8. Foot and Ankle MCQs

A patient with multiple severe midfoot crush injuries presents with a tense, swollen foot and severe pain with passive toe dorsiflexion. If foot fasciotomies are indicated, what surgical approaches are commonly utilized to release all 9 compartments?

A 24-year-old rugby player sustains an axial load to a plantarflexed foot. Radiographs reveal a 'fleck sign' adjacent to the base of the second metatarsal. The primary injured ligament connects which two osseous structures?

A 45-year-old female presents with severe bunion pain. Weight-bearing radiographs demonstrate a hallux valgus angle (HVA) of 42 degrees, an intermetatarsal angle (IMA) of 18 degrees, and clinical hypermobility of the first tarsometatarsal (TMT) joint. Which of the following procedures is most appropriate to effectively correct the deformity and minimize recurrence?

When performing an extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, the surgical flap must be carefully elevated as a full-thickness layer to the periosteum to prevent necrosis. Which artery provides the primary blood supply to the apex of this lateral flap?

A 55-year-old patient with poorly controlled diabetes mellitus presents with a red, hot, and swollen left foot. Radiographs show periarticular osteopenia, fragmentation of bone, and early subluxation at the midtarsal joints. Infection has been definitively ruled out. According to the Eichenholtz classification, what stage is this, and what is the standard initial management?

A 26-year-old male sustains an inversion ankle sprain while his foot is maximally plantarflexed. He later develops persistent deep ankle pain. MRI reveals an osteochondral lesion of the talus. Based on the mechanism of injury, where is the lesion most likely located and what is its typical morphology?

A 42-year-old runner complains of chronic medial heel pain radiating to the plantar aspect of the foot. Examination reveals maximal tenderness over the medial tuberosity of the calcaneus, exacerbated by palpation distal to the abductor hallucis. Entrapment of the first branch of the lateral plantar nerve (Baxter's nerve) is suspected. This nerve typically courses between which two muscle bellies?

A 20-year-old male with Charcot-Marie-Tooth disease presents with a symptomatic bilateral cavovarus foot deformity. A Coleman block test is performed, which normalizes his hindfoot varus. Which of the following muscle imbalances is the primary driver initiating the plantarflexed first ray in this specific deformity?

A 58-year-old male presents with dorsal first MTP joint pain. Radiographs demonstrate advanced joint space narrowing, large dorsal osteophytes, and subchondral sclerosis. Clinically, he has severe pain at the extremes of motion AND during the mid-arc of motion (Coughlin and Shurnas Grade 4 hallux rigidus). Which surgical procedure is considered the most reliable gold standard for this patient?

A 14-year-old boy presents with a history of recurrent ankle sprains and a painful, rigid flatfoot. Examination reveals restricted subtalar motion and peroneal spasticity. Lateral radiographs reveal a continuous bony contour forming a 'C-sign'. Which of the following describes the most likely anatomic location of the pathology?

During the surgical repair of an acute syndesmotic injury (high ankle sprain) without a medial malleolus fracture, the surgeon places a syndesmotic screw. Historically, teaching dictated fixing the syndesmosis with the ankle in maximal dorsiflexion to prevent overtightening. What anatomical characteristic of the talus was the basis for this traditional teaching, even though recent studies show anatomical reduction is the true determinant of postoperative motion?

A 45-year-old male presents with chronic lateral foot and ankle pain 18 months after sustaining a closed, displaced intra-articular calcaneus fracture treated nonoperatively. He reports difficulty wearing standard closed shoes. Physical examination reveals limited subtalar motion and tenderness inferior to the lateral malleolus. What is the most likely pathophysiologic cause of his current symptoms?

A 55-year-old female presents with a painful, progressive flatfoot deformity. Examination reveals an inability to perform a single-limb heel rise and significant flexible hindfoot valgus. Weight-bearing radiographs demonstrate a talonavicular coverage angle of 45 degrees and uncovering of the talar head. Which of the following surgical strategies is most appropriate for this stage of deformity?

A surgeon is performing a minimally invasive percutaneous repair of an acute Achilles tendon rupture. To minimize the risk of iatrogenic nerve injury during suture passage, the surgeon must be acutely aware of the course of the sural nerve. At approximately what distance proximal to the calcaneal insertion does the sural nerve typically cross the lateral border of the Achilles tendon?

A 62-year-old patient with poorly controlled type 2 diabetes presents with a globally swollen, erythematous, and warm right foot. Pedal pulses are palpable. Radiographs reveal fragmentation, periarticular debris, and subluxation at the tarsometatarsal joints. What is the most appropriate initial management?

A 22-year-old female with Charcot-Marie-Tooth disease presents with bilateral cavovarus feet. A Coleman block test is performed, and her hindfoot varus completely corrects to a neutral alignment when the first metatarsal is allowed to drop off the block. What does this finding dictate regarding surgical planning?