf. He is diagnosed with a Grade 3 turf toe injury. Which of the following radiographic findings is most consistent with a complete disruption of the plantar plate in this condition?

A 45-year-old runner presents with chronic medial heel pain that radiates into the plantar aspect of the foot, which has failed conservative management for plantar fasciitis. MRI reveals isolated atrophy of the abductor digiti minimi muscle. Entrapment of the first branch of the lateral plantar nerve (Baxter's nerve) is suspected. Between which two structures is this nerve most commonly compressed?

A 45-year-old woman presents with pain and difficulty wearing shoes 2 years after undergoing a distal chevron osteotomy and lateral soft-tissue release for hallux valgus. Examination reveals a flexible first metatarsophalangeal (MTP) joint with a 15-degree hallux varus deformity. Radiographs show no degenerative changes in the MTP joint. Which of the following is the most appropriate surgical treatment?

A 55-year-old female presents with severe hallux valgus, an intermetatarsal angle of 22 degrees, and clinical hypermobility of the first tarsometatarsal (TMT) joint. Which of the following surgical procedures is most appropriate to provide a durable correction?

A 60-year-old male undergoes surgical treatment for severe insertional Achilles tendinopathy. During the procedure, the surgeon discovers extensive degeneration and debrides 65% of the tendon's distal insertion. What is the most appropriate next step?

A 55-year-old patient with poorly controlled diabetes presents with a swollen, erythematous, and warm foot. Radiographs show fragmentation, periarticular debris, and subluxation at the midfoot. What is the most appropriate initial management?

A 24-year-old football player sustains a twisting injury to his midfoot. Weight-bearing radiographs demonstrate a 3 mm diastasis between the medial and middle cuneiforms, as seen in the provided image.

What is the primary ligamentous restraint disrupted in this injury?

A 28-year-old woman presents with a progressive bilateral cavovarus foot deformity. A Coleman block test is performed, and the hindfoot varus corrects to a neutral position when the first ray is allowed to drop off the block. Which of the following procedures is most appropriate as part of her surgical reconstruction?

A 45-year-old female presents with a painful bunion. Weight-bearing radiographs show a hallux valgus angle (HVA) of 42 degrees, an intermetatarsal angle (IMA) of 18 degrees, and hypermobility of the first tarsometatarsal (TMT) joint. Which of the following surgical options is most appropriate?

A 55-year-old man presents with dorsal midfoot pain and limited, painful dorsiflexion of the right great toe. Radiographs show dorsal osteophytes and mild joint space narrowing at the first metatarsophalangeal joint, consistent with Grade 2 hallux rigidus. He has failed shoe modifications and NSAIDs. What is the most appropriate surgical management?

A 62-year-old woman complains of progressive medial ankle pain and flattening of her left foot arch. Examination reveals a flexible flatfoot and inability to perform a single-leg heel raise. The heel is in valgus but passively corrects to neutral. Which combination of procedures is most appropriate?

A 42-year-old woman presents with persistent midfoot pain 6 months after a twisting injury sustained during a fall. Initial radiographs in the emergency department were reportedly normal, but she continued to have swelling and severe pain with weight-bearing. Current weight-bearing radiographs are shown in Figure 28, demonstrating dorsal subluxation and widening between the first and second metatarsals with early dorsal osteophyte formation.

What is the most appropriate definitive surgical management?

A 50-year-old avid runner complains of posterior heel pain that worsens when beginning to run but improves slightly after warming up. Conservative management, including eccentric stretching, physical therapy, and heel lifts, has failed after 8 months. The lateral radiograph is shown in Figure 91, demonstrating an enlarged posterosuperior calcaneal tuberosity and intratendinous calcification.

Which of the following is the most appropriate surgical intervention?