8. Foot and Ankle MCQs

During a surgical approach for a highly comminuted talar body fracture, the surgeon notes damage to the artery of the tarsal canal. This artery is the predominant blood supply to the talar body. From which parent vessel does it originate?

A surgeon is performing an extensile lateral approach for a calcaneus fracture. The sural nerve is at risk of iatrogenic injury. At what approximate distance proximal to the insertion of the Achilles tendon does the sural nerve typically cross the lateral border of the Achilles tendon?

A runner presents with chronic, recalcitrant heel pain. A nerve block of the first branch of the lateral plantar nerve (Baxter's nerve) completely resolves his pain temporarily. If left untreated and compression worsens, which of the following muscles would primarily demonstrate denervation changes on an MRI?

A 6-year-old patient with SMA Type II undergoes bilateral soft tissue releases for severe equinovarus foot deformities. Postoperatively, she is braced. What is the most critical physiological reason why surgical release of contractures in non-ambulatory SMA patients often yields poor functional outcomes?

A 13-year-old male presents with rigid, painful flat feet and recurrent ankle sprains. On examination, he demonstrates restricted subtalar motion and peroneal spasticity. Radiographs demonstrate an 'anteater nose' sign. Which of the following is the most likely diagnosis?

A 12-year-old boy complains of recurrent left lateral ankle sprains and a painful, rigid flatfoot. Physical examination reveals spasm of the peroneal tendons. Which radiographic view is best to properly identify a calcaneonavicular coalition (the 'anteater nose' sign)?

A 14-year-old boy presents with chronic, insidious-onset left hindfoot pain and recurrent ankle sprains. Examination shows a rigid, flat foot with severely restricted subtalar motion and peroneal spasticity. A lateral radiograph of the foot demonstrates the 'anteater nose' sign. Which anatomical structures are abnormally connected?

A 12-year-old boy complains of recurrent ankle sprains and rigid, painful flatfeet. A lateral radiograph demonstrates an elongated lateral process of the talus projecting toward the navicular. What is the most likely diagnosis?

A 14-year-old boy presents with rigid flat feet and recurrent ankle sprains. Examination shows restricted subtalar motion and peroneal spasticity. A CT scan confirms a talocalcaneal coalition. Which non-operative management is typically considered the most effective initial step?

A 32-year-old male suffers an acute mid-substance Achilles tendon rupture playing basketball. He is discussing operative vs. non-operative management.

Based on level I evidence comparing modern treatment protocols (e.g., Willits et al.), which of the following is true?

Review the following clinical indication for midfoot trauma:

A 28-year-old athlete sustains a purely ligamentous Lisfranc injury. Plantar ecchymosis is present. According to prospective randomized trials comparing open reduction internal fixation (ORIF) to primary arthrodesis for purely ligamentous Lisfranc injuries, which of the following represents the primary advantage of primary arthrodesis?

When utilizing the extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, full-thickness flap necrosis is a dreaded complication. The viability of this flap is primarily dependent on which of the following vascular structures?

A 22-year-old collegiate football player sustains a pure ligamentous Lisfranc injury. Weight-bearing radiographs demonstrate 4 mm of diastasis between the medial cuneiform and the base of the second metatarsal. Current orthopedic literature suggests which of the following treatments provides the lowest rate of hardware removal and highest long-term functional scores for this specific injury pattern?

A 28-year-old male is brought to the trauma bay after a high-velocity knee dislocation. His knee was reduced in the field. On physical examination, his dorsalis pedis and posterior tibial pulses are present but diminished compared to the contralateral leg. His Ankle-Brachial Index (ABI) is calculated to be 0.85. There is no expanding hematoma or pulsatile bleeding. What is the most appropriate next step in his vascular workup?

Following open reduction and internal fixation of a rotational ankle fracture with syndesmotic instability, intraoperative fluoroscopy is used to assess the reduction of the distal tibiofibular joint. However, postoperative CT imaging frequently identifies malreduction even when radiographs appear acceptable. In which plane does syndesmotic malreduction most commonly occur?

During a lateral extensile approach to the calcaneus for open reduction and internal fixation of a displaced intra-articular fracture, a full-thickness subperiosteal flap is elevated. Which nerve is most at risk in the proximal and posterior portion of the vertical limb of this incision?