8. Foot and Ankle MCQs

To perform an open release for tarsal tunnel syndrome, the surgeon incises the flexor retinaculum posterior to the medial malleolus. The normal sequence of structures in the tarsal tunnel from anterior/medial to posterior/lateral is Tibialis posterior, Flexor digitorum longus, Posterior tibial artery, Veins, Tibial nerve, and Flexor hallucis longus. Based on this, which structure is immediately adjacent and posterior to the posterior tibial artery?

When performing an anterolateral approach to the distal tibia and ankle, the superficial peroneal nerve is at risk of injury. At what approximate level does this nerve reliably pierce the crural fascia to become subcutaneous?

The Lisfranc ligament is an essential stabilizer of the midfoot, particularly preventing lateral translation of the lesser metatarsals. Between which two osseous structures does the strongest, primary band of the Lisfranc ligament attach?

The distal tibiofibular syndesmosis is stabilized by a complex of ligamentous structures. Among the components of the syndesmosis, which structure provides the greatest resistance to diastasis and is mechanically the strongest?

The 'Master Knot of Henry' is a key anatomical landmark in the plantar aspect of the midfoot. At this location, which two structures cross?

The anterior inferior tibiofibular ligament (AITFL) is frequently injured in 'high' ankle sprains. It originates from the Tillaux-Chaput tubercle on the tibia and inserts onto which anatomical structure on the fibula?

The contents of the tarsal tunnel course posterior to the medial malleolus beneath the flexor retinaculum. What is the correct anatomical order of these structures from anterior to posterior?

During an extensile lateral approach to the calcaneus for an intra-articular fracture, full-thickness flaps are elevated. Which nerve is at greatest risk of injury if the superior flap is improperly developed?

A posteromedial approach to the ankle is used to fix a large posterior malleolus fracture. Dissection proceeds between the Achilles tendon and the flexor hallucis longus (FHL). What structure is immediately medial to the FHL and must be protected?

A 12-year-old boy presents with frequent ankle sprains, peroneal spasticity, and a rigid, flat foot. Radiographs show a prominent 'C-sign' on the lateral view. Which of the following is the most likely diagnosis, and what is the best initial imaging modality to confirm the specific anatomic location and plan surgical intervention?

A 12-year-old boy presents with recurrent ankle sprains and a rigid, painful flatfoot. Oblique radiographs of the foot demonstrate an "anteater nose" sign. What is the most likely diagnosis?

A 30-year-old construction worker falls from a height, sustaining an axial load to a plantarflexed foot. Radiographs show widening of the space between the first and second metatarsal bases and a small avulsion fracture fragment ('fleck sign') in this interval. What critical ligament has been avulsed?

A 52-year-old woman presents with medial ankle pain, a progressively flattening arch, and an inability to perform a single-leg heel raise on the right side. On examination, the foot is flexible, but she has 'too many toes' visible from behind. This condition is most commonly managed operatively with a flexor digitorum longus (FDL) transfer. To optimally restore biomechanics and protect the transfer, the FDL transfer is most commonly combined with which procedure?

A 58-year-old male with long-standing poorly controlled diabetes presents with a swollen, warm, and erythematous right foot. Radiographs show periarticular osteopenia, early fragmentation, and subluxation at the tarsometatarsal joints. According to the Eichenholtz classification of Charcot arthropathy, what is the current stage and the most appropriate initial management?

The Lisfranc ligament connects which two osseous structures in the foot?

A 14-year-old boy presents with frequent ankle sprains and rigid, flat feet. On examination, he has restricted subtalar motion and peroneal spasticity. Radiographs show a 'C sign' on the lateral view. What is the most likely diagnosis?

A 13-year-old boy presents with a painful, rigid flatfoot and peroneal spasticity. A lateral radiograph of the foot reveals the 'C-sign'. This radiographic finding is pathognomonic for which condition?