8. Foot and Ankle MCQs

A 29-year-old male presents with severe medial ankle pain after a twisting injury playing soccer. Radiographs show a widened medial clear space, but no fractures are visible around the ankle mortise. What is the most critical next step in the clinical and radiographic evaluation?

A 35-year-old female is scheduled for open reduction and internal fixation of a displaced intra-articular calcaneus fracture via an extensile lateral approach. To minimize the risk of wound edge necrosis, the full-thickness subperiosteal flap must be developed carefully. The vascular supply to the apex of this flap is primarily derived from which of the following arteries?

A 60-year-old smoker with diabetes presents to the emergency department after a fall from a ladder. Examination reveals a swollen heel with severe posterior skin blanching over the Achilles insertion. Radiographs demonstrate a tongue-type calcaneus fracture with superior displacement of the posterior tuberosity. What is the most appropriate next step in management?

A 68-year-old patient with long-standing, poorly controlled diabetes mellitus and peripheral neuropathy sustains an unstable bimalleolar ankle fracture. Which of the following modifications to standard surgical and post-operative protocols is most strongly supported by current literature to prevent catastrophic failure?

A 45-year-old male presents with persistent lateral hindfoot pain and limited ankle dorsiflexion two years after non-operative management of a displaced intra-articular calcaneus fracture. Radiographs show a healed fracture with significant loss of calcaneal height and a flattened Bohler's angle. The limitation in ankle dorsiflexion is most directly caused by which of the following anatomic alterations?

A 24-year-old gymnast sustains an ankle injury upon landing. Radiographs reveal a transverse fracture of the medial malleolus and a short oblique, comminuted fracture of the fibula exactly at the level of the tibial plafond. According to the Lauge-Hansen classification, what is the mechanism of this injury?

During open reduction and internal fixation of a calcaneus fracture via an extensile lateral approach, the surgeon places screws directed from lateral to medial to capture the sustentaculum tali fragment. If these screws are overly long and penetrate the medial cortex of the sustentaculum tali, which structure is at highest risk of iatrogenic injury?

A surgeon opts for a posteromedial approach to directly reduce and fix a displaced posteromedial fragment of the distal tibia (pilon fracture). To safely access this fragment while minimizing neurovascular risk, the deepest dissection interval is typically developed between which of the following structures?

A 29-year-old athlete presents with an isolated Weber B distal fibula fracture. A gravity stress radiograph is obtained to evaluate the integrity of the deltoid ligament and syndesmosis. At what threshold of medial clear space widening on the stress radiograph is the deep deltoid ligament considered incompetent, necessitating operative intervention?

A 55-year-old female sustains a Rowe Type I calcaneal fracture (avulsion of the calcaneal tuberosity) following a trip and fall. The fragment is proximally displaced by 2 cm and the skin overlying the posterior heel is visibly tented but intact. What is the most significant clinical consequence of failing to adequately treat this specific injury pattern?

In the evaluation of a Lauge-Hansen Supination-External Rotation (SER) Type IV ankle injury, understanding the primary stabilizers of the ankle mortise is crucial. Which of the following ligaments acts as the primary restraint to lateral talar excursion?

A 55-year-old female presents with a long-standing, painful hallux valgus deformity that has failed conservative management including wider shoes and orthotics. Clinical examination reveals a severe deformity with a hallux valgus angle of 40 degrees and an intermetatarsal angle of 18 degrees. Radiographs confirm these measurements. Which of the following surgical procedures is most appropriate to address this deformity?

A 25-year-old athlete sustains a severe midfoot injury during a football game. Weight-bearing radiographs reveal widening between the medial and middle cuneiforms and a 'fleck sign' at the base of the second metatarsal. What structure is avulsed to create this specific radiographic finding?

A 45-year-old male recreational basketball player sustains an acute Achilles tendon rupture. He is discussing operative versus nonoperative management with his surgeon. Compared to nonoperative treatment with an early functional rehabilitation protocol, surgical repair is associated with which of the following outcomes?

A 24-year-old football player sustains a hyperplantarflexion injury to his foot. Weight-bearing radiographs reveal widening of the interval between the first and second metatarsals. An injury to the Lisfranc ligament is suspected. What are the correct anatomical attachments of the Lisfranc ligament?

A 35-year-old recreational basketball player feels a "pop" in his posterior ankle. Examination reveals a positive Thompson test and a palpable gap 4 cm proximal to the calcaneal insertion. He opts for non-operative management. Which of the following best describes the appropriate functional rehabilitation protocol?

Six weeks following open reduction and internal fixation of a displaced talar neck fracture, an anteroposterior radiograph of the ankle demonstrates a linear subchondral radiolucency within the talar dome. What is the clinical significance of this radiographic finding?

During the initial clinical examination, the patient demonstrated profound weakness in active dorsiflexion of the ankle and toe extension, with a rapid decline in motor strength from 3/5 to 1/5. Sensation was diminished in the first dorsal webspace. Which nerve is primarily affected by the acute compartment syndrome in this scenario, and what compartment does it innervate?

A patient presents with acute compartment syndrome isolated to the lateral compartment of the lower leg. If left untreated, which of the following functional deficits is most likely to result?