8. Foot and Ankle MCQs

A 24-year-old professional football player presents with severe midfoot pain after his plantarflexed foot was axially loaded during a tackle. Weight-bearing radiographs demonstrate a 2 mm diastasis between the bases of the first and second metatarsals. An injury to the primary stabilizing ligament of this region is suspected. What are the true anatomical origin and insertion of this specific ligament?

A 55-year-old female presents with stage II adult-acquired flatfoot deformity. Her surgical plan includes a flexor digitorum longus (FDL) transfer and a medializing calcaneal osteotomy (MCO). What is the primary biomechanical advantage provided by the MCO in this procedure?

A 40-year-old female presents with a painful bunion. Weight-bearing radiographs reveal a hallux valgus angle of 38 degrees and an intermetatarsal angle of 18 degrees. Clinical examination demonstrates significant hypermobility of the first tarsometatarsal (TMT) joint in the sagittal plane. Which of the following procedures is most appropriate for this patient?

A 60-year-old patient with long-standing, poorly controlled diabetes mellitus presents with a swollen, red, and warm right foot. Which of the following clinical findings most reliably differentiates acute Charcot arthropathy (Eichenholtz stage 0 or I) from an acute localized infection?

A 38-year-old roofer falls from a height and sustains a displaced, intra-articular calcaneus fracture. The surgeon elects to perform an open reduction and internal fixation utilizing an extensile lateral approach. Which of the following neurovascular structures is at greatest risk of iatrogenic injury at the proximal and distal extents of this specific surgical incision?

A 65-year-old male with a chronic Achilles tendon rupture and a 6 cm defect is scheduled for reconstruction utilizing a flexor hallucis longus (FHL) tendon transfer. During harvest of the FHL in the retromalleolar region, the surgeon must remain cognizant of the primary neurovascular bundle. What is the precise anatomical relationship of the posterior tibial artery and tibial nerve to the FHL tendon at this level?

A 21-year-old collegiate basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. Intramedullary screw fixation is planned. Due to the inherent anatomy of the fifth metatarsal, what is the optimal starting point for the guidewire to avoid iatrogenic lateral cortical breach during drilling and screw insertion?

A 58-year-old male with end-stage post-traumatic ankle osteoarthritis opts for a tibiotalar arthrodesis. Achieving the correct position of the fused joint is critical to minimize adjacent joint arthrosis and preserve an energy-efficient gait. What is the universally accepted optimal position for an ankle arthrodesis?

A 30-year-old male undergoes open reduction and internal fixation for a pronation-external rotation ankle fracture. Following fixation of the fibula, the Cotton test reveals syndesmotic widening, and the surgeon proceeds with placing a syndesmotic screw. To perfectly capture the center of the tibia and avoid malreduction, how should the drill trajectory be oriented relative to the fibula?

A 13-year-old boy presents with recurrent ankle sprains and rigid flatfeet. Radiographs show an 'anteater nose' sign on the lateral view. Which of the following is the most likely diagnosis?

A 14-year-old boy presents with rigid flatfeet and recurrent ankle sprains. Examination reveals restricted subtalar motion and peroneal spasticity. Radiographs show a 'C sign' on the lateral view. What is the most likely diagnosis?

A 14-year-old boy presents with recurrent ankle sprains and a rigid, painful flatfoot. On examination, he has decreased subtalar motion and peroneal spasticity. A CT scan confirms a talocalcaneal coalition. Which facet of the subtalar joint is most commonly involved in this type of coalition?

A 12-year-old boy presents with a painful, rigid flatfoot and recurrent ankle sprains. CT imaging confirms a calcaneonavicular coalition. He has failed 6 weeks of short leg cast immobilization and NSAIDs. What is the most appropriate surgical intervention?

A 13-year-old boy presents with a rigid, painful flatfoot and a history of recurrent ankle sprains. A lateral foot radiograph demonstrates an "anteater nose" sign. What is the most likely diagnosis?

An infant presents with a rigid equinovarus foot deformity characterized by a deep transverse plantar crease, a shortened first metatarsal, and severe equinus. Initial attempts at standard Ponseti casting result in cast slippage and worsening of the deformity. What is the most appropriate modification in the management of this specific condition?

A 50-year-old woman develops severe hyperalgesia, swelling, and localized erythema in her foot after a minor crush injury. What pathophysiological mechanism is primarily responsible for the initial warm, erythematous phase of this syndrome?

A 50-year-old woman develops Complex Regional Pain Syndrome (CRPS) following a minor crush injury to her foot. Radiographs demonstrate patchy periarticular osteopenia.

In the pathophysiology of CRPS, which neuropeptide released from C-fiber terminals is primarily responsible for mediating the localized neurogenic inflammation?

The clinical photograph shows a classic claw toe deformity. Which of the following best describes the muscular imbalance responsible for the hyperextension at the metatarsophalangeal joint?