8. Foot and Ankle MCQs

A 10-year-old boy presents with a history of recurrent lateral ankle sprains and a rigid flatfoot. Oblique radiographs of the foot demonstrate an elongated anterior process of the calcaneus, commonly known as the 'anteater nose' sign. Which of the following is the most likely diagnosis?

Osteochondral lesions of the talus (OLTs) have distinct morphologic characteristics based on their location. Which of the following descriptions classically characterizes an anterolateral OLT?

A 45-year-old female presents with pain in the second webspace, radiating into the toes. Clinical examination reveals pain upon lateral compression of the forefoot accompanied by a palpable click (Mulder's sign). She undergoes surgical excision through a dorsal approach. Which of the following is a known risk specific to the dorsal approach compared to the plantar approach for this pathology?

A 26-year-old skier presents with snapping over the lateral malleolus after an acute eversion injury. Examination confirms subluxation of the peroneal tendons with resisted eversion. Surgical management involves repair of the superior peroneal retinaculum (SPR). To which structure must the SPR be anatomically reattached?

A 50-year-old runner undergoes a complete surgical release of the plantar fascia for recalcitrant plantar fasciitis. Post-operatively, she reports relief of her heel pain but develops new-onset, severe pain along the lateral border of her midfoot. What is the most likely biomechanical cause of this new symptom?

A 14-year-old female presents with insidious onset forefoot pain localized to the second metatarsophalangeal (MTP) joint. Radiographs demonstrate sclerosis, flattening, and early fragmentation of the second metatarsal head. What is the most likely diagnosis?

A 40-year-old roofer falls from a height and sustains a displaced intra-articular calcaneus fracture. He undergoes Open Reduction Internal Fixation (ORIF) via an extensile lateral approach. Postoperatively, he complains of numbness over the lateral aspect of his heel and foot. Which nerve was most likely injured during the surgical approach?

A 55-year-old female presents with a progressive flatfoot deformity. Examination reveals a flexible hindfoot valgus and inability to perform a single-leg heel raise. Weight-bearing radiographs show more than 30% uncovering of the talonavicular joint on the AP view. Which of the following surgical interventions is most appropriate for this Stage IIb posterior tibial tendon dysfunction?

A 20-year-old track athlete presents with insidious onset of vague dorsal midfoot pain. CT scan reveals an incomplete stress fracture of the tarsal navicular located in the central third of the bone. What anatomical feature primarily predisposes the navicular to stress fractures in this specific region?

A 19-year-old professional basketball player sustains an acute, displaced fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. To minimize the risk of nonunion and expedite return to play, intramedullary screw fixation is planned. What is the optimal entry point for accurately placing the screw in the medullary canal?

When performing a minimally invasive repair of an acute Achilles tendon rupture, care must be taken to avoid injury to the sural nerve. At what approximate distance proximal to the calcaneal insertion does the sural nerve typically cross the lateral border of the Achilles tendon?

A 60-year-old poorly controlled diabetic male presents with an acutely swollen, red, and warm right foot. He denies trauma, and his pedal pulses are bounding. Inflammatory markers are mildly elevated. Radiographs show early fragmentation and debris at the midfoot. What is the most appropriate immediate management?

A 52-year-old avid runner presents with worsening great toe pain. Examination reveals less than 10 degrees of dorsiflexion and significant pain through the mid-arc of motion. Radiographs demonstrate severe joint space narrowing, subchondral sclerosis, and large circumferential osteophytes at the first metatarsophalangeal (MTP) joint. What is the most definitive and reliable surgical treatment?

In patients with Charcot-Marie-Tooth (CMT) disease, a classic cavovarus foot deformity develops due to specific muscle imbalances. Which of the following combinations best describes the primary overpowering muscle forces driving the plantarflexed first ray and hindfoot varus?

A surgeon is performing a dorsal approach for the excision of a recurrent Morton's neuroma in the third web space. To gain adequate exposure and successfully identify and resect the neuroma, which of the following structures MUST be transected?

A 60-year-old male is undergoing surgery for chronic insertional Achilles tendinopathy with a large Haglund's deformity. During debridement through a central tendon-splitting approach, it is determined that 65% of the Achilles tendon insertion must be detached and excised to adequately remove the degenerative tissue. What is the most appropriate next step in management?

A 52-year-old female presents with a progressive, painful flatfoot deformity. Clinical examination reveals an inability to perform a single-leg heel rise. Weight-bearing radiographs show a flexible hindfoot valgus and greater than 30% uncovering of the talonavicular joint with forefoot abduction. What is the most appropriate surgical management for this Stage IIb posterior tibial tendon dysfunction?

A 35-year-old recreational basketball player suffers an acute Achilles tendon rupture. Based on high-level level I evidence (e.g., the Willits trial) comparing operative repair versus non-operative management with early functional rehabilitation, what is the expected outcome profile?