8. Foot and Ankle MCQs

Following open reduction and internal fixation of an ankle fracture, an intraoperative external rotation stress test indicates widening of the medial clear space and tibiofibular clear space. The surgeon elects to place a syndesmotic screw. Which ligament of the syndesmotic complex provides the greatest mechanical strength and resistance to posterior displacement of the fibula?

A 65-year-old patient presents with end-stage post-traumatic tibiotalar arthritis and is requesting a total ankle arthroplasty (TAA).

Which of the following conditions represents an absolute contraindication to primary total ankle arthroplasty?

The spring ligament complex is a crucial static stabilizer of the medial longitudinal arch of the foot, preventing pes planus deformity. What are the exact bony attachments of the main component of the spring ligament?

A 35-year-old presents to the ER with lateral foot pain and swelling after an acute inversion injury. On physical examination, maximal point tenderness is localized approximately 1 cm distal and slightly inferior to the lateral malleolus. Radiographs demonstrate an avulsion fracture of the anterior process of the calcaneus. Tension from which ligament is primarily responsible for this specific fracture pattern?

A 45-year-old male undergoes surgical treatment for refractory insertional Achilles tendinopathy with a prominent Haglund's deformity. The procedure requires reflection of the Achilles tendon to aggressively resect the retrocalcaneal exostosis and debride the diseased tendon. What is the maximum percentage of the Achilles tendon insertion that can typically be detached and debrided before primary augmentation (such as FHL tendon transfer) becomes biomechanically required?

A 14-year-old boy presents with a painful, rigid flatfoot and a history of recurrent ankle sprains. A lateral radiograph of the foot is obtained, which demonstrates a continuous "C-sign".

Based on the most likely diagnosis, which specific anatomical structure is most commonly involved in this pathology?

A 32-year-old male sustains a high-energy trauma resulting in an irreducible lateral subtalar dislocation. Attempted closed reduction in the emergency department is unsuccessful. What anatomical structure is most likely acting as the primary block to closed reduction in this specific injury pattern?

A 24-year-old athlete sustains a midfoot injury. An AP weight-bearing radiograph demonstrates a "fleck sign" in the first intermetatarsal space.

The primary ligamentous structure avulsed in this injury connects which two osseous structures?

A 45-year-old runner presents with chronic, severe heel pain that has failed 6 months of conservative management including stretching, orthotics, and corticosteroid injections. He reports a burning sensation radiating to the lateral aspect of the heel. Examination reveals maximal tenderness at the medial aspect of the heel, slightly distal to the calcaneal tuberosity. The clinician suspects entrapment of the first branch of the lateral plantar nerve (Baxter's nerve). Between which two structures does this nerve most commonly become entrapped?

A 68-year-old patient with end-stage post-traumatic ankle arthritis is undergoing a tibiotalar arthrodesis. To optimize the patient's postoperative gait kinematics and limit the progression of adjacent joint arthritis, what is the ideal position for ankle arthrodesis?

A 50-year-old man undergoes surgical reconstruction for severe insertional Achilles tendinopathy with a large Haglund's deformity. Intraoperatively, extensive tendinosis is noted, requiring debridement of 60% of the Achilles tendon insertion. The surgeon elects to augment the repair with a Flexor Hallucis Longus (FHL) tendon transfer. Which of the following represents the most compelling biomechanical rationale for choosing the FHL over the Flexor Digitorum Longus (FDL) for Achilles augmentation?

A 22-year-old patient with Charcot-Marie-Tooth disease presents with a bilateral cavovarus foot deformity. The clinician performs the Coleman block test. During the test, the patient's heel varus completely corrects to neutral when the lateral aspect of the foot is supported on a 1-inch block and the first ray is allowed to drop off the block into plantarflexion. What does this specific physical examination finding indicate, and what is the appropriate targeted bony correction?

A 16-year-old female presents with a progressive, symptomatic hallux valgus deformity.

Weight-bearing radiographs demonstrate an intermetatarsal angle of 15 degrees and a Distal Metatarsal Articular Angle (DMAA) of 25 degrees. The MTP joint is congruent. If a simple proximal crescentic osteotomy or a standard shaft osteotomy is performed to correct the intermetatarsal angle without addressing the DMAA, what is the most likely biomechanical consequence?

Diabetic Charcot neuroarthropathy can present insidiously or as an acute, hot, swollen foot that mimics infection. According to the Brodsky anatomical classification of Charcot arthropathy, which joint complex represents the most frequent site of involvement (Type 1)?

A professional American football player sustains a hyperextension injury to his first metatarsophalangeal (MTP) joint, diagnosed as a severe "Turf Toe" (Grade 3). Which of the following combinations of clinical and radiographic findings serves as an absolute indication for acute surgical repair of the plantar plate in this athlete?

A 60-year-old female presents with Hallux Rigidus. She reports moderate pain mostly at the extremes of dorsiflexion, which restricts her ability to wear high-heeled shoes. Clinical examination reveals a palpable dorsal osteophyte and 30 degrees of dorsiflexion. Radiographs demonstrate dorsal joint space narrowing with preservation of the plantar joint space (Coughlin and Shurnas Grade 2). The patient fails non-operative management. When performing the indicated cheilectomy, how much of the dorsal aspect of the metatarsal head should typically be resected to restore adequate dorsiflexion and relieve impingement?

A 35-year-old male sustains a purely ligamentous Lisfranc injury. After a thorough discussion, he is randomized in a clinical trial comparing Open Reduction Internal Fixation (ORIF) with transarticular screws versus Primary Arthrodesis. Based on the landmark prospective randomized study by Ly and Coetzee, what outcome is most likely to be expected if the patient undergoes Primary Arthrodesis rather than ORIF?

Anterolateral osteochondral lesions of the talus (OCLT) are typically caused by a specific injury mechanism and present with a distinct morphological appearance compared to posteromedial lesions. Which of the following correctly pairs the mechanism of injury with the classic morphology of an anterolateral OCLT?