8. Foot and Ankle MCQs

A 40-year-old male "weekend warrior" presents with acute heel pain after pushing off to run during a tennis match. Examination reveals a palpable gap in the posterior ankle and lack of plantarflexion upon squeezing the calf. The injury most commonly occurs in a vascular watershed zone. Approximately how far proximal to the calcaneal insertion is this zone located?

A 38-year-old male sustains an inversion ankle injury. Radiographs show a widening of the medial clear space but no apparent fracture around the ankle mortise. Which of the following injuries MUST be ruled out to avoid missing a highly unstable injury pattern requiring operative fixation?

A 24-year-old female presents with midfoot pain after a fall from a horse with her foot plantarflexed in the stirrup. Weight-bearing radiographs show a 3 mm widening of the space between the base of the first and second metatarsals. What is the primary stabilizing structure that has most likely been injured?

A 55-year-old poorly controlled diabetic patient presents with a warm, swollen, and erythematous right foot. There are no open ulcers, and laboratory inflammatory markers (ESR/CRP) are mildly elevated but inconsistent with severe acute osteomyelitis. Radiographs show extensive periarticular debris, fragmentation, and subluxation at the tarsometatarsal joints. According to the Eichenholtz classification, what stage does this represent, and what is the most appropriate initial treatment?

An ankle radiograph demonstrates a short oblique fracture of the lateral malleolus that begins at the level of the tibial plafond and extends posterosuperiorly, alongside a transverse fracture of the medial malleolus.

According to the Lauge-Hansen classification, what is the specific mechanism of injury?

A 55-year-old diabetic male presents with a swollen, erythematous, and warm foot. Radiographs reveal fragmentation of the navicular and subluxation of the talonavicular joint, consistent with Eichenholtz stage I Charcot arthropathy. What is the most appropriate initial management?

During a posterior Kocher-Langenbeck approach to the hip, the sciatic nerve is at risk of iatrogenic injury. Which of the following clinical signs would most specifically indicate an isolated injury to the common peroneal division of the sciatic nerve?

The Achilles tendon is most vulnerable to spontaneous rupture in its relative hypovascular zone (the 'watershed' area). Approximately where is this hypovascular zone located in relation to its insertion on the calcaneus?

A 35-year-old weekend warrior sustains an acute Achilles tendon rupture while playing basketball. He opts for percutaneous surgical repair to minimize wound complications. Which nerve is at greatest risk of iatrogenic injury during a percutaneous Achilles tendon repair?

A 26-year-old soccer player has chronic lateral ankle instability despite aggressive physical therapy. You plan a modified Brostrom-Gould procedure. Which structures are repaired and advanced in this procedure?

A 21-year-old collegiate football player sustains a syndesmotic ankle injury after a teammate falls on his lower leg. What is the classic mechanism of injury for a syndesmotic (high) ankle sprain?

A 25-year-old professional athlete sustains a severe syndesmotic sprain (high ankle sprain) with radiographic widening of the ankle mortise. The surgeon discusses fixation utilizing a dynamic suture-button construct versus rigid syndesmotic screw fixation. Based on current literature, what is a primary advantage of dynamic fixation?

A 34-year-old male sustains an acute, mid-substance Achilles tendon rupture playing basketball. He elects for percutaneous surgical repair to minimize wound complications. Which nerve is at the highest risk of iatrogenic injury during this specific procedure, and what is its anatomic relationship to the Achilles tendon?

During the normal human gait cycle, controlling the descent of the foot to the ground is critical. Which muscle group primarily functions eccentrically during the initial contact (heel strike) to loading response phase to prevent a 'foot slap'?

The "screw-home" mechanism of the knee ensures stability in full extension by maximizing articular congruency. Which of the following best describes this obligatory kinematic sequence as the knee moves from 30 degrees of flexion to terminal extension during a closed-kinetic chain movement (e.g., rising from a seated position)?

A 40-year-old male arrives in the trauma bay with a severely deformed left knee after a low-velocity sporting collision. Radiographs show a posterior knee dislocation. The knee is successfully reduced. Pulses are palpable and symmetric. The Ankle-Brachial Index (ABI) on the injured side is 0.85. What is the next most appropriate step in management?